You’d never know that this week’s guest was a man without a plan when he first arrived on UK shores from native Italy some 11 years ago.
Since then, Dr Alfonso Rao has launched an expanding group of clinics and a dental training academy while also building a name as one of the Southwest’s foremost implant dentists.
And he’s achieved all of this before the age of 40, seemingly without ruffling a single feather.
We probe Alfonso on the secrets of his success, life in the UK, work-life balance and much more.
“I don’t really often like to be told what to do. If someone tells me and explains to me and I see the reason I’m fine. But if someone says, “you have to do that because it is the way you have to do it,” I’m not too good following.” – Alfonso Rao
In This Episode
01.19 – Backstory
08.27 – Italy vs the UK
11.28 – Practice ownership, expansion and work-life balance
19.48 – Teaching
24.37 – The plan
29.00 – Associates
32.03 – On mistakes
37.09 – Out of the clinic
40.11 – Thinking of Italy
43.37 – USPs
45.08 – Exit strategy
46.21 – Last day on earth
About Alfonso Rao
Alfonso Rao graduated from the University of Chieti in 2007 and spent time in practice in Italy before moving to the UK.
He opened a series of clinics in Bristol and Portishead which he later consolidated under the Apollonia Group brand.
He also founded the Delta Training Academy – a leading dental and implantology training centre.
Alfonso is a member of the British Academy of Aesthetic Dentistry and the Association of Dental Implantology.
He is also a key opinion leader and brand ambassador for Strauman, Geitlich, NSK and several other dental technology brands.
Payman: Well, you know my best advice to you buddy?
Alfonso: Yes. Please.
Payman: Keep doing what you’re doing.
Speaker 3: This is Dental Leaders. The podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.
Prav: It gives me great pleasure to welcome the original Style Italiano of UK dentistry, Alfonso Rao, to the podcast. Me and Alfonso met quite some years ago now, and I remember that conversation because it was all done in Italian flair. He’s a straight-talking kind of guy. He doesn’t beat around the bush. He tells you what he wants. He tells you how he wants it, and it always ends with, “And I don’t want any bullshit either.”
Prav: And that’s him through and through. We’ve, during this period of time, become good friends. As well as helping him out with his practises. And Alfonso, I want you to just take us back to your childhood. Where you grew up. What your upbringing was like, and just give us your backstory buddy.
Alfonso: Yeah, thanks very much Prav. Yeah, I fully agree with everything you say. It’s been a great pleasure to know you for the last few years and it is really nice that we are friends as well as working together. So I obviously am born in Italy in Caserta, close to Napoli. And quite like you, in terms of the background and the grow up. So, my dad is an eye surgeon and most of my background in the family they are all medics. However, one of the things that is probably one of the main difference between Italy and the UK is that most of us are going to public school. So it’s quite nice, because with the public school in Italy you really got variety of class mates. So you can get someone who is the son of the probably, someone extremely rich and wealthy. Someone, son of a professor. You might get someone with a lot more humble background. And I really like that part- [crosstalk]
Prav: I may be the son of a shopkeeper or something, Alfonso.
Alfonso: Right. Yeah, that is my point is that it doesn’t really make any difference, the family and the background. Especially when you’re young, you don’t have any of this pre-concept. So you treat everyone as a friend and you grow up with your main interests that might be the football, or cars, or whatever you’ve got. Without having any pre-judgement . And that is great, because you really learn to deal with a lot of different type of people. And I think that is extremely valuable in your life, because I personally feel comfortable in every context. I’ve got no problem if I’m in a gala dinner but I’ve got no problem if I have to be in a market where there is no toilet and no… any place where to have a seat on a table with a fork and knife. So, from that point of view I think yeah, Italy that can teach a lot. Because obviously you learn and you are dealing with all sort of people. Some good and some less good.
Alfonso: But then you learn how to treat the different people. That’s one thing that has been definitely one of, a valuable point of growing up there. In terms of other things, again family background. I’m the only child so I’ve always been quite supported, let’s say that. However, I’m really grateful to my parents because they never really felt me the only child in terms of the freedom of whatever I want to do without feeling the pressure of succeed or do what my dad did, or anything like that. So I’m quite lucky in that aspect.
Payman: What made you become a dentist, Alfonso?
Alfonso: I always thought that I want to be in medics. And when I was 15, 16, my idea was to become a doctor. And again, I don’t know how much you unconsciously… you obviously look your parents, they are role model. You want to become like them. You might want to please them unconsciously as well. And my uncle is a dentist. And I remember that when I was kind of the point where I was starting to do some work experience, I realised that one of the problem with the medicine and being a doctor is that, for example, at that age when you’re 18, be a surgeon is really, really cool. But then you realise that you got lot of, out-of-hours call. You have to work in a hospital. You’ve got no freedom. So I was a little bit scared of that part of lifestyle that my Dad had. Because he’s been always a head consultant and head of department, which means he’s always been on call almost 24 hours.
Alfonso: But then I always felt that my uncle was a dentist, because he had this private practise, he probably had the slightly better life balance with work and his own life. So that was the bit at the time attract me of dentistry rather than medicine. But I always had the passion of healthcare, involved and helping people. And helping them sorting out their problems.
Payman: And when you qualified as a dentist, how long did you stay around your family area? Did you study near your family or did you go somewhere else?
Alfonso: Oh yeah. No, I left home when I was 18. And yeah, I graduated really quick, so I was one of the youngest graduates of my year. So I basically, I was qualified dentist I had just turned 23. And then at the time I worked a little bit in Rome and around the area where I qualified, which is Abruzzo, Pescara, so the Adriatic Coast. And then the idea was for me eventually to go back and work in my uncle’s practise. So then I went back year, year and a half later and started to work with him. But we’ve got quite similar personality and that clashed. Plus, probably one of my limit as a personality, maybe Prav can confirm that, is that I don’t really often like to be told what to do. If someone tell me and explain me and I see the reason I’m fine, but if someone say, “You have to do that because it is the way you have to do it,” I’m not too good following. [crosstalk]
Prav: I think your response to that sort of request usually is in two words and the second word is off.
Prav: With the typical Italian hand gesture. Yeah?
Alfonso: Yeah. Yeah. So really, I went back home to work with my uncle and then basically we start have argument. And he’s my mom’s brother, so that was bit of a drama at the time because it was, “Okay, what should I do?” I cannot really work and for one of his competitors and have a competition in my own town with my uncle there. That would really upset my mom and cause tension in the family. And so I said, “You know what? I’m just going to take my gap year and go to UK to study English.” And that is how I then moved here 11 years ago.
Payman: Oh, so you never went back after that.
Alfonso: No, I did. Two, three years after. Once, I was start to get more established in UK, at one point I almost had a bit of crisis where I was, “God, now I’m not going to be able to go back again.” Because then I was starting to lose contact with colleagues and a way of working. So then I opened a practise. I think Prav, when I met you the beginning, I had a practise in… I set up a practise in my own town. And I was working in Bristol from Monday to Thursday. Thursday night drive to Gatwick. [crosstalk] Stay there overnight. Fly Saturday morning. Go in practise at 9:00 in the morning until midnight Friday and Saturday and then fly back on Sunday. And then drive back Sunday down to the Bristol and then start again on Monday.
Payman: Bloody hell.
Prav: I remember. I remember.
Payman: What were your impressions of the UK with regards to dentistry when you first got here, and outside of dentistry. Why Bristol? How did that happen?
Alfonso: I mean, no. Like all Italian, my first step was London.
Alfonso: Everyone goes to London first. Because again, the idea was to study English more than really to do dentistry. And then I remember that I was in this English course in London, and everyone say, “Well you have to present.” I was unable to speak English. Now I’m much better, but I was even worse at the time. So I was like a beginner, it was my first class. And everyone had to stand up and say, “My name is Alfonso.” I say, “I am a dentist.” And everyone say, “Ah, you’re a dentist. You should make so much money and you’re here doing this class.” And then I start to understand a little bit more about how the system worked. And I really, really liked the idea of the NHS in terms of the social system for everyone able to get healthcare and dental care. Because in Italy we don’t have anything similar.
Alfonso: And as I said earlier, I always had a passion of helping people. So I thought, that’s great. I can get good lead in that, helping people and do dentistry, which is kind of what I like. So, that was my first impression, which unfortunately that was completely different then when I start working some of the NHS practise. And I realise that the quality of dentistry that I could offer was not really what I was hoping to offer. And then I had to make some decision and start to work and move to a private practise.
Payman: Alfonso, [crosstalk] just as an idea. If I walk into a random restaurant in Italy, I’m going to get better food than if I walk into a random restaurant in London, right? But what would be the same story with dentistry? If I walk into a random practise in Rome, am I going to get better dentistry than if I walk into a random practise in London?
Alfonso: Definitely not. So Italy, what we usually say is that you’ve got, is like an S, you’ve got the peak. So in my opinion, UK you’ve got some standard. Then you might don’t get the highest quality that you might reach in Italy, but you don’t really have the really lowest peak of quality that we reach in Italy as well. So in Italy, this is how it is. You can go somewhere where you can get some fantastic, incredible clinician that can do amazing work. But you can also go somewhere where you find that dental technician, they work as a dentist illegally. And the level of what they’re doing is terrible. So that is the problem in Italy. Everything is a little bit less regulated, and that is why you tend to get this peak.
Payman: Yeah, I can get that.
Prav: Alfonso, how did the whole practise ownership come around?
Alfonso: That is another really nice story that I don’t think you really knew, because at that time I was working in a mix practise in Bristol. And there were three expense share and I was hoping to buy into this expense share practise. But then I think, there was an argument between them. And one day, one of the partner went there overnight and removed all of the dental chair. So we went to work and there was no dental chair there. So I realised that I was not really keen to get involved in that type of situation and that’s why then I resign and I left. And at the time I was working as a visiting implantologist for James Hall. And then Joe, that is my partner now in some of the practise, he was working in one in the Queen’s Square, the practise now I own. And unfortunately the dentist that owned the practise at the time, he had some problem. So he was unwell, so he was off. So they asked me to just help them, just as local because I had some spare base, because I was in between jobs.
Alfonso: And then unfortunately, he was not really able to get back to work. And as I was there and I had really good relationship with the practise manager, with the staff, then he offered me to buy. And then I just bought the practise at the time.
Payman: But I mean, this domination that you’re doing in Bristol feels like, to me, you and my old pal Touraj Razavi, buying up all of Bristol. Was this a plan from the beginning?
Alfonso: Oh no. That definitely was not the plan.
Payman: There’s seven practises that you own or part-own now, is that right?
Alfonso: Yeah, correct. They’re not all in Bristol. And now, we are moving a lot more down the M4 corridor. So now we are, yeah. Prav, is where that we’ve got this 10-town clinic project and we’re moving from, ideally from Cardiff moving toward London. And I know Touraj really well as well. And yes, we… it’s nice because we’ve got good relationship, and a respectful relationship with each other. So, although we are competitive, we’ve got really nice relationship which I really like. But was never been the plan. The original plan was I buy my own practise, at least I can be my own boss. As I said earlier, I’m not really good to be told what to do. And then I talk and I start to realise how many headaches I have in one practise, and I thought, you know what… if I have three, I probably have got the same three headaches. But then I remove practise, but then it was not the case. So now I’m trying to say, “Okay, if I am seven. This is got to at one point be getting any better.” I don’t know the answer yet, but yes, we’ll see.
Prav: But Alfonso, you talk about headaches. I tend to get, although we’ve spoke about many stresses that you have of practise, ownership and dealing with certain individuals. You tend to handle stress quite pragmatically and quite simply, I think, as a business owner. Some people really let it get to them. What’s your way of just, handling these stressors… two practises, three practises, up to seven. And then you’ve got this idea, and you can talk to about it later of growing this empire, right? But how do you let these things not get to you and just flick it off your shoulder the way you do.
Alfonso: You know it’s one of those things and we had this conversation. I don’t know. I think again is a little bit my background. I try to take things with the proportion. Like sometimes, I stop and I think, “What’s important in life?” It’s family, health. This is at least my kids, my wife. And I’m lucky. I’m lucky that I do a job that I like. I’ve got almost everything in the world, and that is what is really important. So I always try to take things in proportion and understand that yes, there are a lot of these things that they are, complaints and they can cause stress, but in the proportion with important things in life, they are just things that don’t… the daily bit that can annoy every one.
Alfonso: But I don’t think it should really affect my health or my nature. And this is how I try to manage that. And yeah, I have to say, a lot of people that make comments at how I can be so relaxed with all those things. I don’t know. I honestly sometimes look my phone and I’ve got 25 message, 100 email a day or something like that, and-
Payman: You certainly make it look easy buddy. On your Vespa with your handkerchief hanging out of your coat. Prav, you don’t know, he took us out in Mini Smile Makeover when we came to Bristol. And to this day, the team, we talk about our favourite Mini Smile Makeover, it was that one. He took us to some, where was that place you took us to, the Richard said something about the pizza place that was really-
Alfonso: Yeah, yeah. Bosco, yeah. I remember that.
Payman: Fantastic food and we drank and we had a great time. And then Dipesh rode his Vespa and had an accident. And then he was limping around the next day. But you do make it look easy. I know it’s not. I know it’s not. Of course, it’s not. How many employees do you have now?
Alfonso: We’re at about 50.
Payman: So what’s the secret of that? Do you have managers on each site that you really trust? How does it work? What’s the corporate structure?
Alfonso: Yes. We do have a manager on each site. The truth is that I’m at the sites at the moment and it’s why I say maybe growing my headaches. I’m at the sites at the moment where we’ve got practise manager on each site and I trust them a lot. However, I don’t really have the office back up yet, which I what I hope is going to make things easier moving forward. That’s why, again… joke aside, I’m not really aim to become like a corporate or anything big. But I think if I can get to that 12, 13-practise size, we’d probably be a nice group size where I can still have control of the clinical standard, hopefully in some of the benefit of having the group management. But I still do a lot of micromanagement in terms of, the dealing of the daily staff, with everyone. I think it’s important to build the relationship and to give people the opportunity, to empower people to make the decisions. So they know that they need to make the decision and I will be there to support their decisions. And yeah.
Payman: So then what kind of a boss are you buddy? Are you firm or are you fun or what are you? What’s it like working for Alfonso?
Alfonso: I can ask, there is a practise manager around the corner. I can get her [crosstalk] I’m intense in the way that I usually, am all my relationships. So I give 100% and I often present 100%. For more point of view, I do have a personal relationship with a lot of them, and most of my managers are my age or they’re older than me. So that obviously something that play a part as well. I’m type of person that when is the time to work I’m 100% focused, it’s work, work, work, work, work. But then outside I try to always be, really friendly relationship and I almost always try to support them in a personal aspect or life as well. Because I think it’s important to be there for them and they usually, that is building a relationship that works on both sides and they will be there for me. So there is a lot of respect on both side.
Payman: And you still work how many days as a dentist? Do you do mainly implantology now?
Alfonso: Yeah, so I do only implant and Invisalign. So some cosmetic. I do three and a half days clinical. I work, like this week where I’ve done four clinical days and then we are running a course today and tomorrow with the academy. So I will end up doing six days.
Prav: And Alfonso, how did the teaching come about? Because I remember when we first met we were having our initial discussions were on, “Hey I’ve got this company who want me to teach for them. I’ve got this company who want me to teach for them. This one wants to give me X. This one wants to give me Y,” et cetera, et cetera. I remember those conversations so vividly. So how did you, coming from Italy to here, being as young as you are, how did you get yourself recognised as, ‘Hey I can teach.” Or, “I want to teach.” Or what was your teaching journey?
Alfonso: That is something that I always really, really liked since my time at university. I think that everything you said is obviously completely correct. It’s not something that has been taught. Like a lot of things. I’m not extremely good sitting and making business plan and say, “This is going to open now. This is going to open next.” I can do a lot of things as I feel are right for me, for my colleagues, for my practise and for my family. So a lot was that I was invited to teach for different companies in a different aspect.
Alfonso: Now at that point, I start to feel that, that was not enough. Because I was doing things for others rather than for myself. And I think especially when you do teaching, it’s extremely important to be as independent as possible. Obviously, I do work with a lot of company and I do make a relationship with them as well. But I wouldn’t have shown or discuss in the course something that I honestly don’t really use in my clinical work every day, because there is obviously dignity and ethics. I don’t think that otherwise I would be good at explaining either.
Alfonso: So that is the reason, because we started the academy, so okay. Rather than teach for other people or teaching or a company, why don’t we reverse-engineer that. Why I’m not having my academy, I’m happy to deal with the company, I usually work with my clinical staff anyway, but basically in my way, in my rule, in my time. And I decide how to do it. But teaching is something that I find extremely rewarding. From a clinical point of view, I find that, that help me to be a better dentist. Because since, you remember, this was conversation where the beginning. At the beginning I was not taking enough clinical photos, but now I do photos of almost every cases, because obviously I need for the teaching.
Alfonso: And then when I review my photos because obviously I have to prepare a lecture or presentation, I often try to be self-critical and say, “Okay, I should have done this in a different way. I should have done this in a different way.” And I’m not too competitive with people around me, that’s why I was saying even with Touraj, I’m really relaxed about my competition and my competitors. But a lot competitive with myself. So I always want more from me.
Payman: And what do you guys teach? Obviously implantology. And Massimo does endo, is that right?
Alfonso: Yeah, so I do all the implant side. Massimo does endo. But then we also use our entire connection the last few years to do some prosthetics course or restorative course. We are doing courses from Rubber Dam to oral surgery, from GDP, to full large cases, so microsurgery. So we always try to do course with the different level. But one of the nice things that we try to do is keep the academy as nice and fun place to be. And that’s why we realise that a lot of people, they are coming to the academy for one course and then they’ll end up doing the whole journey with us. So-
Payman: Is the academy part of Queen’s Square? Is the building, or is it a separate place?
Alfonso: No, it’s a separate building. So it’s part of the High Street Dental Clinic at the moment. Ultimately, our dream and goal is to have dedicated centre with the proper facility in there, but at the moment is a dedicated centre but is within the practise. The top floor of the practise. [crosstalk]
Payman: And the name Delta Dental Academy. Is that a different name to, what’s the group called? Is it called Queen’s Square?
Alfonso: No, so the group now. The new setup of the group is called Apollonia. Apollonia Clinics. That was started as a Queen’s Square group but now is getting bigger and is becoming Apollonia. The name of that was for, is an acronym of my and… now I can’t remember what that is…
Payman: Prav, you need to get on to the branding.
Alfonso: Yeah, Prav.
Payman: Get everything in brand.
Prav: Alfonso, where is all this going? Because we have conversations and they’re so random mate. So sometimes you’ll buy a business in the same way Payman or Destat is in a restaurant, mate. Yeah? So just to give everyone a little bit of insight into that, we go to a restaurant and Payman says to me, says to the waiter, “Yeah, we’ll have everything in your starter list.” And the waiter looks at him like there’s something wrong with him, right? And then as he looks at him, he holds two fingers up and says, “Twice.” Yeah?
Alfonso: I’ve seen that. I’ve seen that.
Prav: You’ve seen that. Right? In the same respect, I’ll get a phone call from you and go, “Yeah Prav, I’m just buying that practise across the road and there’s another practise down there I’m going to buy and there’s another two practises here I’m going to buy,” and for me, looking at it from the outside I’m looking at this and thinking, “I don’t think he’s looked too much into these businesses, it just seems like a good idea.” And you’ll say, “What’s the worst thing that’s going to happen? I’m going to lose a bit of money. But let’s just give it a go anyway.” Is there a plan?
Payman: But, but, but… where does the confidence come from yeah? To get up, go to another country. Go to some random town at the end of the day Bristol for you, being from where you came from, and open seven dental practises. Where does… were you always super confident?
Alfonso: The answer is probably yes. In terms of-
Payman: What’s the answer to Prav’s question? Do you look into these businesses or do you work more off emotion?
Alfonso: No. So, okay. So to articulate a little bit the answer. In terms of confidence, is that in a little bit is again, going back to the background. So I’ve always been probably again, married to my parents. They support me but with the right distance at the least, well I felt that. And I kind of feel confident because I know that I’ve got my family behind, which means I know that important things are fine. And they will be there for me. If I’m successful or not, so I don’t feel that the success is something that obviously is going to change the relationship that I care. And is why I don’t feel that I’ve got much to lose, because I’ve got them anyway.
Alfonso: In terms of how I decide to buy business, I honestly trust my feeling a lot. And I also choose the business based on the people. So I do believe a lot in having that feeling when I see people, and I do like… I like to make sure that I buy business where there are people that I can work with. A business that I feel that I can add the value to their business and we can work together as a team. So for example, I’m never really attract to buy a business that is extremely successful and say, “This is what I really want.” I rather to get involved in a project, where I know that I can go there, work hard and try to succeed.
Payman: So what is the vision man? Where is it going to go when you say 13 practises? What’s the vision? What’s your five-year best case scenario that you would really like to achieve?
Alfonso: I enjoy dentistry too much. So there are some people they say, “Okay, now you…” I think I will still be in five years. So let’s say, best case scenario in five years time, I will be able to do only the bit that I like of dentistry. So really, which is… I’m quite already quite liking the position. I only do implant and Invisalign. I would probably do only the implant case that I want and the Invisalign case that I want.
Alfonso: And then, I quite like the business side as well. So in terms of, the management of the practise, or take a practise that from smaller to [inaudible 00:28:31]. Support my younger associate. So if I can get, I realise that being in clinic and trying to be at high level 4 or 5 days a week is too much. So I find that doing the bit of teaching, business and clinic help me be sharp in all the different things.
Payman: What about- [crosstalk]
Alfonso: I’ve got different view. From the different perspective.
Payman: What about associates? How do you handle associates? What pisses you off about associates? What’s the best associate and the worst associate? I don’t mean names.
Alfonso: No, no, no, no, no. Not going to do any names. So again, I’ve been quite lucky, because I’ve never been in the position where we have to, really rarely we have to advertise for the associate. So again, like you said, I know a lot of people in dentistry. Through the Academy we’ve been able to know delegates and they’ve become associates over the years as well. Which has been really positive as well.
Alfonso: But then sometimes the associate is often, they don’t really appreciate the work that is behind the scene. So what I mean is that, a lot of the associates they see, the bit that is nice of owning the practise, being able to make the decision, and they don’t really realise that for example, this morning before I run the course at High Street and Delta, I went to Queen’s Square at half seven to look at the rotor. We had an autoclave broken. So I spoke with an engineer about that. We’ve got one of the receptionists, that have flatmate test positive, so she’s off. So we’re to make arrangement about who is going to cover what.
Alfonso: And they don’t really see all that amount of work that is behind, not just by myself, but by my practise manager and everyone else. And they turn up to work and they say, “But why the coffee machine is not working?” And you think we don’t respect you, obviously we want the coffee machine to work as well. But there is a lot more that is behind. And like everything in life, you need to choose what you want. There are some people that they prefer to come to work, do their bit and then go home. And there are other people like myself, that I enjoy to look the 360 degree package. But some people, they don’t really understand that, and they would like to pick and choose, and that is what annoy me with an associate.
Alfonso: I really like the associate on the other side, that they work as a team player. Because I think one of the key of the success of some of my practise in Bristol has been always the [inaudible] approach. So every associate, and you can speak with all of them, they’ve got full clinical freedom. I really rarely interfere with any decision. I only interfere if I start to see things that they, abuse the clinical standard that we want to produce as a practise. And I think that empowering people works for everyone.
Prav: Yeah. But we’ve been asking everyone this question in order to try and learn from each other’s mistakes. Because in medical, people tend to hide their mistakes. And there’s a book, I don’t know if you’ve read it, Black Box Thinking. It’s about-[crosstalk 00:32:02]
Prav: So what’s been your biggest clinical mistake that you’ve made? If you’re happy to talk about that.
Alfonso: Yeah, no problem. If I have to generalise, as a clinical mistake, I would say the biggest mistake is when I didn’t say no. When you’ve got that patient on the chair and they start to make pressure, and the pressure can be from every different source. There are some type of pressure is financially, if I’m prepare to pay whatever. And I am being completely honest it doesn’t affect me at all much and often is a counter-productive sign. Because I feel that they are trying to buy me and I don’t like that.
Alfonso: But the most common, I think for us, and for a lot of dentists, the ego, when they say, “No one else was able to do that. I heard that you’re the best. I think you can do that.” And you almost feel that you want to prove something. That to the patient, to yourself. And when I didn’t say no, and I start cases where I realise that other people, if they make a mistake, there was a reason because they made the mistake. So when I was trying to re-do something and that didn’t work. So for example, I don’t know, you might… with an implant case, you see a case where the implant fails and you say, “Okay, the case failed because the reason, we wait and see.” You re-do it, and then yours fail as well. And then you realise that maybe was nothing wrong with the clinician and in the implant, but maybe was the genetic of the patient, or the overall hygiene, or medical conditions, or other factors.
Alfonso: And so, to generalise the answer is, my advice is never to say no. This is probably the main thing that I’ve learned from my mistakes.
Payman: I like that man. The level of work that you’re doing. The complex implant work… there’s going to be failure, isn’t there? That’s something that anyone who does complex implant work knows. But learning from it’s the key. If I wanted to get a job at your practise, what would be the best thing for me to do?
Alfonso: Again, as I said earlier, for me it’s really important building relationship. And often, I think it’s important for me to choose the person, not just the clinical skills. I strongly believe that you can train and teach clinical skills, but everything you can teach. You can teach skills. But you can’t easily change the nature of the person. So for me, if I know that you’re the nice person and I think you’re the person that we can work together because we’ve got similar value, similar ethics, I think that for me is more important than probably everything else.
Payman: So look, building such a massive organisation. It’s easy to look at it now and say, “Hey, he’s got a great life.” But along the way, where was the pitfalls? What would you do differently? What was your darkest time in building this thing?
Alfonso: I think the most difficult part for me was when… So when I first moved in UK, I think I was telling you about, went to London, studied English. And then I was looking for a job. And I was speaking with one of these recruitment company, they say, “Oh, I’ve got perfect job for you in a nice practise.” And I didn’t obviously understand a lot of the things at the time. So I went to work in the [inaudible] dentist, outside Lincoln-
Payman: Oh yeah. [crosstalk]
Alfonso: It’s a really, really… It’s a beautiful town. Really, really nice. And I have to say, when I look back at my time in Lincolnshire, people were really nice and friendly and they helped us a lot. But I went to work in this practise and the clinical standard of that practise, they were really, really low. And at that time, I remember that I moved from London to Lincoln, with my girlfriend at the time that is my wife at the moment, with a cat hidden in my car, because I was not allowed to have a pet in this apartment. We don’t [inaudible] in the car, but the flat that we rented was not ready when we arrived in Lincoln, so we had to live in the car for weeks and I went to work and they didn’t even have an autoclave.
Alfonso: So I say, “What am I going to do now in Lincoln?” Quite a few miles away from Naples. With the cat, and the girlfriend in the car on the phone and not even a place to live. So that probably was one of the most difficult time where I thought, why I’m here, why I’m not back home, why… And was raining outside.
Payman: Wasn’t it. Your frontier.
Alfonso: When everyone in Naples was probably on the beach with an apéritif, or having… But then I think like everything, you need to go through that part and learn from the mistake and be prepared to work hard. So again with my family, my ethics, my values always been work hard and hopefully the reward will come eventually. And I always felt that that was probably my way of working out.
Prav: Alfonso, obviously life outside building this empire, what’s it like for you? And how do you maintain that balance? Because I think you’ve got a really, really good way of doing this. The work-life balance, and what from I think it revolves around levels of intensity in both aspects of your life, right? So just tell us, typically, what does Alfonso do outside of work and how do you manage that work-life balance as a multiple business owner with a family as well, and a young family at that.
Alfonso: I have to say, and I’m not saying that because you are here. But this is a conversation where at a lot of times, and I remember at the beginning when I was work, work, work, you always say, “Look, think about that. Think about that.” And a lot of my changing about my life balance is been from conversation with you. So I’m happy to give you this merit in this conversation. And again that is also part of testament of our friendship. You see, you were telling me things that you didn’t get reward with the second part of.
Alfonso: And I think it’s really, really important to try and understand. To try and divide it. So when I work, I 100% focus on my work. But when I go home, I try to switch different half and I like to spend my time with my wife, my girls and try to enjoy the time that I spend with them. Obviously, I work out to try and give them more opportunity, a better life, and see they are happy with their life. For me is really rewarding. And that is part of what makes me happy. I always try to also try to have… I agree with you, I’m happy with my balance. I think I should try to find a bit more time for myself. Because I try to spend a lot of time with my family, a lot of time with my work. Probably not enough for just myself. Like things, training.
Payman: Yeah, what would that look like if you had a day to yourself? What would be your ideal day?
Alfonso: Probably watching 6, 7 game of Napoli, one after the other. I really like football, I like, and I’m massive support of Napoli. Sometimes for me, time for myself is just really time of, even go for a walk and have time to think about, a bit of exercise. But I’m no massive fan of a gym, but I like play sport, like tennis or football. Something that is social is well. And then social time with friends. Having time to have a chat with them. Catching up. Nice pizza and a beer. Just talk about stupid things that they don’t necessarily matter. Just a bit of distraction.
Payman: What do you miss the most from living in Italy?
Alfonso: The seasons. So, here the thing that for me is most difficult is when in the spring here, after we’ve got nice weather. But in Italy, especially when you come from close to Naples like myself, from April to June, July, when the weather is nice, you work til Friday and then on the weekend you are going on the seaside. You are going on a boat. You are staying on the beach. There is only apéritif on the beach, restaurant outside. That is the thing that I miss. That part of the lifestyle. And I have to say-
Payman: I thought-
Alfonso: …as a lifestyle, there is a little bit less stressful than in UK. Everyone is a bit more relaxed, little bit more with the good and bad.
Payman: What don’t you miss about it tell me? Is it that thing you said about lack of regulation and…
Alfonso: Yeah, working in Italy. So when I set up my practise in Italy, I remember I said, “Okay, I liked the way I worked in UK. I’ve got microscope, I’ve got this.” So I give the appointment, first patient at 2:30, second patient 3:00, third patient 4:00. I went there at 2:00, no one there. 3:00, no one in there. 4:00, no one in there. Everyone turned up at 5:00. Planning to have a treatment now and there. And I said, “But your appointment was, you don’t even…” “Yeah, but my daughter, she was… I had to drop her to school, I had to do that.”
Alfonso: So then, you end up working until midnight because this is what everyone does. No one complains because you are running late. Everyone accept. They are sitting in the waiting room, talking with other people, there for hours. But then they get in the lifestyle, then where is the time with my family. Then I’m there until midnight, and probably to get the same income I would have get if everyone was turning up in time and I was finished at 6:00. And that is the bit that I don’t really like.
Payman: And what’s the bit you don’t like about the UK? Apart from the weather. The food, huh?
Alfonso: No, the food’s lovely. We’ve got a lot of Italian deli around. Great restaurant. One of my best friend in Bristol is at the Michelin-star restaurant, Peter.
Payman: Actually the food’s really improved a lot in the UK.
Alfonso: Yeah, yeah. The food in Bristol is really nice.
Alfonso: The thing that I don’t like sometimes in UK is that sometimes I feel that there is a lot of stress and pressure for things that are not important. So you’re going to back to what we were saying, getting stressed. And I remember when I owned the practise, one of the first complaints that I received, a patient wrote me a letter to say that we didn’t have Home and Garden, one of these magazines? Why are you spending half an hour of your life writing a letter because there is no magazine room. By the way, it was in the waiting room. It was back and she couldn’t find. And sometimes I’m thinking, that is just creating negativity forever, for me. And I think is an unnecessary negativity.
Payman: And so, Alfonso, there’s this group that you’re… call it, you’ve been winging it to get there, right? Just buying a practise here and buying a practise there and now you’re formalising the Apollonia group, right?
Alfonso: Yeah. Correct.
Payman: And you’ve got this loose strategy.
Payman: Want to start acquiring practises down the corridor, right? What are you bringing different to the table in comparison to other corporates who are out there buying practises? What is it? What’s your point of difference that you’re bringing to the table?
Alfonso: I think the main point for us is that I’m a dentist, and for me is everything about the clinical work. My view of dentistry is that if you do good dentistry, and if you do high quality level of dentistry, the financial aspect will always naturally follow. And I think that a lot of dentists, especially if they decide to sell their practise, they often are scared of getting corporate and going down. They try to micromanage and change the way that they are doing dentistry. Then our view is that we want to improve the quality of dentistry to get the practise to succeed. And I think that view, I know there are a lot of corporate that say that they will have a similar view. I don’t think there are many that are really doing that. So, we’ve got great retention of clinician and staff when we buy a practise because we treat them well.
Payman: What’s the exit plan, dude? Are you saying you love it so much you’re not going to exit? Or what are you saying?
Alfonso: I’m 36, Payman. So for my exit, there’s always…
Payman: Is that all? My goodness.
Alfonso: I look a lot older since I start to work with Prav, I’m losing hair. But I’m only 36. [crosstalk]
Payman: Same thing happened to Payman.
Alfonso: So my view is that if your practise are profitable and are successful, why sending? So you know, I would be happy to go another 10, 15 years to working as a dentist 2 or 3 days a week and then as a business owner and teaching the rest of the time. So that is something that I really don’t have a long-term exit plan.
Prav: You’ll figure it out as you go along, right?
Alfonso: Yeah, you’ve seen by now. This is a lot about me. I find out how, what I will do.
Prav: Listen Alfonso, I know we’re running out of time, so let me just ask you the final couple of questions.
Prav: Imagine you’ve got your girls around you, it’s your last day on the planet and you’re going to leave them with three pieces of advice from Daddy. What are they going to be?
Alfonso: It’s a really good question. I think would be, be yourself. Do only what you are feel comfortable and happy to do, because the main thing is to be happy. And you only live once and I think it’s important to try and be as happy as possible. Be respectful because it’s extremely important to be respectful to everyone. Because if you want to be respected, you need to be respectful to everyone. And I think that this is something extremely important as a value to have. And the third part is probably, to don’t have any regret. Do everything that you feel is the right thing to do and enjoy.
Prav: And then, finally Alfonso, how would you like to remembered after passing? So imagine somebody years after you’ve gone turns around and says, “Alfonso was…” and then just complete that sentence.
Alfonso: I’m glad Prav, that you can only see the first part of my body not the second. In Italy, I’m quite romantic on these things. Alfonso was a nice person in terms, helpful with everyone, is what I always try to be. Happy and smiling, so you know, a pleasure to have around other than be grumpy and be moaning about problems. And I think that is really what I hope people that will think of me. And yeah.
Prav: I think it’s definitely a fair summary. That you’re a pleasure to be around and certainly one of the people when this rings and your face pops up, it always brings a smile to my face. Because I know it’s all going to start with, “Ciao, como esta?” And it’s always a pleasant conversation. So-
Payman: And a real, real pleasure to have you on, man. Thank you for doing this.
Alfonso: Thank you very much, and really it’s a pleasure to be invited and to have time to share and my experience with you. And again, hopefully people that can… I hope I can inspire some people as well. I’m honest, because again, my experience was move to UK without any plan and the moment I’m happy with what I’ve achieved so far. So I think that working hard hopefully pay off in the end.
Payman: You know my best advice to you buddy?
Alfonso: Yes please.
Payman: Keep doing what you’re doing.
Speaker 3: This is Dental Leaders. The podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts Payman Langroudi and Prav Solanki.
Prav: Thanks for listening guys. If you got this far you must have listened to the whole thing. And just a huge thank you both from me and Pay, for actually sticking through and listening to what we’ve had to say, and what our guest has had to say, because I’m assuming you got some value out of it.
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