Ep. 83: Scaling Up Your Practice – What’s the First Step?
Want to expand your practice and increase revenue, but aren’t sure where to start? In this episode, Jeff covers a few key metrics for evaluating where you are at currently, what your potential is, and what your next step should be to jumpstart growth.
Links:
Download the MGE Reactivation Program - https://www.mgeonline.com/mge-reactivation-program
The New Patient Workshop - https://www.newpatients.net
Fees & Plans Analysis – https://www.mgeonline.com/fees-and-plans
Listen to full episode :
Have a question for Jeff?
Fill out the form and he will get back to you.
Questions From This Episode
How should you actually calculate your true active patient count, and why does the industry-standard 24-month definition fall short?
The commonly used definition, anyone seen within the last 18 to 24 months, works fine for a practice sale but doesn't reflect genuine engagement. A more useful number is simply how many patients currently have a next appointment on the books, that's a real, current signal that someone is actually participating in the practice, rather than a broad historical window that can flatter the numbers.
How many active patients do you need per full-time doctor before adding an associate makes sense?
Roughly 800 to 1,200 active patients per full-time GP, enough to support one full-time hygienist at a one-to-one, or at most one-to-1.5, doctor-to-hygiene-day ratio. Pushing much beyond that ratio, say one doctor supporting two or three hygienists, tends to backfire, since the doctor ends up with too many exams to do to properly diagnose and sell treatment, or complete procedures without constant interruption.
Why is reactivating inactive patients often a faster and cheaper path to growth than chasing new patients?
Because someone who's already been a patient, even years ago, already has a relationship with the practice, closing treatment with them is generally much easier than starting cold with a true stranger. In one illustrative example, recovering 1,800 lapsed patients was compared to the roughly 630,000 dollars it would cost to acquire that many new patients through postcard marketing alone, a cost gap that makes a dedicated reactivation effort, even a full-time hire, look like an easy investment by comparison.
How many new patients should a full-time doctor be bringing in monthly, and what does that translate to in hygiene growth?
Roughly 20 to 25 new patients a month per full-time doctor. Sustained at that pace, a practice should be adding approximately one additional day of hygiene per year, so four days of hygiene this year should reasonably become five next year, then six the year after, assuming nothing else changes. Supporting a full-time associate typically means pushing that new patient number up to around 50 a month.
How does heavy PPO participation distort these scaling metrics, and what should you do about it?
Heavy PPO participation, especially plans reimbursing at a steep discount, can make an otherwise healthy-looking patient count deeply misleading, since the actual revenue and margin available to support additional staff simply isn't there at those fees. Dropping PPOs typically costs a practice around 30 percent of the patients in that specific plan, sometimes considerably less when done well, but the resulting fee structure usually makes the practice meaningfully more profitable even with the reduced volume, which is worth factoring into any scaling plan rather than treating patient count alone as the full picture.
Episode Transcript
-
Are you looking to scale up your practice, more patient flow, an additional associate or specialist, more hygiene days? What's the actual next move, how many new patients would you need, what should your active patient base look like, and how do you know when it's genuinely time to take that next step? That's what I want to cover this week, basic metrics for scaling your office. My name is Jeff Blumberg, and I'm your host.
This is a topic I've been asked to cover for a while, and part of the challenge is how many moving parts are involved, hiring, training, sales skills, marketing, organization, there are countless directions this could go. On top of that, our listeners range from solo practitioners with a couple hygiene days to multi-provider practices, so the specific plan looks different for everyone. What I want to focus on instead are the universal metrics, the ones we'd apply regardless of the specific situation, the same numbers we'd use with any client considering an associate.
Let's start with the first thing I'd look at if you told me you wanted to add an associate: your active patient count. I could look at how busy your schedule feels, but that's unreliable, you might just be inefficiently scheduled, or temporarily busier than usual. Add an associate on that basis without real underlying growth, and it tends to fade quickly.
What counts as active is genuinely arbitrary industry-wide. The commonly used definition is anyone seen within the last 18 to 24 months, 24 being more standard. But that's really a practice-sale convention, not a meaningful measure of actual engagement. A better approach: pull your total chart count from your software, then look specifically at how many of those patients currently have a next appointment scheduled. That's your real active number, genuine, current engagement, not a broad historical window.
As a benchmark, a practice needs roughly 800 to 1,200 active patients per full-time GP, specifically a general practitioner, not a specialist. A stable, healthy practice should maintain one doctor day for every hygiene day, or at most one doctor day for every 1.5 hygiene days. Push much beyond that ratio, say two or three full-time hygienists per solo doctor, and you start running into real trouble: not enough time to properly diagnose and present treatment when several exams stack up in the same window, and procedures constantly interrupted by having to step out for those exams.
Take the midpoint of that range, 1,000 active patients. That translates to roughly 2,000 potential recall visits a year, conservatively, since some patients recall every three or four months rather than six. Subtract a reasonable 20 percent for no-shows, leaving 1,600 visits. Spread across 50 working weeks, that's 32 recall visits a week, and at 8 patients a day, that's four full hygiene days, right at the threshold for a full-time hygienist, possibly more if you're running a strong periodontal maintenance program or seeing new patients through hygiene.
Why the wider 800 to 1,200 range rather than a single number? I'd personally lean toward the higher end, it gives you more margin for error. At 800 active patients, your front desk has to be genuinely airtight to keep that hygienist consistently booked. At 1,200, there's simply more cushion.
Why does that full-time hygienist matter so directly to growth? Because theoretically, more than half your revenue as a doctor should come from your existing patients of record. If you pull up your incomplete treatment list right now, diagnosed treatment patients haven't accepted or completed, you'll likely find several hundred thousand dollars sitting there, which is genuinely not unusual. With that 800 to 1,200 active base, a full-time hygienist, and real sales skill, converting a meaningful share of that incomplete treatment into more than half your total revenue is entirely achievable.
This is also where a lot of practices unintentionally settle into a rut, seeing the same easy, highly compliant patients over and over, since they're simple to work with, while the real incomplete treatment sits with a different, less consistently engaged group that gets increasingly neglected. So at minimum: 800 to 1,200 active patients per full-time doctor. You can double or triple this same math if you already have one or two associates and want to add another.
Let's walk through a concrete example. Say you're a solo practitioner, four days of hygiene, one hygienist, and you want to add an associate. First step: look not just at who has a next appointment, but your total charts going back a reasonable window, say five years. Say that's 4,000 charts, roughly 800 patients a year moving through the practice, with 1,000 of those currently active.
That means 3,000 charts are currently inactive. Since you're already at capacity with four hygiene days supporting those 1,000 active patients, you don't yet have the hygiene infrastructure to support an associate. I have seen the reverse work, a single hygienist supporting three doctors purely through unusually strong new patient marketing, 100 to 150 new patients a month, but that's a genuinely harder way to build a practice than growing hygiene alongside it.
Worth a brief detour here, because it matters directly to this math: dentistry handles patient retention almost backwards compared to how general business treats customer retention. In a typical practice, real money gets spent acquiring a new patient, 350 dollars for a postcard-driven patient, 422 dollars on average through Google pay-per-click, treatment gets completed, and then that patient is essentially left on autopilot, booked for a six-month recall and otherwise largely forgotten. If they miss that appointment and follow-up is minimal, which is genuinely the norm, two years can pass, and now, by the standard industry definition, that person isn't even counted as an active patient anymore. Some practices then run a chart audit and formally deactivate them entirely.
Compare that to how general businesses treat past customers. I still get regular emails from Build-A-Bear years after taking my grandson there once, they're actively working to keep me engaged as a past customer, because reaching someone who's already had a positive experience with you is consistently easier than reaching someone who has no idea who you are. There's no arbitrary two-year cutoff where a business simply gives up on a past customer. Dentistry, as an industry, does this almost backwards, and it's a significant, avoidable source of lost potential business. I've actually covered when a patient chart should genuinely be deactivated in another episode, and the honest answer is almost never, barring a couple of clear exceptions.
Back to our example: 1,000 active, 3,000 inactive. In this scenario, I'd estimate you could realistically recover around 60 percent of those inactive patients, roughly 1,800 people. Think about your own experience, has a patient ever walked back in after three, five years, mentioned it hadn't seemed that long, and clearly still considered you their dentist the whole time? That happens constantly. Much of that incomplete treatment sits specifically with this inactive group, not with your consistently compliant regulars, who tend to represent a smaller, easier slice of your overall patient base.
Here's why this matters financially: a patient who hasn't been in for a few years but already knows and trusts you is, in practical terms, almost as easy to close as a brand new patient, sometimes easier, since the relationship already exists. If acquiring 1,800 genuinely new patients through postcard marketing alone would cost roughly 630,000 dollars, recovering 1,800 existing but lapsed patients costs a small fraction of that.
Play that forward into hygiene: 1,800 recovered patients at two recalls a year is 3,600 visits annually, likely more accounting for three and four month recalls. Across 50 working weeks, that's 72 hygiene visits a week, nine full hygiene days at 8 patients a day, factoring in new patient initials and a strong periodontal program, that's realistically three additional full-time hygienists beyond the one you already have. At a one-to-one or one-to-1.5 ratio, four hygienists could reasonably support two additional doctors, not just one.
So the concrete first step here, before anything else: start a genuine, dedicated reactivation effort. We have a Reactivation Program available as a download on the episode page, a structured sequence of outreach steps and sample letters or emails you can send, whether by mail or digitally, alongside whatever patient management or contact software you're already using.
Be realistic about what this actually takes. Your front desk staff would probably love to call 3,000 inactive patients, they simply don't have the time. A text or email campaign alone won't get most of these people back either, we're all genuinely inundated with marketing messages, plenty of which land straight in a promotions folder unseen. You might recover 15 to 20 percent of that group through texts and emails alone, the low-hanging fruit, patients who slipped through recently and just needed a nudge.
The remaining roughly 80 percent generally requires actual phone calls. If your target is recovering 1,800 of 3,000 inactive patients, and a few hundred come back through digital outreach, you're still looking at calling roughly 2,500 to 2,700 people. At a realistic 50 to 100 calls a day, and 17 to 18 working days in an average month, that's genuinely more than a month's worth of work just for the first pass, and this needs to repeat at least monthly to stay effective, which often means a dedicated, full-time hire.
Weighed against the roughly 630,000 dollar equivalent cost in new patient acquisition, even a fully loaded 35,000 to 40,000 dollar annual salary for a dedicated reactivation hire, potentially with a performance incentive tied to patients actually rebooked, is a clearly strong investment. Reactivation is also a genuinely easy role to train from scratch, a scripted conversation, clear guidance on checking a patient's recall status, and some role-play practice is generally enough to get someone productive quickly, this isn't a high-skill-ceiling position the way reception often is.
Scale this same logic up for a larger practice, say 8,000 charts with 2,000 active, and you might reasonably justify two dedicated reactivation hires instead of one, same underlying math, just larger scale.
One caveat: if you're newer to practice with, say, only 800 total charts, there's genuinely no meaningful inactive pool to reactivate yet, in that case the path to 800 to 1,200 active patients per doctor runs entirely through new patient acquisition instead.
Regardless of your reactivation potential, new patients remain essential on their own. The benchmark here: 20 to 25 new patients a month per full-time doctor. If you're newer and below that 800 to 1,200 active threshold, you'll need more than that baseline to get there. If you're already at that threshold and actively reactivating patients specifically to support an associate, you'll likely need to push new patient volume up toward 50 a month to fully support that additional full-time provider.
Here's the growth math in simple terms: sustained at 20 to 25 new patients a month, a practice should be adding roughly one additional day of hygiene per year. Four hygiene days this year should reasonably become five next year, six the year after, assuming nothing else changes. That steady combination of new patient flow and attrition replacement is what keeps the practice genuinely growing rather than just treading water.
So in our original scenario, 4,000 charts, 3,000 inactive, 1,000 active, one full-time hygienist, wanting to add an associate, the plan runs on two simultaneous tracks: an aggressive reactivation effort targeting that inactive pool, and a genuine push in new patient marketing to move from 25 up toward 50 a month. Hygiene is typically the first part of the practice to visibly grow from this combined effort, moving from four days, to five, to six fairly quickly.
Once you cross into a seventh hygiene day with a single doctor, you've exceeded that healthy one-to-1.5 ratio, and that's usually where things start working against you, not enough time for the doctor to properly present treatment or move through procedures without constant interruption. At that point, practices often grow in smaller, incremental steps, bringing in a part-time associate initially to help absorb hygiene overflow, sometimes even having that associate work hygiene days directly at first, then gradually shifting into doing restorative dentistry as patient flow continues to build, eventually needing dedicated hygienists again as the associate transitions fully into treatment.
Which path makes sense really depends on how many patients you have to reactivate, how effective that reactivation effort actually is, and critically, your own sales skill, since that determines how much diagnosed treatment actually converts into scheduled production. Organization matters enormously here too, a genuinely capable office manager becomes essential once you're juggling multiple providers and growing schedules across the board.
Worth noting directly: if a practice is only doing around 300,000 dollars a year and the owner tells me the core problem is disorganization, that's usually not actually the root issue yet, more often it's sales and marketing volume that needs addressing first, since there isn't yet enough complexity to genuinely need heavy organizational structure. Organization becomes the real priority once you're managing multiple full-time providers and a genuinely complex schedule.
One major variable that can throw all of this math off entirely: heavy PPO participation. Take that same example, 4,000 total charts, 1,000 active, but say 90 percent of that combined active and inactive base, 3,600 patients, are tied to poorly reimbursing PPO plans. That fundamentally distorts the picture, since the actual revenue available to support new hires simply isn't there at those reimbursement rates, no matter how strong the raw patient numbers look.
If PPO participation is heavy, dropping some of those plans is genuinely worth factoring into your scaling plan directly. Done well, dropping a PPO typically costs a practice around 30 percent of the patients specifically in that plan, sometimes considerably less, one client recently reported losing only about 10 percent. Delta specifically tends to be a bit more complicated to exit cleanly, worth researching separately if that applies to you. But the resulting fee structure, lower write-offs and lower associated material costs, generally makes the practice meaningfully more profitable even accounting for some patient loss, and a strong, active reactivation and new patient pipeline gives you real cushion to absorb that transition while still growing overall.
If your practice carries significant PPO participation, say 80 to 90 percent, and full independence from those plans is the eventual goal, that's realistically a multi-year process, not something completed in three months. Starting now, rather than waiting for conditions to feel perfect, matters, and yes, this remains worth pursuing regardless of broader economic conditions at any given time. We offer a free Fees and Plans Analysis specifically for this, working directly with one of our practice management specialists to map out exactly how to approach it for your specific situation, link on the episode page.
So, to summarize the core metrics: 800 to 1,200 active patients per full-time doctor, 20 to 25 new patients a month per full-time doctor, and a doctor-to-hygiene-day ratio that stays between one-to-one and one-to-1.5, never exceeding that upper bound if you want sustainable, healthy growth.
I hope this helps. Give it a try, and if questions come up as you work through your own numbers, reach out anytime, through the Dental Business Rx site directly or by emailing me at jeffb@mgeonline.com. Links to the Reactivation Program, the MGE New Patient Workshop, and the Fees and Plans Analysis are all on the episode page. If you want to learn more generally, visit us online at mgeonline.com or call 800-640-1140. Have a great week, and we'll talk to you at the next episode.