All right, good morning, everybody. We're excited for our next presentation to host Henry Schein. For those of you who don't know me, I'm Glen Santangelo. I recently started covering the dental industry again after a brief hiatus, but I covered it for a couple of decades before that. So we're very excited to have Stanley Bergman, the CEO of the company, and Graham Stanley to his right, who heads the investor relations function for the company. So we're going to dive right into it because we are a couple of minutes late. So, you know, Stanley, why don't we get right to it? You know, this has been an interesting year. You know, obviously, you had the cyber attack roughly this time last year.
I kind of feel like you've been sort of, the company's been digging out of that hole all year, trying to win that market share back in a stable but tough market. So, you know, given that we're two weeks off of 3Q results, maybe that's sort of a good place to start on your overall assessment. You know, at a high level of the market, the cyber attack last year, where you think you are in terms of recapturing that market share? Does that bleed into fiscal 2025? Just an overall assessment. Then we'll sort of dive into more specific questions.
Sure, Glen. We just have an FD requirement, if you don't mind, and Graham might just.
Oh, yeah. Yeah, so just because we're from the U.S., we have all this sort of like Reg FD sort of disclosures to make. So just before we begin, Glen, I'd just like to sort of be clear that we'd like to make a statement about forward-looking statements and that things that we may say today may include forward-looking statements and that the risks and uncertainties of the company's business, which are disclosed in our SEC filings, means that actual results may differ from those forward-looking statements. In addition, Henry Schein regularly engages with its shareholders with the goal of enhancing shareholder value, and we analyze any shareholder proposals in that context. So over to you again, Stan.
So, Glen, it's good to be here at your conference. I think we kind of started out more or less the same in the public sector, in dentistry. So it's good to be here. You're asking a very relevant question. How is the dental market and how is Henry Schein doing? So the dental market in the United States is quite stable. Visits are constant. In fact, could be slightly up. The challenge is that from a sales point of view, there has been a movement since COVID towards lower-priced products, not discounting per se at the distribution level, but the specific products that come from the more well-known national brands went up significantly in price in 2022, because of the shortage of labor, raw materials were up and have stayed up. But what has happened since is that second-tier brands are being more frequently sought after by customers.
They can go to the internet and they can learn about the product. Historically, you would buy because of brand. Now you can do your own research and get information on a product, and you can see whether there's a lower-priced product that provides the same functionality available at a lower price, and this is a trend that has occurred post-COVID in dentistry, but I suspect it's occurred in many other industries. Within those categories of products, there has been a movement towards at Henry Schein towards our own brand products. These are products that under the Henry Schein brand are OEM for us, or in the specialty areas, products that we manufacture ourselves under different brands, sell under different brands, so we've had this movement.
From a profitability point of view, it's actually pretty good because the profit we make per unit generally is as good, if not better, than the branded national brand product. But from a sales point of view, the selling price is down. So the inflationary impact on per unit pricing that one may have experienced in 2019, 2020 is no longer there. So the pure sales in units are good. The GP is good, and the profit operating income is good. Sales are not as good, comparable one year to the other. And what you'll see is that this is the case in North America, outside of North America with consumables and equipment. Now, on the cyber, generally with customers where we're analyzing now, cyber incident occurred in the middle of the fourth quarter of 2023.
What you'll see with the cyber is that generally with the larger customers, and those customers where we have a relationship with the customer through salespeople, either field or telesales, that business has stabilized and has largely come back and, in fact, is growing. The area that we are having a challenge is with customers that would go to the internet to do their shopping. Our website in the United States was down for a month, and in parts of Europe, as much as two, two and a half months. So what happens is ratings on Google are down. So when you go and look for gloves, you're not at the top of the list unless we pay for it. So we pay for some of these products, of course, but many products, dental products, etc., we don't necessarily pay, and our ratings are down.
And so what we have are these incidental customers, the customers that come to us just to go shopping and see the price of the product. That is still a gap. It's closing. Each quarter is closing a little bit more than the previous quarter, but it's not closing at the rate we expected when we gave guidance originally in early 2024, and we adjusted our guidance after the second quarter. So if that's.
Stanley, you've been the CEO of this company for what, 29 years from when you took this public? Think about the growth in the 1990s, 2000s, 2010s, and now we characterize the market as stable, maybe a little better, maybe a little bit worse. Has there been some type of shift? Do you think the economy is playing an impact on individual sort of utilization habits? And what sort of changes? And do you see anything from a macro perspective with RFK? I mean, dental stocks got a bump. I don't know if we're going to take fluoride out of the water. I don't know what stance we are going to have on vaccines. Do you see the market evolving or changing relative to what we see in the past couple of years?
Is there any incremental concerns or any incremental optimism based on kind of what you see?
Glen, dental, it's pretty stable and it's growing in certain countries, and in the U.S., I think the visits are growing. Having said that, there are public companies that focus on implants or aligners, and there are dynamics within those markets, but do not apply those dynamics to every product, so if you take implants, because of the high interest rates, the top of the market, the most expensive $20,000, $30,000, $40,000 implant cases are just not taking place as much as they did. Now, this is at the margin. It's not as if there's a disaster in implants. Our implant business is doing just fine, but at the top end, because of the cost of money, the interest rates, that's come down, so you see some of that. Similar issues with aligners. We're not a big player in the aligner market.
There's the shift, as I mentioned earlier on, towards lower-priced, comparable products, often the generic that from our point of view is profitable, but when you look at the sales of certain companies, you see, whoa, there must be a problem in dentistry. Basically, the business is okay. From an equipment point of view, please be careful. 2019 was a good year. 2020 was a problem because of COVID. 2021, as the year went by, there was a problem in getting product. Practices weren't ready to receive the product because the buildings, the buildouts were not ready. They couldn't get the doorknobs. They couldn't get the windows, all that sort of stuff. We had this big bulge in 2022, and we had quarters with double-digit growth in equipment, totally unrealistic. We made that clear.
If you take a line and you look at where the business was in 2019 or where the dental industry was in 2019, and you X out gloves, there's a mask and the bulge is in equipment, etc., it's a pretty nicely growing business, and if you have inflation, it can grow at above inflation. So if inflation is 2%, it could grow 3% or 4%. If you have no inflation, which we don't have right now, and we're not in a depression, we once used the wrong word, and people thought it was the end of the dental industry, that is not the case. Prices are just not going up, but the business is growing.
So it's not growing at the top end, and equipment is not being financed as easily as it was, but the business is a stable, growing business with, I must add, good cash flow from our point of view and from the practitioner, our customer's point of view.
Anything you see with the change in the administration or RFK that gives you cause for concern or opportunity, or should we not even go there?
I have no idea, but.
Okay, fine. Let's move on.
Fluoride in the water has been an issue that has been dealt with in the 1960s. When I came into the dental industry, it was a long-dealt-with issue. And anyway, it's not a federal government issue, as far as I know, unless Congress passes a ban on it. I think it's something done at the local level, and local government, New York City, controls the water and the fluoride in the water.
Okay.
As much as I would love to see a massive increase in sales because we're all going to have bad teeth in about six months. Fluoride could take 10 years to have an impact.
Okay. All right.
I'm not a public health dentist.
Just moving to the different segments. Let's start with dental merchandise. You're coming off sort of four consecutive quarters of negative growth, and obviously that's probably driven a lot by cyber, and can you sort of talk about does that spell some relief in fiscal 2025 on easier comparisons? Back to that original question, are you gaining? Is there much more incremental share to gain back and combined with the fact that we'll be benefiting from easier comparisons in 2025? Are we thinking about that correctly?
So you're asking a numbers question. I think I have to go to Graham because I'll give you too much information, get in trouble.
Okay.
Graham.
Yeah, so I mean, we haven't provided guidance for 2025, but clearly, I think we've clearly articulated over the course of this year that we feel that sequentially we've been gaining market share, clawing our market share back following the cyber incident, and as that annualizes, that should provide some tailwind for next year.
Okay. All right. Well, maybe then let's move on to sort of equipment growth. I mean, clearly, we saw some type of recovery in 3Q. I mean, sales were up almost 2%, maybe some incremental optimism. What sort of drove that? Is that a sustainable trend? If you could just provide a little bit more color around that.
Yeah. I mean, our equipment business has been pretty good this year. I think it's certainly been in line with our expectations. Last quarter, I think our equipment business in North America was like flattish. It grew about 5% internationally. We think that as interest rates come down, that will provide some benefit to our equipment business. And then our portfolio in equipment is a little bit different to other companies out there. We're probably about two-thirds traditional equipment, which are the chairs, cabinets, and lights, and about a third digital. Traditional equipment has really been the growth driver for us. Digital has been a little bit softer, mainly because of the cost of technology coming down. You can buy a scanner now at a much, much lower price than you could do sort of four or five years ago.
That impacts our sales growth within that one category, but it's a very, very small category within the overall portfolio, and really, one of the big drivers for us on equipment, we have a significant parts and service business. About 15% of our equipment sales are parts and service, and that's something that we've been investing in because we see it as a significant value add for our customers. It's also got a much better gross margin than equipment sales, so that's been growing high single digits really for a number of quarters now, so we're pleased with our equipment business.
Stanley, maybe you'll.
I'll just add that specifically in the third quarter in the United States, the traditional business was doing quite well, two units light. But on the digital side, which is, as Graham said, about a third of the business, our big supplier of digital equipment had their convention and their big sales meeting in the fourth quarter of this year, not in the third. So the promotions will certainly be shipped in the fourth quarter.
Can we talk about the DSO market? I mean, it's had such a meaningful impact on the dental landscape over the last five and sort of 10 years. Can you talk about where we are in that sort of process of the DSO influence and how that may be sort of impacting utilization trends, pricing behavior, things of that nature? I mean, yeah, I mean, I guess at a high level, I mean, what sort of appetite are you seeing in those companies to continue to invest, get bigger? And is that a benefit to you, or does that create an incremental strain given the consolidation of that customer base?
The very large DSOs, Glen, are growing, but not as fast as the mid-size regional DSOs, which do very, very well. We have a business that buys and sells practices, and we have a business, LPS, Large Practice Sales, which focuses on larger DSOs, and the business is doing quite well. There is investment going on in the large DSO world. Obviously, it's a business that's private equity owned, so interest rates do impact some of these DSOs, but there are greenfields taking place, not as many as there were, say, when interest rates were half the price. There are sales going on in the DSO world. For us, it's a great business. I can't tell you the exact number because it's hard to get data, but we're well over three-quarters of the DSO business. I think 25 of the top 27 buy from us.
More than we're a primary supplier. And it's good business because we go to the DSOs with a bundled package. Buy your Schein branded products. Please buy some consumables. Please get your implants from us, your endodontics, and your software. So those are all high-margin businesses, and we bundle them together.
All right. We got four minutes left, and I got four more questions, so I want to just sort of rattle them off really quickly. Let's talk about the medical business. We're now nine quarters in a row of sort of negative growth. I think people are pretty familiar with the headwinds you're facing there, particularly on the PPE side. Sort of where are we at this point, and are we getting closer to a trial for an inflection in that business? What can you tell us at this point?
Correct. Your points are correct. You've got to take out the PPE and the COVID tests to get to the base business. Then you've got to peel the onion further. In the first quarter and the third quarter, traditionally, those have been high respiratory quarters, flu, particularly flu season in the first quarter and in the third quarter, and also vaccinations, which is a part of the business, a nice part of the business. Low margin. Vaccination rate was down this year. Maybe it'll go up in the next few months, but it's pretty far down, low margin. And then if you don't have flu, you tend not to sell the diagnostics, and that's a big business for us. It's at the margin, for sure. And then you have the cyber recovery from the small customers, but it's a good business and very profitable, and the bottom line is growing.
Okay. Maybe could you talk real quickly about the BOLD+1 sort of initiative? I mean, you realize what, $50 million in cost savings at this point? Maybe a little bit more than that?
BOLD is our building of the high growth, high margin. The O is the optimization. The L is leveraging, which is very important. Leveraging one customer base against another, specialty and distribution. D is the work we're doing in digital. But on the restructuring, we committed in this go around $75 million-$100 million run rate, and I think we're pretty much there.
Yeah. I think, Glen, in Q3, we announced that we'd taken actions to achieve over $50 million so far. So we're making very, very good progress even after a month and a half to 2 months. So yeah, we're very, very pleased with what's going on with our restructuring plan at this stage.
All right. Could we maybe shift gears and just sort of talk about capital allocation? It's always been a big part of the Henry Schein sort of growth algorithm, doing those acquisitions, buying those joint venture pieces, expanding your geographic presence. I mean, is that still the right strategy at this point? Do you still see opportunity for that to be a contributor to the growth algorithm?
We generate just under $1 billion of cash each year, Glen. Traditionally, about a third has gone into buying back a stock, a third into investments, acquisitions, and the like, and then a third just to pay down debt. And we did acquire $1.3 billion on investments in the BOLD+1, primarily in specialty businesses, which, by the way, are all doing okay. And we don't expect to invest anywhere near that level going forward. You never know, but that's not the plan. Lots of small businesses to add, but all within the $250 million-$300 million range.
I just want to address the issue that I'm sure is on people's minds. I saw the way the stock reacted yesterday, right? There was an activist fund that sort of got involved, pushing for some changes, maybe questioning, wanting to know what the succession plan is. I don't know if there's any sort of. You certainly seem very spry to me and very energetic, so I don't think anyone's pushing you to the exit yet, but I'm kind of curious. I mean, have you thought about how deep the bench is, what a succession plan might look like, and are you constantly evaluating all the businesses within the Henry Schein portfolio?
So first of all, we're constantly evaluating. We spun out our vet business, great business, had some challenges unrelated to when we handed it over. But on succession, we have a robust succession program. Our board is deeply involved. We have highly qualified people on our board. Take a look at them. People have stepped down, a former secretary of the head of the FDA, a former head of HHS, different kind of head. They were all on our board, and we've had great succession on our board. Each of our senior leaders has been part of a succession program. I think you know Steve Paladino resigned. We had a succession, not resigned, retired. The head of our Chief Operating Officer retired, was replaced.
All internally, each of our businesses is headed by people that have either grown in the company or joined us in the last three, four, five years and are relatively new people. And the board on CEO succession has been highly engaged. As before, he's had a plan. So succession is there. Of course, we're not going to announce today who's going to be my successor. I don't think that's the right thing to do, but there is succession.
Okay. Any last word for the audience? It seems like dental markets are stable. Comps are getting easier. Anything else you want to relay to the audience in the last 20 seconds?
It's a good business. We generate a lot of cash. We grow. We reinvent the business every few years. We were a pure-play distributor when you came into the business. Over half of our profits today are coming from businesses that were not even around even five, six, seven years ago. High growth, high margin products, services, value-added services, brands we control, and we still are the largest in the business and expect to continue to gain global market share and have a deep bench of succession. A lot of that's in place. I mean, we've got a new CFO that's doing great. We've got a new head of North America that's great. We've got a great international head of the business. Implants, two great leaders there. Also recent successions.
And all of our specialty businesses combined are under a great leader, young fellow that comes out of the orthopedic business, put us into the orthopedic business with a good business. So I can't guarantee every single month it'll go like this, but I can tell you, look at the track record, it hasn't been bad.
Okay. Stanley and Graham, thank you guys very much. We'll end it there.