Intro:
On this episode of Great Work, we're diving in to one of the most unexpected and fastest growing corners of staffing, dentistry. Our guest, Ian Prendergast, co-founder of Toothio, is bringing an Uber-style labor marketplace to dental offices across the country. We get into how a chance conversation on a golf course turned into an 11-market staffing platform, why hygienist burnout is costing practices tens of thousands in hidden revenue,

and how narrowing in on the right ICP saved Toothio from burning time and money. If you're a staffing leader thinking about marketplaces, worker flexibility, or just the real cost of being short staffed, this one's full of lessons you can apply tomorrow. Let's get into it.

Kirti Shenoy (00:51)
Ian, welcome to the Great Work Podcast. Super excited to have you.

Ian Prendergast (00:54)
Thanks for having me. Excited chat.

Kirti Shenoy (00:54)
Thanks, Ray.

Of course. Well, Ian, I've known you for years, but for those who are not familiar, what is Toothio? maybe you could just give us a little bit of a background on what you guys are building.

Ian Prendergast (01:04)
Yeah, absolutely. So, Toothio is, think of Toothio as kind of an Uber-esque model, but for the dental space. So we're technically a labor marketplace for the dental industry. We give dental professionals the ability to pick up shifts on demand. Those shifts are sent directly to their phone. They can accept or decline. They clock in and clock out with our technology and they get paid the same day they work. So, gig work, gig based, but in the dental industry.

where there is a massive labor crunch and supply constraints. So we launched back in 2021 and since then we've expanded to about 11 markets. So it's been quite the ride.

Kirti Shenoy (01:38)
So amazing. And Ian, you know, I've known you since your time at Quick when you were building hospitality staffing at Quick and you you've done some work in home services before that. So you've always sort of had this experience in the contingent workforce and in providing a really amazing software and payment experience for them. But what got you excited about dentistry in particular, because it's kind of one of the more niche staffing models, would be so curious to hear, you know, how you found that niche and why you decided to dive in there.

Ian Prendergast (02:07)
Yeah, I mean, I'll share the story. I'll share the story that I've shared a few times now, a few different podcasts, but I'll go into it again here. obviously my background is in labor marketplace and learned a tremendous amount through my experience with quick. then once again, with steady install, kind of in 2020, 2021. And I was on a golf course actually of all places back in 2021 ended up connecting with a

dentist out of Denver, Colorado. And he ended up in our foursome. And he starts talking about how he's a dentist and he had multiple practices and how he's had these kind of massive staffing problems. And everybody he's talking to wants to be part-time or temporary. They don't want to work full-time. They're, you know, they're expensive and recruiting is really, really hard. And so this was like, you know, kind of a micro view or atomic view of the industry as a whole. And I didn't know much about dental at that point in time.

But it piqued my interest, so I went home and I started doing a little bit of research into the dental space as a whole. And I found some things that were pretty compelling. The first thing I found is that there was a survey out of the American Dental Association. And in that survey, it said that 97 % of dentists, of doctors said that staffing was their number one factor limiting volume. And 95 % of doctors said staffing was extremely difficult.

We knew there was a huge problem with staffing in general in the industry as soon as I saw that. The second thing I saw is that there was another ADA survey. I think it was 2020 was that 75 % of dental hygienists had flexibility as their number one priority or number one value proposition. So it wasn't necessarily how much they were getting paid or what kind of benefits they have or what type of practice they're working with. They wanted flexibility in their schedule and

When I saw that, I thought, okay, we have something here. There's nobody really doing a great job of this. A couple legacy players, a lot of traditional mom and pop legacy staffing companies, but not a lot of great tech companies. Not a lot of true labor marketplaces. So thought we had a huge opportunity. The last piece of the puzzle was, it didn't happen that day. I think it was a few days later. Somebody sent me a survey. It wasn't an ADA survey.

But it was an article, and I forget who wrote it, it was an article about how the demand for dental services is going to continue to trend up. It's going be one of the top five industries in the country over the next decade. And I think at the time when we launched, the dental industry was growing at about a 9%, 10 % cager. And that trend is continuing to hold. It's still one of the fastest growing industries in the country. And it's projected to be for the next decade.

Kirti Shenoy (04:42)
Wow.

Ian Prendergast (04:46)
So you've got this problem, right? have this demand for dental services is through the roof and it's supposed to continue to climb. And then on the flip side, you have less supply, less dental professionals to fulfill that demand than you've ever had, right? Enrollment in dental schools, dental hygiene schools is down, in dental assistant schools is down. So we have this very interesting dynamic brewing in the dental space right now.

Kirti Shenoy (05:07)
Wow, that totally makes sense. And just curious, what were these dental offices using before you guys existed? Like how were they finding people last minute to fill in those shifts or to come on board for a couple weeks at a time while someone was out of office? How did they solve that problem before Toothio existed?

Ian Prendergast (05:27)
Yeah, it's crazy, but it's group texts. It's people trying to store information of the hygienist they met six months ago or a year ago, friends of friends, family members. getting in social groups and posting in these social groups, these hygiene groups and assisting groups locally. You might have a local staffing company in your market where you call, you email and you send them an email like, here's what I'm looking for. And they email you back and they.

You go back and forth and they try to figure out if somebody is available from their network, then they charge you a 50 % markup on the labor for that day. like completely antiquated, very slow, very inefficient. That was primarily what was happening back five years ago.

Kirti Shenoy (06:07)
That's so

true. And I really like that point on the supply side because to your point, you know, a traditional staffing company like let's say a nurse and healthcare staffing firm that's not used to working with dental offices just quite frankly wouldn't really have even the supplier, the Rolodex of workers to reach out to. It really have to be a special project that they take on which could take weeks or months to even try to figure out how to market it to the right workers, get them, check their credentialing and make sure that, you know, they're qualified to work.

at one of those dental offices. there's no, quite frankly, no way that a traditional staffing company would be able to do that ⁓ as quickly as probably a dental office would need. And I guess that kind of leads me to the next question, like how, what does it actually look like when a practice has hygienists that are supposed to come in for work but then they call at last minute or there's a family emergency and they're short staffed.

Ian Prendergast (06:41)
Absolutely.

Kirti Shenoy (07:01)
you know, what kind of happens to that dental office when they are short staff like that?

Ian Prendergast (07:07)
Yeah, so it's interesting. So there's a lot of data points on this. The first thing that I want to point out is that turnover is at an all time high in the dental space. And what we're seeing is many indications of burnout across the entire industry. So, and I think a large part of that is because of the lack of supply, right? Of actual staff to be able to support those offices. So what these offices are doing is they're putting more workload onto their existing smaller

group of employees, of clinicians in the office. so burnout at an all time high, which is a huge problem. But generally speaking, what happens in the dental office is, know, Susie, your hygienist, is supposed to show up and take care of your, you know, your eight patients for the day, right, eight to nine patients for the day. And Susie calls out because, you know, kids get sick, she's sick, whatever comes up.

Now the office manager is left typically scrambling because she's trying to figure out, know, do I cancel the entire day? Do I cancel all of our patients? Do I cancel the morning and try to find somebody between now and, you know, 11 a.m. to get the afternoon patients done? How much support are we going to need? And, you know, basically going back and forth with, you know, the dentist and the doctor or the owner to try to figure out how to game plan for that day.

The trickle-down effect is, one, if you cancel an entire day, you're just in production, you're losing $1,200 to $1,600 in production. So that's gone, it's out the window, done. What I think a lot of people don't realize is that when they cancel the day, they didn't just lose that $1,200 to $1,600 a day in production that they were going to get from their hygienist. They lost, they're going to lose two of those eight patients, statistically, on average.

those two of those eight patients are going somewhere else, well, their lifetime values are 10 to $15,000. So you didn't just lose the $1,200 in production that you were gonna get that day. You now lost probably 20 to $30,000 more than likely because you have two of those patients that are gone that aren't coming back. Somebody else is gonna service them and we're getting to this age where there's less and less loyalty, right? And so more than likely they're gone, specifically they're gone.

And so the opportunity cost of not having somebody in that chair that day is much higher than I think a lot of people realize. A lot of the DSOs understand it, but a lot of the individual private practices don't fully understand what the opportunity cost of canceling a day or not having somebody in the chair that day really is.

Kirti Shenoy (09:31)
Everything you're saying totally makes sense. guess for me, ⁓ putting my CEO hat on, do dental offices and private practices get what you're saying? Can they actually visualize the concept of that revenue loss if someone is not staffed? What are the ways or methods that you're actually convincing them to see that potential in the revenue loss? Because we know it's true, but when you put a number on it and you actually visualize it, how are you convincing those dental offices and private practices to really

heavily considered the revenue loss that comes from short staffing.

Ian Prendergast (10:02)
It's a good question. I don't think we figured it out quite yet. What I will say is DSO, so Dental Service Organizations, which are our enterprise customers, there are Heartlands and your DCAs and your MB2s. These are the corporate dentistry companies. These are your private equity roll-ups. They are very, I would say, very aware of their core drivers of their businesses, their revenue drivers, their production drivers.

Kirti Shenoy (10:13)
Okay.

Ian Prendergast (10:25)
And they understand, I think, the value, the true value of what we're bringing to the table more so than private practices. So we have like two distinct customers. DSOs, great. They're highly retentive. They're sticky, high volume because they understand the value that we're providing to them on a daily, weekly, monthly basis. And they understand the opportunity costs of not having that service, not having somebody in that chair. Whereas private practices, it's kind of a mixed bag.

You know, you'll get the dentist that's like, you know, cancel the day, you know, I'm going to pay more if I bring in a 2PO professional or a temporary professional than I would if, you know, I'm going to make less than I would if I just canceled the day, right? And they're not, obviously, but they don't understand the opportunity cost. you know, historically, we've not had a tremendous amount of success convincing, you know, private practice, doctor.

you know, Dennis John, that he's gonna lose more by canceling his day than by bringing in a Toothia professional, regardless of what we're charging. It's not even relevant because of, you know, the opportunity cost. So it's been a struggle. It's been a struggle. So what we've done more than anything, we've actually just kind of pivoted to, you know, we want to serve as private practice because there's a need and many of them, you know, certainly do understand the value. But we've pivoted to like, we're gonna focus on.

Kirti Shenoy (11:28)
Right.

Ian Prendergast (11:43)
RICP, which is Enterprise, right, DSOs. So instead of trying to force square peg in a round hole, we're like, gonna go where we can just slide it in easily, right? Where it's perfect, right? There's not a lot of friction.

Kirti Shenoy (11:48)
Yep, that totally makes sense.

That totally makes sense. And I think what you're saying really will resonate with lot of staffing leaders because we all have a mixture of customers that want different things from us. And when we know that there's typically this larger market where there's a lot more leads, there's a lot more companies that we could really have our sales team or demand team sort of go after. But just thinking about,

maybe connecting more with the folks that are already halfway on board with the plan and the challenge that they're facing will kind of help you to close deals faster. So sometimes it's better to just like focus in on, you know, what's working and whoever's already values aligned with your staffing business's mission and then wait for kind of some of those other larger lead lists to kind of catch on as more and more people start, you know, playing around with this type of staffing model. So that totally makes sense.

that think a lot of staffing leaders are probably hearing this, just shaking their heads and saying, yes, I agree, there's certainly, it's certainly better to just focus on your ICP and go all in there.

Ian Prendergast (12:59)
I guess just to share a little bit more of my experiences, like we initially, we focused on private practice and enterprise and we did both equally. And at one point, actually, we put tremendously more resources into focusing on private practice than we did on enterprise. And it wasn't until probably maybe 12 to 18 months into our business that we started to realize like

wow, there was a distinct difference in how those two different users behave. And we started to focus on like unit economics and just good business fundamentals, which we all have to do right now because let's be honest, one, labor marketplaces is not in vogue, right? What's in vogue right now is, know, gen AI, AI, right? It's AI, right? And so you can obviously, we can leverage AI, and maybe that's something we'll talk about, we can leverage AI to gain efficiencies in our marketplaces.

Kirti Shenoy (13:39)
AI.

Ian Prendergast (13:49)
But we're not in vogue. So what do we have to do? We need to get really efficient. We need to have as many opportunities on the table as we possibly can. We need to control our own destiny. And we need to get really efficient in attracting supply and demand. So as we were going through this exercise, we really started to segment our ICP, or not ICP, our customer profiles. We're like, OK, who's actually using us regularly? Who's sticky? Who's not?

you know, who are our customers that are expensive to acquire and what does that look like across the different buckets? And it was, it was one of the greatest exercises we've ever done to really drill in down to a granular level of what type of customers are truly our ICP. And then how do we design the org and put dollars into going after those customers? So I know it's a long winded way of saying like really hone it on your ICP early, but truly, I mean, I think even though we found figured it out in 18 months, I wish you would have figured, I wish obviously would have known day one.

It would have saved us probably hundreds of thousands of dollars and tons of headache.

Kirti Shenoy (14:47)
Totally,

totally. That makes sense.

So we've talked a lot about the business side of these dental offices and private practices and what they really need in this day and age. I want to switch to the supply side. So is there something in particular with the dental hygienists that requires them to want more sort of on-demand style work, flexible work? Or is this just like a macro trend that everyone across all industries wants just like more flexible on-demand style work? What are your thoughts on that?

Ian Prendergast (15:17)
I it's interesting. This is a hotly debated topic. So I gave a presentation at a conference maybe a year ago in Atlanta. And I talked a lot about the transient nature of work kind of evolving and the different verticals that it's impacting the most. And dental is certainly one of them.

you know, the gig economy, which I think, you know, we don't use that word for some reason very much these days, but like, it really is kind of a great way to describe kind of the macro trend. But it's growing and it's been growing steadily for the last like, you know, eight to 10 years. And especially the last few years, we've seen tremendous growth. I don't remember what the exact numbers were, but the gig economy as a whole is trending up. Like there's more people that are looking for flexible work, gig based work, more people making gig based work a full time.

you know, kind of a full-time job versus a part-time or supplementary income. And it's happening in dental. And so I think specifically in the dental trends that we've seen, I think a lot of it is a function of what happened in 2020. And I think we had this boiling over point where, you know, we had dental hygienists, dental assistants, generally people that were working in these dental offices that were burnt out, they were feeling the pressure. They weren't necessarily happy.

And in 2020, everything shut down and they got to go home and kind of reset. And, and I think what happened is there was a fundamental ideological shift across, across the entire space, across all these, all these dental professionals that were previously in the space. think when they came back, there was a, there was a sense of, I'm not willing to put up with this anymore. Right. There was a sense of, don't, I don't want to be overworked.

I want to be able to, I learned what this work-life balance was with spending time with my family, spending time with my children, going on vacations. And they didn't want to give it all back. They want to hold on to that. So I think what they started doing is they're looking for these like alternative approaches of, all right, well, how can I still earn money for my family and still do in some cases what I love, but without the additional pressure of being in a full-time role and having all that stress and everything on top of it.

they turn to like these temporary solutions, right? These, these, you know, labor marketplaces, these platforms. And so 2020 was this huge like catalyst that I think really accelerated the transient nature of the dental industry. And I think also what we're seeing, which is another, you know, tailwind for, for businesses like ours in the dental space is the younger generation, you know, particularly the younger generation that's just coming into the space. They're not.

broadly looking for, you know, five days a week full-time either. They still value flexibility. There's an ideological shift. They don't want to go commit, you know, 40, 50, 60 hours every week to working in a dental office. They would love to be able to plug in for a week or two or three or maybe a month and then go take two weeks and travel or two weeks to do whatever the heck they want to do. So there's an ideological shift across the entire industry that I don't think stops in dental.

I think there's many other industries that this shift is occurring in or has occurred in. And I honestly think it's maybe a better time than ever to be building a later marketplace. I really do. For a lot of reasons.

Kirti Shenoy (18:23)
Yep, I'm also

long on labor marketplaces and I think this shared sentiment of the macro trend of just workers all around wanting a little bit more work-life balance or just the ability to be a little bit choosier about the days and times that they work is definitely there across all industries. know, earlier in our conversation, you mentioned a little bit about dental hygienist burnout because there quite frankly aren't enough dental hygienists for the demand that we have. mean, you and I and every other American, we're getting our

two cleanings and then plus more. So there's certainly a ton of consumer demand compared to the hygienists that are sort of out there on the market.

So burnout is huge and just making sure that staffing platforms can kind of be used to supplement these offices, especially for the workers that are experiencing burnout. Because if a worker's burnt out and you're having them work those 60 hours a week, week over week over week, something's gonna pop. it's really just important for these offices to just be conscious of that and to kind of supplement with these staffing platforms to ensure that the workers don't get burnt out and still wanna

in the field for as long as possible because we need them. ⁓

Ian Prendergast (19:34)
Exactly.

Yeah. Yeah. Turnovers extremely costly.

Kirti Shenoy (19:36)
Yeah, exactly. sort of, you know, one of the final questions I want to ask you is, you know, you guys have obviously done an amazing job building a tech forward like labor marketplace that's really connecting the hygienist with the actual office that they're going to be working at. Is there something in particular that's special about the tech that you're doing that makes it easier and faster than ever before to connect these two parties together?

Ian Prendergast (20:03)
That's a good question.

We, this is, you this is kind of, I'll say our, because I'll refer, you know, our founding team. have two co-founders, two fantastic co-founders. And we, this is our, you know, kind of our fourth or fifth collective rodeo when it comes to the labor marketplace. And so we chose a tech stack that gave us tremendous flexibility early. And one of the tools that we use, I think that was maybe one of the most impactful that gave us flexibility was Hasura.

And, has Sura just gave us the ability to effectively like completely, rebuild our schema, over and over again, without like basically choosing a path and being married to it. Right. So we could kind of, we could take the time to figure it out early and we could pivot easily. so, you know, that was, that was a big one for us. And then I think just generally speaking, like,

Kirti Shenoy (20:38)
You

Ian Prendergast (20:53)
We didn't overbuild early. we really, we, we use a lot of growth hacks, a lot of Zapier, a lot of air table, a lot of, a lot of, ⁓ you know, low code, no code solutions to try to validate before we decided to go spend a lot of engineering resources and money to build it. And I think that's something that maybe gets overlooked pretty consistently is you have it. I think we, as founders, we have this idea in our head and we're like, we need to go build this, but.

Kirti Shenoy (21:11)
Totally.

Ian Prendergast (21:21)
What happens is you go spend a bunch of time and energy and effort and money to go build it and you go to market and you realize, shit, this is cool, it's great, but what my customers actually want is not what we went and just built. So, know, kind of that lean startup approach of just building light, building low code, no code. It didn't have to be the prettiest or most effective solution. Just validate before you go spend a tremendous amount of resources building on top of

We're building out fully coded solutions.

Kirti Shenoy (21:48)
That's so true and I really like the concept that you brought up around just building the tech infrastructure around a method where you could build different routes and different paths because I think for every labor marketplace and quite frankly any business that has customers you learn so many of these micro intricacies in the way that both the supply side and the demand side thinks. And there's so many different workflows and so many different nuances between even the job types that might require a certain amount of credit.

or a certain amount of vetting compared to other types of roles. just having a really flexible stack where you're able to build these paths, as you mentioned, just allows you to sort of tap into what your users really want and deploy quickly once you see consistent results of the same user type asking for the same things consistently, which is the dream for every founder. And I love that. This was a really great conversation, and I definitely

want to ask you a couple more questions. We like to do this lightning round with our speakers and ⁓ try to have these questions answered in 30 seconds or less, but let's dive in. The first question I have for you is what's something that you believed about staffing when you started tootheo that you don't believe anymore?

Ian Prendergast (23:03)
Oh man, that is a really tough one. Is this a lightning round? Oh my goodness. Wow. I would say that the...

Kirti Shenoy (23:07)
Hahaha!

Ian Prendergast (23:13)
I would say that quality is of the utmost importance, like, putting a warm body in place is one thing, but generally speaking, once you stop focusing on quality, everything else around it falls apart. And I think maybe my approach originally was like, just focus on high fill rate, right? No matter what. And high fill rate's great, like there is value in that, but you do have to figure out, like you need to take a quality first approach. So I'll stop there, because then we're lighting around.

Kirti Shenoy (23:27)
Yep.

Totally, And then, what's one tool that you can't live without? This could be for actually building toothy ova, but also in your day to day, if there's a tool that you use that you can't live without.

Ian Prendergast (23:49)
Well, one, my EA, like literally like that saves me like so much time. It's unbelievable. Not a tool, but a, you know, saves me a ton of time. A resource, absolutely. Two, I would say...

Kirti Shenoy (23:57)
resource.

Ian Prendergast (24:02)
would say my click up is probably, that's fundamental to our team. Our click up is like our Bible right now. It's like just everything you could possibly want and more and that kind of keeps us organized. And I'll bounce into Asana a little bit too, but I would say click up is probably the tool.

Kirti Shenoy (24:15)
Nice. And lastly, you know, we call this show Great Work. What does great work mean to you?

Ian Prendergast (24:21)
⁓ great work. Great work is like putting your customers first. You know, I really think like if at the end of the day, if you want to build a great company, you need people to pay you for your product and they're only going to pay you equivalent to the value that you're providing. Right. So like if you put your customers first and make them the priority and truly every decision you make, you build to build value for your customers, everything else will take care of itself. You'll figure all the rest of it out.

Right? So yeah, to me that's great work, is putting your customers first.

Kirti Shenoy (24:50)
Love it. Well, Ian, thank you so much for taking the time today. I so enjoyed our conversation and looking forward to see what is next in Tuthio's journey.

Ian Prendergast (24:59)
Absolutely, well, I'm sure we'll be in touch, I have no doubt. you for having me on, appreciate it.

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