Q & M Dental embarks on Asian brand-building journey

GROWING up, Raymond Ang's favourite hangout was Singapore General Hospital, the 198-year-old grand dame of healthcare institutions in the city-state.

"My dad worked as a clinical technician, running SGH's EEG and ECG machines, and I would hang around him after school," recalled the chief operating officer of SGX-listed Q & M Dental Group (Singapore) Ltd. Electroencephalograms (EEGs) and electrocardiograms (ECGs) are tests that monitor electrical activity of the brain and heart.

"As a kid, I spent quite a lot of time in the hospital, and that piqued my interest in healthcare. I was intrigued by the idea of being able to help someone, of making a difference to another person's well-being."

Unfortunately - or fortunately in retrospect - Dr Ang's attempt to pursue a course in medicine at the National University of Singapore decades later fell flat.

"Everyone wanted to do medicine. Dentistry was not popular then - it wasn't a degree that you could impress someone important, like your future mother-in-law, for example," chuckled Dr Ang.

"Dental school was my second choice, and it was there that I met Chin Siau - another medical-school reject - and we became buddies," he added, referring to Ng Chin Siau, founder and chief executive officer of Q & M Dental Group.

"We got to know each other pretty well during those years at university. He taught me how to play mahjong, and I probably helped to finance his education, since he frequently beat me at the game and won my pocket money!" Dr Ang guffawed.

That bond - forged over the clacking of mahjong tiles and spanning three decades - proved to be a catalyst for the transformation of the group into a regional dental services provider.

At first, their paths diverged. After graduation, Dr Ng went on to open his Q & M dental clinics, while Dr Ang joined another dental practice.

They became competitors, jockeying to see who could build a bigger network.

Nearly another decade passed before their love for the Chinese tile-based game brought them together again.

"We reconnected at a mahjong session with friends. At the time, I was thinking of leaving my practice, and it so happened that Chin Siau wanted to find someone to help him grow Q & M to the next stage," Dr Ang said.

Catch a shooting star

Back in the 80s and 90s, Singapore's dental industry was fragmented. "Each dentist was a sole proprietor, running his own business. Chin Siau had a grand vision of uniting a group of dentists under one roof to form the largest dental network in Singapore, with the eventual goal of listing it on the stock exchange," he recalled.

"That was revolutionary. In those days, no one even liked to see a dentist, and doing an IPO for a dental practice was virtually unheard of."

But Dr Ang had faith, and he shared Dr Ng's dream. "I believe that if you hitch a ride on a shooting star, you will go places you might not be able to reach on your own. And Chin Siau was that shooting star."

In 2008, Dr Ang was appointed executive director of Q & M Dental Group.

A year later, he assumed the role of chief operating officer, managing the group's human resources, information technology and marketing functions.

Q & M Dental Group made its debut on the mainboard of Singapore Exchange in November 2009. It celebrates its decade as a listed company this year, with a market capitalisation of over S$380 million.

Today, it operates 74 dental outlets and four medical clinics in Singapore, 27 dental clinics in Malaysia, as well as three dental supplies and equipment distribution companies across Singapore, Malaysia and China.

With more than 230 experienced dentists and nearly 400 supporting staff, the group has an outreach of more than 600,000 patients locally.

The group owns 42.6 per cent of Aoxin Q & M Dental Group, which listed on SGX's Catalist board in April 2017.

Aoxin manages and operates six dental hospitals and 11 dental polyclinics across eight cities in Liaoning province, north China. It also has its own dental laboratory and equipment distribution company.

Bolt from the blue

On hindsight, what does he consider to be Q & M Dental's make-or-break strategy? "It was the decision to expand overseas in 2013 and 2014 that was critical to our success," Dr Ang said.

"Singapore is a small market - there are only so many teeth you can drill or pull out," he noted, tongue firmly in cheek.

Malaysia was the first and most obvious choice, being the city-state's closest neighbour and home base for many of the group's dentists.

Next was China, due to its physical proximity to Singapore, and demographic as the world's most populous country.

"Back then, there were all these horror stories about investing in China and losing your pants. That made us very cautious about going into that market," he recalled.

"At the same time, there was overwhelming competition. Every father's son and mother's daughter was venturing into the Tier 1 cities of Beijing, Shanghai and Guangzhou - all of us were chasing the same patient pool, which consisted of wealthy Chinese nationals and expatriates."

In those early years, the group's clinics in Nanjing and Beijing didn't bear much fruit. "We didn't lose money, but we didn't make much either."

The turning point came as a bolt from the blue, with an unsolicited telephone call from Shenyang-based oral medicine specialist Shao Yongxin, who later became the CEO of Aoxin Q & M Dental Group.

"Dr Shao had heard about Q & M Dental Group in Singapore, and wanted to learn from us, to find out how he could also successfully list his dental hospital on the stock exchange," Dr Ang said.

Through Dr Shao, Dr Ang and Dr Ng were introduced not only to the joys of baijiu - China's national liquor distilled from fermented grains that packs a fiery punch - but also Shenyang, capital of Liaoning, the country's largest province in the north-east.

"With a population of about eight million, Shenyang is a huge city, but no one was there. This partnership also gave us the opportunity to own private dental hospitals - the main mode of expansion in China's dental industry - as opposed to individual clinics."

Owning private dental hospitals in Shenyang also opened up other opportunities, including research and development (R&D) collaborations, human resources management, as well as access to China's healthcare insurance programmes.

These dental hospitals are also a branch of Jinzhou Medical University, which facilitates the training of its dental students.

"This means that patients are queuing up for appointments in our clinics, rather than our dentists sitting around waiting for patients to call. In China, the population is where you win the game," he added.

No risk, no gain

While the road ahead will have its fair share of bumps, the group's focus and strategy are clear. "We will continue to pursue organic expansion in our existing markets of Singapore, Malaysia and China, which have enjoyed good growth so far," Dr Ang noted.

"The next big wave of our regional push - into South-east Asia - will take place within three years," he said, adding that the group is exploring opportunities in Thailand, Cambodia, Myanmar and Vietnam.

Competition in South-east Asia's dental markets remains muted, partly due to the splintered nature of the industry. "Not many local dental firms are expanding as aggressively as us overseas, and there are pockets of opportunity, particularly in Indochina."

But new markets also mean increased risk exposure. "To grow, we need to take calculated risks - no risk, no gain."

That's why the group is taking its time to understand regulatory infrastructure and policies in the different markets before jumping in. "We've been spending time building knowledge in each country, and looking at whether we should work with strong local partners," Dr Ang noted.

Ultimately, it's about leveraging Q & M Dental Group's already familiar brand. "Our success in China has attracted attention, and our name is known in the region. The next step is to for us become the top clinical dentistry brand in Asia-Pacific," he added.

And the outlook is bright, thanks to favourable healthcare dynamics.

"In the 70s and 80s, people never cared much about their teeth - if it rots, pull it out; if you lose all your teeth, just get dentures. But as the population matures and wealth increases, consumers' expectations and healthcare standards change," Dr Ang pointed out.

There's now a growing realisation that teeth do more than just chew food - they also play important roles in speech, physical appearance and first impressions.

"Societies are moving away from pull and replace to preventing decay and loss, as well as aesthetics, such as orthodontics and veneers. Overall demand for dental services will also rise as populations age," he added.

With industry trends shifting more into specialist dental services, such as root canals, crowns and bridges, constant technological innovation is critical to keep abreast of the competition.

Q & M Dental is one of the pioneers of Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) dentistry in Singapore, and the first worldwide to produce multi-layer zirconium blocks - used in teeth restoration - through its Chinese associate Aidite (Qinhuangdao) Technology.

"We're moving into pioneer territory by developing AI-based diagnostics and treatments, which will raise the bar on treatment quality and planning in the region," he added.

To achieve this, Q & M Dental AI was set up in November 2018. The first prototype of the artificial intelligence (AI) software is expected to be rolled out in the final quarter of this year.

The next generation

Apart from tech, grooming and retaining talent looms large in Dr Ang's mind.

"What keeps me awake at night - apart from too many cups of coffee - is the issue of leadership renewal," he said.

"Although Chin Siau and I are in our 50s, and we still have some way to go, we need to focus on the next generation of leaders at Q & M."

"The key is to tackle this not when current management is on its way out, but when we - and the organisation - are on our way up. With the latter, our employees will be able to grow together with us, understand the culture better, and plan for the long term more effectively," he added.

The group set up its Q & M College of Dentistry subsidiary in end-2018, and is planning to offer a post-graduate dental diploma programme, training new dentists in implant dentistry, root canal treatment, prosthodontics and other surgical procedures.

It also offers sponsorships and bursaries for aspiring dental graduates, as well as job attachments to the group's specialists and senior dentists in the region.

When the jovial 50-year-old is not caught up in board or investor meetings, he is treating patients in his Bukit Panjang and City Square Mall clinics.

"I make it a point to see patients twice a week - that's my down time and I really enjoy it," Dr Ang grinned.