Ep. 64: Practice growth stalled? How to move to the next level!
Has your practice hit a plateau? Struggling to increase production/collections over a certain number? There are only three reasons a practice stops growing and this week Sabri Blumberg joins us to discuss what those are along with how to kickstart growth again.
Topics:
1:30 – The only three reasons a practice hits a “plateau.”
17:35 – Scheduling and organizing for production
Links:
Download the Hygiene Formula Spreadsheet - https://www.mgeonline.com/hygieneformula
The Scheduling Coordinator Training Course - https://ddssuccess.com/p/scheduling-coordinator-training
Scheduling downloads - https://www.mgeonline.com/scheduling-downloads
Free consultation - https://www.mgeonline.com/free-practice-analysis
Contact Sabri – SabriB@mgeonline.com
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Questions From This Episode
What's the real cause of a practice plateau, regardless of what dollar level it happens at?
It's always an organizational issue, never something like running out of physical chairs or space, which is usually the wrong reason people assume. The plateau always comes down to one or a combination of three specific areas, sales, production, or scheduling, and the underlying solution is fundamentally similar whether a practice is stuck at $50,000 a month or $500,000.
Why can a doctor's close rate look fine on paper in dollar terms while actually being a real problem?
Say a doctor diagnosed $100,000 across ten cases and closed $20,000, that 20 percent looks survivable if it happened to come from one large $20,000 case, but it actually means nine out of ten patients who needed help walked out without accepting treatment. Looking only at dollar value can mask a genuinely poor conversion rate, and the real benchmark is closer to 60 percent of full treatment plans closed, not partial treatment or dollar volume alone.
Why are new patients actually the weakest source of sales opportunities, contrary to how most marketing gets framed?
New patients are more expensive to acquire, require more doctor and chair time, and are far less predictable, since there's no way to know in advance what treatment they'll need or how they feel about dentistry in general. Roughly 60 percent of a doctor's existing charts already have outstanding, previously diagnosed treatment sitting in them, which represents a far larger, cheaper, and more predictable source of sales than chasing new patients alone.
Why do pre-authorizations and predeterminations quietly damage case acceptance, even though most plans don't actually require them?
A predetermination is only a verification of benefits, not a guarantee of payment, and very few plans genuinely require one, yet office staff often submit them anyway out of habit or misunderstanding. The real damage comes from the delay itself, since a patient sent home to wait on a predetermination naturally loses motivation over the following weeks, the same way anyone's enthusiasm for a purchase fades the longer they're made to wait.
Why is a schedule booked out several weeks or months in advance actually a bad sign rather than something to be proud of?
Unlike a specialty dental CE course with limited seating that genuinely justifies booking a year ahead, a patient has plenty of other dental practices to choose from and no real reason to wait weeks for care, so a long wait mainly just signals that case acceptance and scheduling organization are weak rather than that the practice is thriving. Pushing the schedule further out doesn't actually grow collections, it just delays the same revenue further into the future while increasing the odds of no-shows and patients calling a competitor instead.
Episode Transcript
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Jeff: Has your dental practice stopped growing? Maybe you've hit a bit of a plateau, things feel maxed out, and you're wondering what you actually need to do to bust through it and get your practice to the next level. That's what we want to talk about in this week's episode of Dental Business Rx. My name is Jeff Blumberg, and I'm your host, joined this week by Sabri Blumberg, our Deputy Chief Operating Officer here at MGE. If you've listened to the podcast for a while, you'll know Sabri, she's been on a number of episodes, and in a nutshell, she's in charge of all technical delivery here at MGE, and genuinely the most knowledgeable person we have when it comes to practice management. Sabri, all set over there?
Sabri: Ready to go.
Jeff: This episode is actually inspired by some conversations we've been having lately, you've run into quite a few clients dealing with exactly this.
Sabri: I have, and here's what's interesting about it. When you say hit a plateau, people immediately picture someone doing huge numbers who simply can't grow further. But that's not really the full picture, sometimes someone's stuck at a much lower number, and the solution is fundamentally the same either way.
Jeff: So the plateau can happen at very different dollar levels, but the fix is similar regardless?
Sabri: Correct, there's variation in the details, but it always comes down to a combination of the same core things we're about to walk through.
Jeff: Alright, let's start there then. What's the most common reason a practice actually hits a plateau?
Sabri: It's always an organizational issue. It always requires reorganization in some form. People usually assign the wrong reason, they'll think it's a space problem, I have no more operatories, but that's essentially never actually the real issue.
Jeff: So is it one specific part of the organization, or does it vary?
Sabri: It's always going to be one of three areas: the sales side, the production side, or how the practice is scheduling. There's also a personnel component running underneath all three, which deserves its own separate conversation, but structurally, it's always one of those three.
Jeff: So let's say I've hit a plateau and you're sitting down with me as a client, since I know you see this with brand new clients and with existing clients pushing through to a higher level too. What are you actually asking to figure out what needs to happen?
Sabri: The first thing I'm looking at is always sales, because sales drives growth. The more I sell, the more I produce, the more I collect. So that's always the starting point, and sales itself breaks down into three separate pieces.
Jeff: The first being the doctor's actual closing skill, their individual communication ability?
Sabri: Exactly, because if I have plenty of sales opportunities but the doctor's only closing 20 percent of them, we're wasting the other 80 percent of treatment plans we could be converting. That's exactly where I'd focus first.
Jeff: For anyone listening wondering how you'd actually measure that, what metrics are you using to determine someone's close rate?
Sabri: I look at how many cases are being presented, the total dollar value of that treatment, and what percentage actually converts. And it's worth looking at this from two angles at once. Say a doctor diagnosed $100,000 worth of treatment last month, across ten separate cases, presented all of it, and closed $20,000.
Jeff: And by closed, we mean the patient genuinely committed, made real financial arrangements, not just said they'd think about doing some this year and some next year.
Sabri: Right, proper financial arrangements in line with the office's actual policy, that's what counts as closed. So say that $20,000 came entirely from one single case out of those ten. On paper, 20 percent of $100,000 collected looks survivable. But look at what actually happened, nine of those ten patients walked out without accepting any treatment at all.
Jeff: So you're looking at both the dollar figure and the actual number of people converted.
Sabri: Correct, because if I'm only converting one out of ten people and got lucky that it happened to be a large case, that's not actually a good outcome. As a doctor, nine out of ten people who came to you for help walked away without getting the treatment they needed. It might look fine on paper, but the reality is you got lucky that month.
Jeff: Fair enough. So what else are you looking at with relation to sales specifically?
Sabri: Whether the closing percentage itself is acceptable. If a doctor is closing on average around 60 percent of the cases they present, I'd consider that acceptable. Could you push it higher? Absolutely, but 60 percent is a reasonable benchmark, assuming we're talking about full treatment plans, not partial acceptance.
Jeff: That's genuinely worth pausing on, because we've talked about this for years. A doctor presents six crowns, the patient says they'll do two this year and two next year to maximize their insurance, and if you ask that doctor afterward what they closed, they'll say, I closed a six crown case, simply because the patient said they were going to do it eventually.
Sabri: That's not closed. And what you typically see is that a year later, the doctor follows up about the remaining crowns, and the patient says, oh, I thought we already did those. They're genuinely not closed cases at all, and often that same patient develops additional problems in the meantime since we delayed getting them fully healthy in the first place.
Jeff: So when someone tells you they closed eight out of ten cases, you're actually comparing that against the dollar value too.
Sabri: Exactly, and you'll often find they only closed the periodontal piece and never actually got to the restorative dentistry, and their follow-up system is so weak those patients never come back to finish it. Ultimately, as a dental practice, the goal is a genuinely healthy patient, not just performing isolated procedures. So when I say sales, I specifically mean full treatment plans accepted.
Jeff: Okay, so assuming that closing percentage is solid, what's next?
Sabri: The amount of treatment they actually have available to close. If someone's converting 60 percent of $100,000 and they're stuck there, sure, we could push that percentage a bit higher, and we will work on that, but more importantly, I want to know how to get this doctor more treatment to actually present in the first place, since they can only diagnose what's genuinely there, they can't invent cases.
Jeff: So that means creating more sales opportunities. How would you actually do that?
Sabri: There are really three broad categories of sales opportunity in dentistry. New patients, which are actually the weakest opportunity, and I'll explain why. Existing patients on the hygiene schedule. And existing patients who've accepted only part of a treatment plan and still have outstanding work sitting on the books.
Jeff: Could you repeat that first part, since I think that might catch some listeners off guard, new patients being the weakest sales opportunity? Because most marketing, especially to prospective clients, treats new patients as the solution to everything.
Sabri: Right, and new patients absolutely have their place, you do need them, there's always going to be attrition, and if you're a genuine startup with no existing patient base, you're completely reliant on them. But if the goal is hitting your sales quota, since your growth and income are directly tied to your sales, you want to go where your sales opportunities are actually most plentiful. On average, 60 percent of a doctor's charts have outstanding treatment sitting in them already diagnosed. That's a tremendous amount of available sales. I'll often have a newer client print out the last year of proposed treatment that never closed, and it's genuinely striking how much is just sitting there, walking out the door.
Jeff: So to recap, new patients are the weakest opportunity, patients of record on the hygiene schedule are next, and patients of record who accepted a partial treatment plan but haven't finished it are the third.
Sabri: Right. And worth adding on new patients specifically, you typically have far fewer of them relative to your existing patient base, they're considerably more expensive to convert, since it takes more doctor time, more chair time, and real acquisition cost, and they're less predictable, you genuinely don't know what treatment plan you'll get out of a brand new patient, or their general attitude toward dentistry, since they're simply unknown to you.
Jeff: Let me pose something theoretical here, since I imagine you've rarely seen this in your career. Say you run into a practice where hygiene is genuinely maxed out, 15 or 20 days a week, one or two associates, and sales conversion is already excellent, 70 or 80 percent. At that point, wouldn't new patients be the actual solution?
Sabri: It would be, but not always. When hygiene looks like it's genuinely rocking, I've rarely seen that actually mean every patient in the practice is coming through hygiene. Usually it means the practice has, say, 3,000 active charts and is running double the normal hygiene volume, appearing busy, when it should really be running four times that. In that case, I'm not going to hand them a third or fourth hygienist as my first move.
Jeff: So what would you actually look at first?
Sabri: Whether they're still heavily in managed care plans. If they are, I'd look at getting them out, which increases the value of every hour of chair time, and since so many patients aren't even making it into hygiene regularly, it's relatively easy to start dropping plans and backfilling with full private-pay patients instead, precisely because hygiene has so much untapped capacity.
Jeff: This actually connects to something Jeff Santone was talking about recently, and something we've both seen play out, a practice where hygiene looks completely booked, but they're really only seeing 15 to 20 percent of their total patient base on any regular basis.
Sabri: Exactly, and it ties back to something we've discussed in prior episodes, we spend real money acquiring a new patient and then very little keeping them in the practice afterward, which is genuinely backwards. A certain percentage of any patient base will show up reliably on their own, twice a year, sometimes just once, and those are the patients a doctor is constantly seeing. So it can feel like there's no real treatment sitting in hygiene, when really you're just seeing your most naturally compliant patients over and over, while thousands of other charts sit inactive.
Jeff: So if you run into that specific situation, hygiene looking clean but actually underbuilt, the answer isn't dropping plans.
Sabri: Right, in that case the answer is building hygiene, so you actually generate more sales opportunities from where they should primarily be coming from. But your outstanding treatment list and your actual patient volume, run through the hygiene formula, will tell you definitively which situation you're actually in.
Jeff: For anyone who wants to check this themselves, we'll put the hygiene formula spreadsheet on the episode webpage as a free download, you enter a few numbers from your own practice and it tells you your real hygiene compliance rate.
Sabri: The third component of sales is making sure the practice is actually organized to allow selling to happen at all. That means the doctor genuinely has enough time to sell. If you've got one doctor running between two or three hygienists and only one person up front, that doctor simply isn't going to have time to sell anything properly.
Jeff: What other organizational issues show up here?
Sabri: Doing pre-authorizations or predeterminations when they aren't actually required. There's no faster way to kill your ability to close a case.
Jeff: You mentioned this to me recently, and I was genuinely surprised people are still doing this. I know a handful of union-style plans might require it, but very few actually do.
Sabri: Very few, and it's mostly a misunderstanding, I've seen it happen three separate times in just the last two weeks. People assume a predetermination is required to actually get paid, when it's really just a verification of benefits, not a guarantee of payment. Most of the time it comes down to one of two things, either the patient wasn't genuinely closed on the treatment in the first place, or the office simply doesn't know how to explain to the patient that their benefits are already verified and the treatment is genuinely needed regardless. But what we do know for certain is that predeterminations dramatically lower your close rate, because of the delay involved.
Jeff: The patient goes home and simply loses motivation.
Sabri: Exactly, life continues, their attention moves elsewhere. How many times have you personally been motivated to buy something, and four weeks later that motivation just isn't there anymore?
Jeff: Completely fair. So that's the full picture on sales, those three components. Once you've worked through that with a client, do you move to production or scheduling next?
Sabri: It genuinely doesn't matter which comes first, they're so interrelated. Scheduling ties directly back into sales too, is the schedule actually structured to allow sales to happen? Meaning, is there enough time built in for hygiene checks, diagnosis, and genuinely talking to a patient about why their treatment matters, rather than trying to present a large case in five rushed minutes because the schedule is packed too tightly.
Jeff: And that assumes the right personnel are actually in place and know what they're doing.
Sabri: Right, and your hygienist specifically needs to be able to back you up here, essentially pre-selling the patient so that by the time the doctor walks in, all they have to do is confirm or slightly adjust an already-explained diagnosis. A lot of this treatment has already been diagnosed previously and is simply sitting there, the hygienist just needs to confirm it and talk with the patient about it. They have a genuinely captive audience for the better part of an hour, the patient isn't going anywhere, and can't easily talk back with instruments in their mouth. If your hygienist is comfortable and effective at this, and you actively work with them to build that comfort, they become a genuinely valuable part of your sales process, not just your clinical team.
Jeff: So the schedule needs a real mix of sales time and production time.
Sabri: Exactly, whatever you want to produce, you have to sell that amount first, or it simply isn't going to happen. Other scheduling issues show up too, doctors booked in a way that isn't logical, operatories not being used efficiently, not enough assistants, or assistants poorly utilized, scheduling a root canal against fillings while also owing two hygiene checks, genuinely physically impossible combinations.
Jeff: We've actually covered a lot of this on our online platform, DDS Success, I'll put a link on the episode webpage, we have a dedicated scheduler course and the Art of Scheduling course covering the whole practice. We also did a two-episode series a while back specifically on building a genuinely good schedule.
Sabri: Right, that covers more of the organizational side of scheduling specifically, and I'm always a little surprised by how few practices are actually organized around this. Someone might have a good idea, do bigger procedures in the morning, for instance, hand it to the front desk, and then get told it simply can't be scheduled that way. But that almost always comes down to staff training, not the idea itself being wrong. It always circles back to having properly placed, properly trained staff and a doctor who's genuinely working in coordination with them to convert patients and grow the practice.
Jeff: So we've covered sales and the organizational side of scheduling. Are there other scheduling points worth mentioning?
Sabri: The next piece really ties into production specifically. I can sell $200,000 worth of dentistry in a month fairly easily, but if I can only actually produce $100,000 of it, that's a real problem.
Jeff: You'd end up with a lot of refunds, or the schedule pushing further and further into the future.
Sabri: Right, and this connects to something you touched on earlier, dentists being taught that a fully booked-out schedule is a good sign. I regularly have newer clients proudly showing me their book is filled a month out, and I'm genuinely wincing, because that means you can't actually grow. If you sell more from that point, your numbers don't go up, the schedule just pushes further out, and patients get increasingly upset the longer they have to wait.
Jeff: And the longer someone waits, the more likely they are not to show up at all.
Sabri: Absolutely. And think about what a long wait actually communicates to the patient, you've just told them this treatment is important, and in the same breath, you're telling them you'll see them in three months regardless.
Jeff: From a sales standpoint, we teach clients to get a real commitment from the patient right away, prepayment or otherwise, but how would that even work if the earliest opening is nine weeks out?
Sabri: It doesn't, really. If you're getting a patient to pay in full today, you want to deliver that treatment within the next couple of days, since the point was never simply collecting payment, it was getting them the care they actually needed. When you see a schedule pushed weeks or months out, what you're usually looking at isn't big, fully prepaid cases, it's partial treatment plans, insurance-driven work, meaning the underlying sales process in that practice usually isn't especially strong to begin with.
Jeff: It's interesting, because people often treat a schedule booked out weeks or months in advance as a mark of success.
Sabri: It's actually the opposite. Compare it to dental continuing education, if I'm signing up for an extensive CE course a year in advance, that's completely reasonable, because seating is genuinely limited, there might only be three similar course options nationally, so booking ahead and paying a deposit makes sense. That logic simply doesn't hold in the consumer patient world. If you make a patient wait weeks, there are plenty of other genuinely excellent dentists they can call instead. You're not the only option in town, and that's especially true for a new patient specifically, make them wait three weeks and they're very likely hanging up and calling someone else while they're still motivated.
Jeff: That's a great distinction.
Sabri: The last production-related factor, and this one's more of a personal judgment call, is how much treatment a doctor is referring out. If a doctor is referring a meaningful amount of work elsewhere and genuinely wants to learn to perform those cases themselves, sometimes that means continuing education, sometimes it means bringing in a specialist to keep those patients in-house. But that's never my first solution for a plateau, it's simply a factor worth being aware of, not the actual fix.
Jeff: So that covers sales, scheduling, and production. Is there anything you'd want to sum up here, since every practice's specific situation is obviously a little different, some people listening might be plateaued at $50,000, others at $500,000?
Sabri: The underlying framework stays the same even though the specific solution varies. One of these areas is almost certainly going to be the answer, even if it turns out to simply be, my sales opportunities really are tied to new patients right now, and I need more effective marketing and referral programs. But ultimately, someone actually has to execute these solutions, which means you always need a genuinely competent office manager. And by competent, I don't just mean a hard worker, or a smart, capable person, I mean someone specifically trained to identify and resolve these issues before they ever turn into a plateau in the first place.
Jeff: So real management training specifically, not just general capability.
Sabri: Exactly, it's a bit like asking me to practice dentistry, I'm not incapable as a person, but I wouldn't succeed at it without an actual dental degree. If you're asking someone to manage a business, you need to make sure they actually have the tools to do that well, genuine management training, not simply familiarity with dental systems. If anyone listening would like me to personally take a look at where their practice might be stuck and how I'd sequence the solution, they're welcome to reach out directly, it usually only takes about fifteen minutes of conversation to identify the actual problem, even though the specific fix varies practice to practice.
Jeff: We'll put your email as a link on the episode webpage, but if you'd like to jot it down now, it's sabrib@mgeonline.com.
Sabri: That's right.
Jeff: One thing worth adding, sometimes people hit a plateau and think, this is exactly where I want to be, doing $180,000 a month feels great.
Sabri: But ultimately, in any business, the thing that actually matters most is your profit margin, and you genuinely can't afford to stop growing, because inflation keeps climbing, salaries keep climbing, expenses keep climbing. If you're not growing, you're shrinking, your profit margin is quietly eroding the whole time.
Jeff: That's basically my own version of the Ricky Bobby line, if you're not first, you're last, except it's if you're not growing, you're shrinking.
Sabri: Exactly right. And it's worth addressing early, since we've both seen practices plateau for a while and then actually start declining, losing a staff member, something shifts, and suddenly it's moving backward instead of just standing still. Ultimately this is genuinely fixable, and fairly straightforward to fix. If you're going to run a dental practice, you might as well run it professionally, build real growth, and create a genuinely great environment for your staff, your patients, and yourself.
Jeff: That's a great way to close this one out. Sabri, thank you so much for joining me this week.
Sabri: You're welcome.
Jeff: Don't forget, we've got the hygiene formula download and Sabri's email address on the episode webpage. If you'd like to learn more about MGE, you can find us at mgeonline.com, or call us at (800) 640-1140. Have a great week, and we'll see you at the next episode.