Ep. 93: Top 3 Reasons Your Dental Office isn’t Making More Money
This week we bring in special guest Jeff Santone to discuss the three most common barriers to increasing practice revenues. Jeff speaks from his experience having run two highly successful offices and lecturing to, meeting with, and observing hundreds of doctors from all over the country on a monthly basis as MGE’s New Client Services Executive.
Topics:
:11 – Reason #1: Your case acceptance rate isn’t what you think it is
22:22 – Reason #2: Your fee schedule
40:17 – Reason #3: Not being a real executive of your practice
Links:
The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc
Fees & Plans Analysis – https://www.mgeonline.com/fees-and-plans
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Questions From This Episode
What's the actual definition of case acceptance, and why do most doctors misjudge their own rate?
Accepted means the patient has agreed to the treatment and made real financial arrangements, paid, prepaid, or financed, not just verbally agreed they want it. Most doctors have an inflated sense of their own case acceptance because they're counting a patient saying yes as a win, even when that patient only ends up paying for a fraction of what was actually diagnosed. The real number, treatment presented versus treatment actually produced, typically lands between 28 and 35 percent industry-wide.
What percentage of doctors think they're good at sales, and how many actually have a genuine sales problem?
Roughly 80 percent of doctors rate themselves as good or better than average at case acceptance. In practice, close to all of them, effectively the vast majority, actually have a real, measurable sales problem, they simply haven't tracked the numbers that would reveal it. Most attribute low production to something else entirely, new patient volume, patients with a low dental IQ, or the wrong kind of marketing.
Why do so many practices keep their fees too low, and how does that actually happen?
Two separate issues stack on top of each other: the practice's actual private fee schedule is set too low to begin with, often set years ago and never meaningfully adjusted, and then heavy PPO participation discounts it further. Since every insurance company requires providers to submit their private fee schedule with each claim, insurers use that submitted data in aggregate to justify keeping reimbursement rates low, so a practice that never raises its base fees is quietly reinforcing its own low reimbursement over time.
Is it true that dropping insurance plans will cost a huge share of a practice's patients?
No, in most cases the loss tops out around 30 percent, and because PPO write-offs are often 40 percent or higher, a practice can lose 30 percent of patients in a dropped plan and still collect the same or more revenue at full fee, with meaningfully lower material, lab, and labor costs. The bigger risk most practices don't calculate is how much revenue they're already losing every year by staying in-network at a steep discount.
What's the third reason practices don't make more money, beyond sales and fees?
Not functioning as the actual executive of the practice. Many doctors hire people for key roles like finance or scheduling and simply assume the work is getting done correctly, without ever verifying it, largely because clinical training doesn't include any real business or management education. When production numbers stall, doctors often respond by adding more clinical skills, like implants or ortho, rather than addressing the actual operational or sales gap, which rarely moves the needle if the underlying case acceptance problem is never fixed.
Episode Transcript
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Jeff Blumberg: When the average doctor contacts MGE, why are they actually calling? The stated reason varies, maybe they want to get out of insurance plans, maybe they want more new patients, but nine times out of ten, if you trace it back far enough, that doctor is ultimately looking to make more income, more profit.
Jeff Blumberg: When we're working with a doctor in that situation, we come at it from a specific angle: if a practice isn't making more money, it's rarely because something is missing entirely, it's usually because something specific is actively holding the practice back. So instead of just pressing the accelerator harder, we try to find out what's pressing the brakes.
Jeff Blumberg: This week, we've boiled that down to the top three reasons a practice isn't making more income and, as a result, more profit. Joining me is Jeff Santone, our expansion executive here at MGE, who's lectured to thousands of dentists across the US and Canada and owned two successful dental practices himself before joining us. Jeff talks to a couple thousand dentists a year, and this list comes directly from that pattern. My name is Jeff Blumberg, and I'm your host. Jeff, you're on and hooked up?
Jeff Santone: I am, thanks for having me.
Jeff Blumberg: So given how many doctors you talk to every year, do these reasons shift much over time, or stay pretty consistent?
Jeff Santone: The underlying issue is always the same, even if the surface details shift a bit.
Jeff Blumberg: If you had to pick just one thing to look at first, with no other context on a given practice, what would it be?
Jeff Santone: The first thing we look at is case acceptance, sales.
Jeff Blumberg: And when you bring that up with someone, do most people assume that's not actually their problem?
Jeff Santone: Until it's explained to them, yes. Most doctors believe they're pretty good at case acceptance. They don't love the word sales, but they've developed a fairly loose definition of case acceptance, mostly along the lines of, everybody wants it. So a patient says they need eight crowns, and I tell them, that sounds great, doctor, I want to do it, and that gets counted as an accepted case, even though nothing's been paid yet.
Jeff Blumberg: So they want it, allegedly.
Jeff Santone: Right, which sounds a lot nicer than saying, I don't want this at all, leave me alone. Everybody wants it until they hear the price. When I actually look at the numbers, most doctors are running somewhere between a 28 and 35 percent real case acceptance rate.
Jeff Blumberg: Meaning out of total treatment diagnosed.
Jeff Santone: Right, for the doctors savvy enough to actually pull that data from their software or connected analytics platforms. I talked to a fairly large practice last year, doing 5 million dollars a year across a few locations, genuinely impressive numbers. I asked him directly what he left on the table last year. Zero hesitation: 10 million dollars in accepted-but-unproduced treatment.
Jeff Blumberg: Wow, and that 5 million probably includes hygiene.
Jeff Santone: Right. But the key thing is, he knew that number cold. Most doctors have no idea, and honestly, the software systems share some of the blame, a lot of practice management systems just aren't built to surface that report cleanly. Even giving people the benefit of the doubt, and you know this from teaching our Communication and Sales Seminars, if a doctor were genuinely good at case acceptance, paid in full, 50 percent would already be a solid number. So if I diagnose 300,000 dollars this month and 150,000 gets accepted and actually paid, financed, or prepaid, that's a strong month, and most doctors aren't hitting that.
Jeff Santone: And to be clear on our definition of accepted, the patient has agreed to the treatment and made real financial arrangements, paid, prepaid, or financed. It's not just, yeah, I want that. What we still run into constantly is a patient needing eight crowns, asking what insurance covers, hearing it covers two this year, and accepting just those two, with the other six left indefinitely undecided.
Jeff Santone: So even a practice that says, we did 1.2 million last year, assuming a generous 50 percent case acceptance rate, that's still 1.2 million left on the table, low-hanging fruit they're completely unaware of because they've never tracked the metric. The quick, rough method I recommend to everyone: pull total dollar value of treatment presented for a given period, and total dollar value actually produced in that same period. Compare the two, that's your baseline case acceptance rate.
Jeff Blumberg: So I diagnosed this much in April, and produced this much in April.
Jeff Santone: Exactly. What's interesting too is a lot of doctors have a vague sense of the dollar value sitting on their incomplete treatment list, but that number's often been accumulating for years, it doesn't actually tell you how you're doing right now.
Jeff Blumberg: That connects to something I was just discussing with a client, they bought an office here in Florida, and the associate working there wasn't trained to sell, the office manager only somewhat trained. This practice was doing 50 to 60 thousand dollars a month when they bought it. As of mid-June this year, they're already at 140,000 dollars for the month.
Jeff Santone: Wow.
Jeff Blumberg: And it's not that the doctor suddenly became some incredible closer, they simply started telling patients what they actually needed. The prior office was fully insurance-driven, only doing what plans covered, and it still has some PPOs in the mix even now, yet they're already at 140,000. It really can make that dramatic a difference.
Jeff Blumberg: Something else worth asking, since Sabri and I touched on this in a recent episode: are you still running into doctors who withhold part of a treatment plan on purpose? A patient needs scaling and root planing, five crowns, and some fillings, and the office only mentions the scaling and root planing up front, saving the rest for a later visit.
Jeff Santone: Genuinely more common than I expected too, I thought that had mostly died out. Usually the reasoning is not wanting to overwhelm a new patient right away, or wanting them to have a good first experience before layering on more. I don't hear it much from doctors twenty years into practice, they've settled into a more direct take it or leave it approach. It's more common with newer doctors, often out of fear of appearing to recommend unnecessary treatment.
Jeff Blumberg: But if it's not actually unnecessary, and the doctor is the one qualified to make that call, what makes it unnecessary is only telling the patient part of what they need. The moment a patient hears part of the picture and declines part of it, the rest doesn't become unnecessary, it's just declined, and usually that's simply because of the cost, not because it wasn't warranted.
Jeff Santone: Exactly, and the number one root cause we see in the sales conversation generally is a mismatch in expectations. A patient walks in expecting a routine cleaning, and suddenly they're being asked to make a 2,000 dollar decision in under seven minutes, for something that isn't currently causing pain, that they didn't know about seven minutes earlier, with 2,000 dollars they don't have readily available. It's not surprising that a large share of patients walk out still thinking about it, it's fundamentally a time and preparation issue.
Jeff Blumberg: Which is exactly where communication skill matters, understanding the patient's starting expectation and, if needed, gently foreshadowing that there may be an issue during the exam itself, rather than dropping it on them all at once. That's part of why you see reviews like, my old dentist never mentioned any of this, so I went back to them.
Jeff Santone: Right, without rehashing everything from prior episodes, the sequence really is: diagnose, explain the diagnosis clearly, and only do that if you actually have enough time to close the case properly, since you can't do it justice in five minutes. Then state the fee directly, ideally with your treatment coordinator present. Most people, hearing a 10,000 dollar fee, will react with something like, wow, that's a lot, and if you respond with genuine understanding and ask how they'd normally handle something like that, you start actually getting somewhere.
Jeff Santone: But most doctors don't do that. What I typically see, especially with newer or prospective clients, is that the moment a patient reacts negatively to a fee, the doctor's instinct is to argue against the reaction rather than actually listen to it. One thing we teach heavily at MGE, and it's genuinely difficult to practice consistently, is listening with the actual intent to understand what someone is saying, rather than immediately explaining why their concern is misguided.
Jeff Santone: If a patient says it's a lot of money, and you respond by listing every negative consequence of not proceeding, you're not actually addressing what they said. If you simply acknowledge, yeah, it is a lot of money, that alone changes the conversation. Sabri made a great point on this once: if a fee conversation turns into an extended back and forth purely about money, that's usually not actually about the money anymore.
Jeff Santone: A lot of prospective clients are genuinely afraid of that scenario, ending up in a prolonged, tense money conversation in the operatory. But if it's escalating that badly, the real issue usually isn't the fee at all. At that point, the better move is to just stop and ask directly: do you want this treatment plan? Because if the honest answer is no or not really, of course there's going to be resistance around the cost, nobody argues hard about paying for something they actually want.
Jeff Santone: When people genuinely want something, they generally find a way to make it work. There are certainly cases where someone truly cannot pay under any arrangement, but that group is much smaller than most doctors assume. In our free seminars, when we bring up the idea of doctors actually discussing fees directly, the number one objection is almost always, I don't have time for that.
Jeff Santone: And my response is usually something like, do you have time to go out of business? If you haven't paid yourself a real salary in a year, this needs to become a priority, block real time for it in the schedule. If you genuinely don't have time to close a case properly in the moment, that's fine, but the rule we teach every client is simple: if you don't have time to close the case, don't start presenting it, bring the patient back instead, even though that's not ideal either.
Jeff Santone: And ultimately, not tracking any of this is probably the single biggest missed opportunity. It's genuinely in a doctor's own interest to keep something outside the practice management software, since that system often can't be trusted to report this cleanly, a simple spreadsheet tracking every treatment plan presented and its dollar value, reviewed monthly against what was actually produced, to calculate a real case acceptance percentage.
Jeff Santone: I did exactly this once with a doctor who came to a free seminar, genuinely confident, borderline cocky, insisting every patient accepted his treatment plans. I liked him for it, honestly. I gave him a simple tracking spreadsheet and told him we'd review it together in a month. He filled it out diligently, this was a comprehensive practice doing specialty work too, implants, bone grafts, real high-ticket items. When we met again, I asked if he'd totaled it. He hadn't, on purpose, he didn't want to know.
Jeff Santone: So I did the math for him: he'd presented 224,000 dollars worth of dentistry that month. Genuinely great number. But he'd only actually produced about 70,000 of it. Factoring in hygiene, he was probably around 100,000 dollars a month total, doing fine on the surface, feeling good about it, but he'd left somewhere around 140,000 to 150,000 dollars on the table.
Jeff Santone: What people also miss is that presenting eight crowns properly takes essentially the same amount of time as presenting and closing two. There's no meaningful time penalty to presenting the full plan versus a partial one, that idea that fully presenting treatment eats up significantly more time is basically a myth. And the time doctors think they don't have is often illusory too, since a lot of that schedule ends up filled with cancellations, no-shows, or single-unit procedures when it could have been quadrant dentistry instead.
Jeff Santone: So when a doctor tells me they're not making enough, step one is always: are you actually tracking this metric, and if not, what's the plan to start? I tell every doctor directly, once you buy the practice, you're a business owner as much as you are a dentist. If you can't state your case acceptance rate for the last month, six months, and year to a precise percentage, you don't actually know how you're doing on this, and the number exists whether you calculate it or not, so you're better off knowing it.
Jeff Blumberg: From a marketing angle, this is genuinely tricky, since if you had to estimate, out of a hundred doctors, what share believe they're already good at case acceptance?
Jeff Santone: By their own self-assessment, I'd say 80 percent or higher rate themselves as good or above average at it.
Jeff Blumberg: And out of those hundred, how many actually have a real, measurable sales problem, even if you have to estimate?
Jeff Santone: Honestly, in my time doing this full time, I'd say close to all of them, the overwhelming majority, have a real sales problem they simply haven't recognized yet. About 20 percent are aware they have a sales issue. The other 80 percent, the majority of them also have one, they just attribute the shortfall to something else entirely, new patient volume, patients with a supposedly low dental IQ, marketing, anything but the actual conversation happening in the operatory.
Jeff Blumberg: Which makes this genuinely difficult to market around, since you're essentially telling someone they have a problem they're firmly convinced they don't have. It's a similar dynamic to a patient whose last dentist told them everything was fine, they don't want to hear otherwise from someone new, and they assume there's an angle.
Jeff Santone: Exactly that dynamic. And look, the intentions are almost always good. I've talked to brand new practices getting one new patient a month who are convinced what they really need is a 200,000 dollar piece of equipment to turn things around, when the actual problem is new patient volume entirely unrelated to equipment.
Jeff Blumberg: So folks, if you're listening and you're not currently an MGE client, this isn't meant as arrogance, but there's a very strong chance, close to certain, based on what Jeff's describing, that you have a sales problem contributing directly to whatever income or profit gap you're feeling. And here's the part that doesn't get talked about enough: this isn't purely a business issue. If a patient needs treatment to genuinely improve their health, and the doctor doesn't communicate it in a way that leads them to accept it, that patient's health suffers as a direct result. That's worth sitting with.
Jeff Blumberg: So, reason one: sales. If anyone wants direct help with this, the MGE Communication and Sales Seminars are exactly built for it, link on the episode page, and you'd likely end up working with Jeff or one of his team directly.
Jeff Santone: Happy to help however's useful.
Jeff Blumberg: What's reason number two?
Jeff Santone: Reason two: fees are too low. Two separate pieces feed into this. First, the base private fee schedule itself is often set too low. Second, heavy participation across multiple insurance plans discounts that already-low fee even further.
Jeff Blumberg: Let's start with the base fee schedule itself.
Jeff Santone: I recently bought the developer version of the Wasserman Guide, which I'd recommend generally, it lets you export your fee schedule as a spreadsheet rather than manually checking each code, and it also flags CDT codes that are outdated or replaced, genuinely useful, just know what you're buying since the developer version costs more but is far more functional.
Jeff Santone: I used it recently analyzing fees for a client's newly purchased practice here in Florida, alongside their existing practice. The new practice's fees weren't even registering on the percentile chart, well below the 40th percentile, which is typically the low end of that scale. And their existing, genuinely successful practice wasn't much better, nowhere near the 60th or 70th percentile we typically recommend.
Jeff Blumberg: Worth noting for our listeners in Canada and elsewhere, fee structures and guidance vary by region, in Canada I believe there's a suggested fee framework through provincial dental colleges, worth checking with your local society directly since I haven't dug deeply into that specific structure.
Jeff Santone: Right, but the broader pattern holds: a lot of doctors genuinely have no clear sense of what they should be charging. Fees get set once, early on, loosely adjusted for inflation over the years, and end up drifting well below market regardless. This is exactly why our Fees and Plans Analysis has become so popular, it looks at current fees against real market data and lays out a path out of low-performing PPO participation.
Jeff Blumberg: And you're pulling this from the Wasserman data directly by zip code now.
Jeff Santone: Right, and up until fairly recently, most practices I looked at were well below the 40th percentile. Which makes sense once you understand the psychology behind it. A doctor thinks, why would I raise my fee to what you're suggesting for this crown, if 80 percent of my patients are in-network anyway? So a well-off patient walks in, flashes their insurance card, and gets the crown at the discounted rate, while a single parent paying out of pocket gets charged full price. It can feel backwards, like the person with fewer resources is subsidizing the person with more, similar to how hospital billing often works. I understand the discomfort there.
Jeff Santone: But the reality is, if you're participating in these plans, you're playing by their rules either way. And here's the part that really compounds it: every insurance company requires you to submit your actual private fee schedule with every claim, not your contracted rate. If your submitted fees are already low, or never rise, insurers use that aggregate submitted data to justify keeping reimbursement rates flat or low across the board. When I first became an MGE client myself, our fees were well below market. I raised a surgical extraction fee from around 200 dollars to 330, and Delta actually reached out asking why we'd suddenly raised fees after years of static submissions, not that they intended to raise our reimbursement regardless.
Jeff Santone: But that data gets used in aggregate to set the baseline for everyone in that zip code. If your actual full fee reflects the 70th percentile instead of the 40th, insurers eventually have to account for that shift too, or risk losing providers entirely by falling too far out of a competitive range.
Jeff Santone: It's funny, when I ask doctors which insurance is their worst, a lot say MetLife. But when I check what they're actually getting reimbursed out of network with MetLife for a standard new patient visit, cleaning, exam, X-rays, it's often close to double what they assumed. MetLife has a public site, feelookup.com, where you can check estimated regional fees and reimbursement percentages by procedure code and zip code.
Jeff Blumberg: Interesting, is that actually a MetLife-run site?
Jeff Santone: As far as I can tell, yes. I checked it against the Wasserman data for my own zip code out of curiosity, standard prophy, exam, four bitewings, and MetLife's own listed full-fee estimate for a prophy came out to around 99 to 105 dollars, landing right around the 40th percentile, while Wasserman's actual full-fee data for that same area showed closer to 110 dollars. So even their own published estimates skew toward the lower end.
Jeff Santone: The broader point is, the moral hesitation a lot of doctors feel about raising fees is largely unfounded. The most common concern I hear is, well, if I raise my fee, what about the single parent who can't afford it? And my answer is always, you can discount your own private fee on a case-by-case basis, that's entirely within your control, your PPO contract already allows you to discount your fee for insurance purposes, there's no reason you can't extend similar flexibility on your own terms for a specific patient.
Jeff Santone: There's also a lot of misinformation floating around about what triggers an audit. Some doctors believe every single chart is at risk, when in most cases it's specifically your in-network patients tied to that particular insurer who could be reviewed. Certain states, California in particular, have additional managed care oversight, and there's ongoing litigation involving the California Dental Association and Delta specifically over fee practices, worth looking up directly on the CDA's site if you want the details, though that's not something we track closely since our focus with clients now is mainly helping them exit these plans altogether.
Jeff Blumberg: So what would you actually recommend here?
Jeff Santone: Get the Wasserman Guide, the developer version specifically, work toward exiting PPO participation, and start with a Fees and Plans Analysis, which we offer completely free with zero obligation, link on the episode page. If the goal is a fully fee-for-service practice, there is some investment involved, learning to sell effectively, learning to market, but it's genuinely not cost-prohibitive relative to what's typically being left on the table.
Jeff Santone: I did one of these recently with a doctor who had excellent records. We ran her numbers through our calculator, and it landed within about 200 dollars of her actual reported production and collections, genuinely tight. And what I consistently find is that doctors aren't uninformed, they're quite sharp, most already suspect they're being underpaid, they just haven't wanted to fully quantify it. I call it Schrodinger's fee schedule, if you don't actually look, you don't have to know how much you're leaving behind.
Jeff Santone: With this particular doctor, once we'd gone through everything, I asked directly why she hadn't already dropped some of these plans. Her answer was simply not wanting to lose those patients, which is a completely understandable concern. But that's exactly the piece that's usually unknown and overestimated. The average expected loss when dropping a plan tops out around 30 percent, Delta being something of a special case, and there are ways to manage even that.
Jeff Santone: My rough rule of thumb for gauging acceptable loss on a given plan: look at your discount rate on that plan. If you're writing off 50 percent, you could lose half your patients in that plan and still collect the same total revenue, with meaningfully lower material and labor costs on top of it. In her case specifically, we modeled it out: if she lost every single patient in a fee-for-service transition, she'd need 27 new patients to break even, but losing all of them was highly unlikely. Since her discount rate was over 40 percent, even a 30 percent loss would leave her ahead, not even.
Jeff Santone: People tend not to think it through this way. If you have a thousand patients in a given plan and lose 300 of them, which is roughly where these numbers tend to cap out, that sounds like a lot on its face. But when we run that through our calculator, accounting for how many new patients would be needed to offset a 30, 40, or even 50 percent loss, the answer is very often none, you'd still net the same or more revenue, while doing meaningfully less work, less lab cost, less supply cost, less labor, especially if that's paired with an active new patient campaign targeting fee-for-service patients specifically.
Jeff Blumberg: Didn't you mention recently running into someone who'd been quoted a huge number just to get help with this?
Jeff Santone: Right, a doctor was quoted 90,000 dollars by another firm just to analyze their fees and help them exit insurance participation. When I asked him what exactly that 90,000 dollars covered, he genuinely didn't know, some graphs, some presentation materials, nothing resembling actual execution work like drafting the exit letters themselves. He was a pretty blunt guy, which I appreciated, and he pushed back on me a bit even after I told him honestly I didn't think it was worth anywhere near that price.
Jeff Blumberg: What size practice was this?
Jeff Santone: North of 3 million dollars a year, writing off around 1.2 million annually. So from a pure return standpoint, recovering even a fraction of that 1.2 million could arguably justify a real investment, I understand the appeal from that angle, and I don't fault another company for pricing based on practice size, that's a legitimate business model choice. It was just eye-opening to hear the number.
Jeff Blumberg: So to summarize this section: talk to us directly, get the free Fees and Plans Analysis, link on the episode page, no cost, no obligation. If the goal is genuinely moving to full fee-for-service, expect some investment in learning to sell and market effectively, but it's modest relative to what's typically being left behind, especially once you factor in also closing that separate case acceptance gap on top of it.
Jeff Blumberg: So, reason one was sales, reason two was fees, whether that's the base schedule or PPO discounting. What's reason three?
Jeff Santone: Reason three: not actually functioning as the executive of the practice.
Jeff Blumberg: What does that look like in practice?
Jeff Santone: It shows up as a disconnect between hiring someone for a role and actually verifying the work is being done well. As an executive, if I delegate a task to someone, part of my job is confirming it's actually happening correctly, not just assuming it is because I hired someone competent-sounding.
Jeff Blumberg: So I've hired someone to handle finances or scheduling, and I genuinely don't know whether it's being done well, I'm just hoping.
Jeff Santone: Exactly, and sometimes that works out by luck, sometimes it doesn't. This is honestly one of the bigger issues in the associate-to-owner transition. As an associate, even briefly, you're working inside someone else's operational system, whatever it is, and you tend to inherit that same approach once you own your own practice, since you went into dentistry wanting to be a dentist, not necessarily to manage people.
Jeff Santone: So staff keep doing things the way they've always done them, and the new owner doesn't have the frame of reference to actually catch and correct issues. It's a bit like me trying to evaluate a dentist's clinical work, I wouldn't know a bad prep from a good one just by looking, someone else would need to point it out to me.
Jeff Santone: I sometimes push back a bit with doctors on this, in a friendly way. Someone will say, I've invested 600,000 dollars in dental school and a million dollars buying this practice, and I'll ask how much formal business training they've had. Usually, almost none. And that's really the disconnect: clinical dentistry is the part they trained extensively for, and it comes relatively easily to them as a result. Getting the phone to ring, having it answered professionally, converting that into a scheduled visit, getting that patient to actually show up, and then presenting a 5,000 dollar treatment plan effectively, that's the genuinely hard part of running a dental business.
Jeff Blumberg: And then getting your staff actually aligned and supporting that whole process.
Jeff Santone: Exactly, everything after the patient's already in the chair with their mouth open ready for treatment is, comparatively, the easy part. If a doctor isn't actively managing that side of the business, sometimes because they genuinely don't want to know, sometimes because there's no time carved out for it, the instinct tends to be retreating into what they do know well: clinical skill. Numbers are down, so the response is learning implants, or ortho, or endo, chasing a new clinical capability to drive production.
Jeff Santone: There's nothing inherently wrong with expanding clinical skills, but if the underlying sales ability isn't there, added clinical capability alone rarely closes the gap. These are also genuinely perishable skills, if you're only placing three to ten implants a year while still struggling to close a routine crown case, you're unlikely to build the confidence or volume needed to make that investment pay off. If you can't sell a crown consistently, selling an implant, an inherently bigger financial decision for the patient, is going to be even harder.
Jeff Santone: So stepping into the executive role and actually looking closely at whatever part of the practice genuinely needs attention is uncomfortable, understandably, nobody goes into dental ownership expecting to spend significant hours on pure business management. But when I ask doctors how many days a week they work clinically versus how many additional days go toward admin, catching up on notes, ordering supplies, and so on, it's common to hear four clinical days plus two more admin days on top.
Jeff Santone: Our clients typically reduce that overall time commitment meaningfully, once real systems are in place and the right people are genuinely accountable for specific outcomes, a doctor only needs to check in on what actually requires their attention, not everything.
Jeff Santone: Reason three tends to intertwine with the first two, it's a bit of a chicken and egg question. Is the lack of executive oversight causing the sales problem, or is the sales and fee problem consuming all the doctor's time and bandwidth, leaving none left to actually run the business? Most of our training here is ultimately designed to help doctors become the actual business owner they intended to be when they bought or built the practice, not just a very skilled employee inside their own building.
Jeff Santone: When we hand day-to-day operations entirely to other people without ever verifying outcomes ourselves, we've effectively become an employee in our own business without fully realizing it. The doctors who show up ready for this kind of training tend to have already tried the other route, more clinical courses, more CE, and noticed their numbers barely moved. They're ready to invest real effort into the marketing and sales side specifically, with the explicit goal of eventually not having to personally handle every piece of it.
Jeff Santone: Ultimately, there are really only two ways this goes long term. Either you stay fully embedded in clinical work indefinitely, which has a natural ceiling, or you deliberately develop into something closer to a CEO role, where other people handle diagnosis and day-to-day execution under your oversight, and you step in personally only where it genuinely matters. You still need to know how to jump back into hands-on work when required, but the goal is genuine leverage, not doing everything yourself indefinitely.
Jeff Blumberg: That makes sense. And it's a tough thing to accept, since nobody wants to feel like they need to go back to school for a second profession on top of dentistry.
Jeff Santone: Right, but ultimately, you've already invested enormous time, money, and effort into this profession, you deserve to actually enjoy running it, not just tolerate it. There's a right way to build this and countless ways to get it wrong, but getting it right is absolutely learnable.
Jeff Blumberg: This was genuinely great, Jeff, thank you for coming on. Anything else you'd want to add before we wrap?
Jeff Santone: Just that if anyone listening isn't sure what's going on in their own numbers, give us a call, that Fees and Plans Analysis link is on the episode page, and we genuinely enjoy doing them, they're eye-opening for us too sometimes, in both directions, we've seen some encouraging trends lately, more doctors actually raising their fees, which is genuinely good to see.
Jeff Blumberg: All right folks, that's everything for this week. If you have questions about MGE, find us online at mgeonline.com or call 800-640-1140. Links are on the episode webpage as always, we'll see you at next week's episode. Have a great week.