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INSIDE THIS ISSUE
Sleepless Nights Worrying About How to Grow Your Dental Practice? It’s Impossible to Know Where You’re Going Without First Knowing Your Starting Point Marketing That Attracts the Dentist You Want to Be Focusing on 3 Levers for Growth The Department That Determines Your Profit The Plan-Do-Check-Act Approach to Patient Volume Knowledge Is Practice. Execution Wins Games
(703) 298-1690 · DentalGrowthAndExit.com
Year 1, Issue 3
Sleepless Nights Worrying About How to Grow Your Dental Practice?
If you answered that question in the affirmative, you’re in good company. Countless practice owners wrestle with the same thoughts at 2 a.m. Why is this so hard? What am I missing? Why does it feel like everyone else has it figured out? Let me share my story. It’s the reason this newsletter exists. I’ve lived the experience of pushing the heavy rock of an underperforming practice up a steep hill, wondering if it would ever crest the top. It’s exhausting work when you’re not sure which lever to pull, which expense to cut, which hire to make, or which opportunity to pass on. I started my journey in dentistry in 1980 (which officially makes me prehistoric). I’m not a dentist. I’m an MBA by training and a health care executive by vocation. I always aspired to business ownership, and I found my way into dentistry after working on a joint project with the University of Maryland Dental School and Dr. Tom Snyder, who was faculty at the time. Eventually, I formed a partnership with a dentist. We borrowed $300,000 and invested additional capital of
our own. In today’s dollars, that was just over $1.2 million on the line. I still break a little sweat thinking about it. At the time, the trend was retail-based practices, extended hours, and bringing specialty services under one roof. It sounded progressive. It sounded smart. So, we got on that bus and drove it hard. We built a 3,000-square-foot, six-operatory Adec- equipped office in a strip shopping center. We staffed it to run six days a week with extended hours. Everything looked impressive on paper. There was just one small detail. We had exactly zero patients when we opened the doors. My responsibility was everything except clinical care. Hiring. Payroll. Marketing. Vendor negotiations. Banking relationships. Systems. Strategy. Cash flow. In short, everything that determines whether a practice lives or dies. And I wasn’t very good at it. I didn’t know what I didn’t know, and that ignorance was expensive.
My Monthly Rant
The Diminishing Case for Continued PPO Participation This Way, Wicked Winds May Blow Cracking the Code of the Mysterious EBITDA
The $10,000 Appointment
Continued on Page 2 ...
How Can the DG&E Team Help You? Why More Leads Isn’t the Answer The Hygiene Shortage Is Here. Now What? The Theory of Small Hinges … and How It Applies to Your Practice
Stan Kinder has over four decades of experience serving the dental profession in a variety of roles. He has helped dentists with every type of practice transition, traditional brokered transactions, consulting on associate-to-partner buy-in/buy-out agreements, and, for more than 15 years, as a senior mergers and acquisition executive with several different DSOs. Along the way, he consulted on practice management and growth. He is a one-of-a-kind resource for the practice owner seeking the optimal exit. Parthiv Shah is a growth strategist, entrepreneur, and bestselling author who helps professional practices scale with clarity, systems, and purpose. He is the holder of two U.S. patents, reflecting his long-standing commitment to innovation and practical problem-solving. Parthiv is the author of two bestselling business books and the recently released “ Dental Growth Machine,” published by EDRA, which outlines a proven framework for building sustainable, scalable dental practices. Through his writing, consulting, and advisory work, Parthiv is known for blending strategic insight with real-world execution to help leaders grow smarter, without burning out.
Buy Revenue, Don’t Chase It.
Stan Kinder - (703) 298-1690 · 1
... continued from Cover
We bled red ink for 18 months before reaching profitability. Every month was a negotiation with reality. Would collections cover payroll? Could we stretch vendor payments another 30 days? Do we invest in marketing now or conserve cash and risk slower growth? Those are not theoretical questions. They’re decisions that age you. I was eating antacids like they were M&M’S. I would lie awake staring at the ceiling, calculating in my head who would get paid that week: staff, lab, supply house, landlord, or the bank. When you’re choosing between obligations, you’re not operating from strength. The stress bled into every part of my life. I was still working full time outside the practice to support my family, essentially working two jobs while trying to keep a startup afloat. That pace isn’t sustainable. It cost me my first marriage. I ended up sleeping on a mattress on the floor of a friend’s house and waking up on Christmas morning without my children. That’s not a memory I cherish. I share that not for sympathy, but because struggle leaves a mark. And it also teaches lessons. We did survive. We stabilized. We grew to three locations. The business continues to operate today. And on the personal side, I remarried and recently celebrated my 31st anniversary. There can be a second chapter. Over the decades that followed, I stayed deeply involved in the profession. I consulted on practice management and operations. I helped owners design and implement buy/sell agreements to protect their futures. I brokered traditional practice sales. And for more than 15 years, I served as a senior executive in mergers and acquisitions for multiple DSOs, participating directly and indirectly in transactions representing hundreds of millions of dollars in enterprise value.
Even Google Maps can’t build a route to your destination without first identifying your current location. The same principle applies to your journey as a dental practice owner. You can’t define what it will take to move from here to there until you clearly define the “here.” That’s precisely why I urge you to obtain a professional practice valuation and an operational assessment as the first step in understanding how your current value compares to your target value at exit — whether that exit happens next month, next year, or 10 years from now. If your current value falls short of your target, you need to understand which levers will close that gap. It’s Impossible to Know Where You’re Going Without First Knowing Your Starting Point
That vantage point changes you. You begin to see patterns:
Mark
Why some practices grow predictably and others stall.
Why some owners exit with life-changing wealth while others leave money on the table. Why systems, structure, and strategy matter more than hope and hard work alone. I can’t help but wish I’d known then what I know now. It would have saved money. It would have saved stress. It might have saved a marriage.
Which brings us full circle.
I wouldn’t wish the pain of learning the hard way on any practice owner. Yes, growth requires effort. Yes, business ownership carries risk. But unnecessary suffering caused by avoidable mistakes is something else entirely.
This newsletter exists to shorten that learning curve.
It’s meant to chart a pathway to practice success, drawing on lessons accumulated from my own journey and watching hundreds of others navigate theirs. Think of it as a road map built from real-world experience, not theory. I’ve lived your challenge. My hope is that what you read here will help you grow with fewer sleepless nights, clearer decisions, and a stronger outcome when the time comes to transition your practice.
If it does that, then the scar tissue was not wasted.
2 · DentalGrowthAndExit.com
Here’s where many dentists go wrong:
Perhaps the practice depends too heavily on you, making it less transferable.
They operate under the comforting — but dangerous — assumption that the value of their practice will somehow “take care of itself.” They stay busy. They keep the schedule full. They work hard. And they assume that when the day comes to sell, the marketplace will reward them accordingly. That assumption has cost dentists hundreds of thousands of dollars — sometimes more — than almost any other mistake in the profession. A dental practice isn’t valued based on effort, longevity, or how many years you’ve “paid your dues.” It’s valued based on measurable, transferable attributes: sustainable profitability, documented systems, patient retention, hygiene performance, team stability, payer mix, and operational efficiency.
Perhaps overhead has crept up to 70% without anyone noticing the gradual erosion of margin.
Each of these is a lever. And levers, when pulled correctly, move very large doors.
The advantage of conducting this analysis early, years before a potential sale, is that incremental improvements compound. A modest increase in EBITDA today can translate into a dramatically higher enterprise value when multiplied by a DSO valuation multiple. An additional $100,000 in sustainable EBITDA, multiplied by five or six, becomes real money at the closing table. The earlier you understand your starting point, the more time you have to influence the outcome. Dentists appreciate precision. Measurements matter. Diagnostics matter. Treatment planning matters. The same discipline should apply to the business you’ve spent decades building. Because if you do not know where you are starting from, you are not planning your exit.
Until those factors are measured objectively, you’re guessing.
Think of a valuation not as a transaction event, but as a diagnostic tool, much like the comprehensive exam you perform for a new patient. You would never propose treatment without radiographs, periodontal probing, and a full clinical evaluation. But many dentists attempt to plan their financial future without examining the health of the very asset that will fund it. A proper valuation tells you what your practice is worth today, and an operational assessment tells you why. Together, those two data points give you clarity, which allows you to act deliberately rather than reactively. Perhaps your hygiene department is underperforming relative to industry benchmarks.
You’re guessing … hoping. And as I’ve said before, hope is not a strategy.
Perhaps collections lag production by several percentage points.
keting That Attracts the Dentist You Want to Be
You cannot build a calm, high-value practice while marketing like a discount store. The dentist you want to become already has a patient base that matches it. To get there, you have to start speaking to the patient you actually want, not just talking about yourself. Talk about the problems you solve, the experience you create, and the kind of care your ideal patient values. Some people will lose interest. Good. The filter is doing its job. The goal of marketing is not to be popular, but to be aligned with your ideal prospects. When your marketing matches the dentist you want to be, the right patients start finding you, and the wrong ones stop wasting your time.
Most dental marketing is built on fear. Fear of empty chairs. Fear of competition. Fear of not being liked. So, practices try to appeal to everyone. And when you try to attract everyone, you end up attracting the people who care the least about what you actually do. Your brand is not supposed to make everyone comfortable. It’s supposed to make the right people feel understood, and the wrong people feel disinterested. That’s what a real brand does: It filters. The biggest mistake dentists make is treating marketing as bait rather than a signal. Bait is designed to catch anything. A signal is designed for the right audience to hear. If your marketing screams discounts, insurance logos, and “we take everything,” you are signaling to price-first patients. You will get exactly what you ask for. And once those patients fill your schedule, you’ll wonder why dentistry feels like retail. If your marketing talks about quality, long-term care, trust, experience, and outcomes, you signal
to people who think differently about health. They may not be the cheapest patients, but they are the best ones. Your brand is not just your logo. It’s the promise your practice makes before anyone ever meets you. It shows up in how your website talks, what your ads emphasize, what your team says first on the phone, how you explain fees, and what you tolerate inside your practice. Every one of those moments tells patients whether they belong.
Stan Kinder - (703) 298-1690 · 3
FOCUSING ON 3 LEVERS FOR GROWTH
If you’ve followed Dan Kennedy for more than five minutes, you know he has no patience for complexity masquerading as sophistication. Strip away the jargon, the consultants, and the tactic-of-the-month distractions, and he’ll tell you there are only three ways to grow a business: 1. Increase the number of customers (patients). 2. Increase the average transaction value. 3. Increase the frequency of purchase.
patient introductions. Run structured reactivation campaigns for overdue hygiene patients. Position yourself as a community authority through lectures, niche expertise, or condition-specific marketing. Most practices are sitting on a goldmine of dormant patients. A disciplined reactivation sequence — email, text, voicemail drop, and even direct mail — can produce dozens of appointments without spending a dollar on external advertising. The hard truth is that if your new patient numbers are flat, it’s not the economy, insurance, or corporate dentistry. It’s the absence of a system. INCREASE THE AVERAGE PATIENT VALUE. This is where many dentists get uncomfortable. They confuse ethical case presentation with “selling.” Kennedy would laugh at that. If a patient needs dentistry and you fail to present it comprehensively and confidently, you’re not being conservative. You’re being negligent. Increasing average patient value starts with better diagnosis and better communication. Comprehensive exams. Digital photography. Intraoral scans. Financial coordinators trained to explain options without apology. Too many practices present treatment as if they are asking for permission. Instead, install structured presentation protocols: • Present full-mouth findings, not isolated problems. • Offer phased options rather than yes-or-no ultimatums. • Bundle appropriate services, such as whitening with restorative cases. • Present third-party financing as a standard tool, not a last resort. And examine your payer mix. If 80% of your production is discounted by PPOs, your average transaction value is artificially suppressed. Strategic 2.
That’s it. No pixie dust or secret algorithm.
And if you’re a dental practice owner drowning in PPO write-offs, staffing drama, and payments on the latest piece of technology, those three levers are the only ones that matter. Let’s apply them where it counts: inside your practice. INCREASE THE NUMBER OF PATIENTS. Most dentists approach new patient acquisition like hobbyists. They “try” a little SEO. They dabble in social media. They sponsor a Little League team and hope gratitude will translate into crowns. 1.
Hope is not a strategy.
If you want more patients, you must engineer their arrival. That means building a predictable lead generation system that doesn’t depend on whether your office manager remembered to post on Facebook. Start here: Who is your ideal patient? Fee-for-service families? Cosmetic- driven professionals? Implant candidates 55-plus? If you don’t define the target, your marketing will be vague, expensive, and ineffective.
A practice that targets “everyone” typically attracts price shoppers.
Next, you have to build direct-response campaigns aimed specifically at your target. Install internal referral systems that reward and recognize
4 · DentalGrowthAndExit.com
patients? Could you schedule post-op checks for larger restorative cases to reinforce care and open the door to additional treatment conversations? Frequency rises when relationships deepen. Patients who feel known and valued don’t disappear for three years and return only when something breaks.
Kennedy-style reality check: Every inactive patient is a marketing failure.
You already paid to acquire them. Letting them drift away is like setting hundred-dollar bills on fire. Here is where it gets interesting. If you increase new patients by 10%, average patient value by 15%, and visit frequency by 10%, the result is multiplicative, not additive. Small, disciplined improvements across all three levers can produce 30%– 50% revenue growth without doubling stress, adding operatories, or hiring another associate. Many dentists chase growth by expanding first: new chairs, new associates, new locations. But expansion before optimization is a rookie mistake. Maximize the economics of the patients you already have. Then, and only then, consider scaling.
fee increases, selective plan elimination, or a gradual shift toward more fee-for-service patients can dramatically increase revenue without adding a single new patient. Another overlooked lever is service expansion. Adding implants, clear aligners, sleep appliances, or sedation dentistry increases per- patient value while deepening loyalty. The patient who trusts you with an implant case is far less likely to price-shop a hygiene visit. When done properly, increasing average patient value isn’t about pushing dentistry. It’s about elevating the standard of care and ensuring patients understand the cost of inaction. INCREASE THE FREQUENCY OF VISITS. Dentistry has a built-in advantage: hygiene recall. Yet many practices treat recall as a suggestion rather than a system. If your hygiene reappointment rate is below 85%, you have a leak. Frequency increases when recall discipline is tight and measured: • Preschedule before patients leave. • Track periodontal maintenance compliance. • Run structured continuing-care campaigns for overdue patients. • Tie adjunct services to recall — adult fluoride, whitening refreshers, oral cancer screenings. 3. Think beyond the six-month checkup. Could you implement membership plans that encourage quarterly visits for high-risk
Growth is not mysterious. It is mathematical. More patients. Higher value per patient. More visits per patient.
If your practice is not growing, one or more of those levers is stuck. Identify it. Fix it. Install systems. Measure weekly. Because dentistry is not just a clinical profession. It is a business. And business growth, as Kennedy has proven for decades, follows simple rules executed with discipline.
Master the three levers, and you do not just grow. You gain control.
Stan Kinder - (703) 298-1690 · 5
The Department That Determines Your Profit Hygiene is your most reliable source of recurring revenue. It runs on pre- appointments, six-month intervals, and long-term relationships. From a business perspective, that kind of predictability is gold. You don’t have to market constantly to generate it. It’s built into the structure of the practice. And yet, in many offices, hygiene is treated like background noise. It’s assumed to be fine. It’s left alone. It’s expected to sustain itself.
And it performs accordingly, usually well below what it could.
Data from Planet DDS, the ADA Health Policy Institute, and the DentalPost Salary Survey reveal some uncomfortable realities. The average hygienist produces about $1,058 per day. Periodontal disease is the leading basis for dental malpractice litigation, but fewer than half of audited charts contain complete periodontal charting. Two-thirds of hygienists operate without written standards of care. Only about 60% of hygiene patients are scheduled within 12 months of their last preventive visit.
And perhaps most importantly, roughly 60% of doctor production originates in the hygiene chair.
That last point should give you pause.
If more than half of your restorative work is seeded in hygiene, then hygiene isn’t a support department. It’s the feeder system for your entire practice. When hygiene is strong, the whole practice feels it. When hygiene drifts, everything downstream suffers. The Most Expensive Word in Dentistry: ‘Assume’ Most dentists assume hygiene is fine. They assume periodontal diagnosis is consistent. They assume reappointment rates are solid. They assume documentation is complete.
But assumption is not management.
If only 47% of charts contain periodontal charting and perio remains the leading source of malpractice claims, that’s not a small oversight. That’s risk exposure. And if 40% of hygiene patients aren’t
When most practice owners think about increasing patient volume, they default immediately to one conclusion: We need more or better marketing. From there, they dive headfirst into the rabbit hole — new agencies, new websites, and new campaigns — often spending significant time and money before determining whether marketing was truly the constraint. That’s not to say marketing isn’t important. In many cases, it’s part of the solution. But before allocating more dollars externally, you need to step back and take a look at the big picture. We’ve talked before about building a culture of Continuous Improvement (CI) using the Plan-Do-Check- Act framework. Let’s apply this to patient volume. Plan: Understand Current Reality The Plan phase starts with an honest assessment of where you stand today. Before deciding what to change, you need to know exactly where you are and what you have. That means cataloging your current patient volume and identifying the operational factors that either support or undermine growth.
Consider the following examples: •
Answer rate of inbound phone calls (Industry data suggests approximately 35% of calls go unanswered in the average practice.) Conversion rate of new patient calls to scheduled appointments
•
• • • • •
No-show rate for initial appointments
Case acceptance rate
Quality and consistency of the patient experience Referral rate from existing patients Percentage of patients pre-appointed and maintained in recall Periodontal diagnosis and treatment compliance, resulting in higher-frequency recall
•
• •
Patient retention rate
Measurable return on external marketing efforts
Of the items above, only one directly references external marketing. But each directly impacts patient volume. Continuous Improvement forces you to evaluate the entire system rather than chase the most visible lever. The second part of the Plan phase is deciding which variables you’ll address first. Think of this as your recipe for change, a defined list of initiatives rather than scattered ideas.
6 · DentalGrowthAndExit.com
scheduled within a year, that isn’t just a scheduling issue. It’s recurring revenue walking out the door. The good news is that these problems are fixable. But they are not fixable by just hoping they correct themselves. The 3 Roles That Change Everything Michael Gerber’s framework in “The E-Myth Revisited” describes three roles in every business: the Technician, the Manager, and the Entrepreneur. The same applies to your hygiene department. Most practices only develop the Technician. The Technician focuses on clinical excellence. Instrumentation. Radiographs. Periodontal assessment. Preventive therapy. Patient education. This is the foundation, and it matters. Without clinical competence, nothing else works. But when hygienists are confined to this role alone, their impact is capped. They’re evaluated primarily on production per day. That’s limiting. The Manager role introduces structure. It means hygiene is driven by written protocols and measurable standards. One hundred percent periodontal charting on adult patients. Defined criteria for diagnosis. Clear reappointment expectations. Tracked adjunct acceptance rates. When 67% of hygienists operate without written standards of care, that’s not a hygiene issue. It’s a leadership issue. You can’t hold someone accountable to a standard that hasn’t been defined.
Manager-level hygiene reduces malpractice exposure and stabilizes recurring revenue because the leaks are plugged. Documentation improves. Diagnosis becomes consistent. Recall rates rise. That’s not motivational. It’s structural. In the Entrepreneur role, hygiene becomes a true growth engine. Hygienists spend more uninterrupted time with patients than anyone else in the practice. That time builds trust. An entrepreneurial hygienist doesn’t casually mention restorative needs; they reinforce the importance of addressing them. They don’t wait for the doctor to “sell” treatment; they prepare the patient to accept it. They identify periodontal instability early, recognize whitening candidates, notice occlusal wear, and connect systemic health conversations to appropriate diagnostics. If 60% of doctor production starts in hygiene, then hygiene influences case acceptance every day, whether intentionally or not. When this role is activated deliberately, hygiene becomes the most powerful marketing asset inside your four walls. Plug the leaks and raise the standard. Take a hard look at your numbers. What percentage of adult patients receive complete periodontal charting? What is your reappointment rate at six and 12 months? Do you have written standards of care? Is diagnosis consistent across providers?
Where you find gaps, you find opportunity. Closing those gaps increases production without adding chair time. It improves retention without increasing marketing spend. It reduces legal exposure. And it elevates patient care. That’s leverage. The Definitive Playbook If you want a comprehensive road map for optimizing hygiene, I consider Wendy Briggs, RDH, and Dr. John Meis’ book, “The Ultimate Guide to Doubling & Tripling Your Practice Production,” to be the clearest operational guide available. What sets that work apart isn’t hype. It’s systems. Defined standards. Measurable outcomes. That’s what most practices lack. Hygiene is not a side department. It’s the pulse of your practice. It drives recurring revenue, protects you legally, retains patients, and influences restorative production. When hygiene is treated casually, performance drifts. When it’s engineered intentionally across the Technician, Manager, and Entrepreneur roles, the entire practice stabilizes and grows. Look at your schedule tomorrow morning. Is your hygiene department coasting … or leading?
Do: Execute With Structure The Do phase is implementation. And this is where many initiatives fail, not from lack of ideas, but from lack of structure. Every improvement should include: • A clear timeline • A responsible party • A measurable outcome Without those elements, “we’re working on it” becomes the default status. The Do phase transforms intention into action. Check: Measure Performance At predetermined intervals, review the results: • Did your call answer rate improve? • Did conversion increase? • Did no-shows decline? • Did recall compliance rise? Measurement creates accountability. It also reveals whether the problem was diagnosis, execution, or both. Act: Adjust and Repeat If performance targets were not met, adjustments are made. Scripts are refined. Training is reinforced. Systems are modified. Then the cycle begins again. That’s why it’s called continuous improvement. Small, disciplined changes, compounded over time, produce meaningful results.
A Word of Caution This process cannot be doctor-driven alone. Your team must be involved. They often see operational friction points you do not. More importantly, involvement creates ownership. Ownership drives execution. Without team engagement, Continuous Improvement becomes another abandoned initiative. While this discussion focused on patient volume, the same methodology applies to every functional area of your practice — hygiene productivity, collections, overhead control, associate performance, and ultimately enterprise value. Two excellent resources for deeper study are: • “Creating a Culture of Continuous Improvement” by Wesley Donahue • “Operational Excellence” by Martin Weaver
Both are available through Amazon.
Continuous Improvement is not a program. It’s a mindset. And practices that embrace it rarely struggle with patient volume for long.
Stan Kinder - (703) 298-1690 · 7
MY MONTHLY RANT
Knowledge Is Practice. Execution Wins Games
I’m a baseball fan, so let’s use a baseball analogy for this one. Learning is hitting a single. Knowing is hitting for extra bases. But putting what you know into action, that’s a grand slam.
All too often, dentists get caught up in the tedium and minutiae of operating their practice. They get trapped in the belief that working harder and producing more dentistry will solve all problems. Simply put, they allocate time and energy to the wrong things. This is a consequence of acting daily with a tactical focus without the overarching umbrella of strategic focus. Thus, the reminder is to always be improving. I’m sure many of you are asking yourself, “What does he mean by strategic focus?” My answer is straightforward. It means being intentional about the end state you want to achieve in your practice for yourself, your patients, and your staff. And importantly, for your family. Paint a picture of your dream practice and ask your staff to do the same. Take inventory of where you are today, measure it against the picture you and your staff built together, and identify the deficits — all the places where your practice falls short of your ideal. If you do this, you’ll now have an agreed-upon improvement road map. Use it as a guide to help you and your staff focus your time and energy. Finally, I believe building your dream practice is less about arriving at some final destination and more about committing to the journey. No matter how much progress you make, there will always be room to improve. Thus, ABI: Always Be Improving. When you adopt a mindset of continuous improvement, you avoid the stagnation that quietly creeps into so many practices over time. Growth becomes intentional instead of accidental. Be clear about where you want your practice to go. Be honest about what isn’t working. And if something isn’t aligned with your vision, change it. Mediocrity is not imposed. Neither is excellence. The direction of your practice is largely the product of the choices you make and the standards you accept. This newsletter is a passion project for me. My goal is simple: to help you reach the outcome you want for your practice. I aim to share ideas that are practical, understandable, and implementable — concepts you can actually use, not just think about.
That’s how you win the game.
The premise is simple: No concept, framework, or strategy outlined in these pages has value without intentional implementation. It may be interesting. It may even be insightful. But without execution, it changes nothing. The operative word is intention. So, the question becomes: How do you intend to benefit from what you find here? I believe where we ultimately end up, personally and professionally, is the product of choices made moment by moment. Growth is rarely accidental. It’s chosen. In these newsletters, you’ll find relevant and potentially valuable ideas. Others you may dismiss as less applicable to your situation. That’s your prerogative. But if you’re like most people, it’s always easier to continue doing what you’ve always done. Keep the schedule full. Solve today’s problems. Postpone structural change. Why? Because change is uncomfortable. It disrupts routines. It challenges assumptions. It tests leadership, not only yours, but your team’s as well. In my experience, what separates practices that grow from those that stagnate isn’t intelligence or even opportunity. It’s leadership and commitment. It’s the difference between trying and doing. We all know “tryers,” and we all know “doers.” One group measures effort. The other measures results. The difference isn’t subtle, and neither are the outcomes. You’re the ultimate determinant of the value you extract from this newsletter. What I can assure you, without qualification, is that what you read here reflects real-world experience — mine and others who have traveled this path successfully and at scale.
So, returning to the baseball analogy:
Play to win. Make intentional choices. Lead with clarity. Commit to execution.
Do not try. Do.
Until next month.
8 · DentalGrowthAndExit.com
The Diminishing Case for Continued PPO Participation
There was a time when signing up with every PPO under the sun felt like a smart move.
They don’t wake up excited about networks.
Smart practices are leaning into this shift. They build brand equity. They invest in communication. They create membership plans and flexible payment options. They train their teams to speak confidently about value.
“More patients. Full chairs. We’ll make it up in volume.”
Sound familiar?
And the result?
Fast-forward to today, and that volume strategy looks more like a slow leak. PPOs have become dentistry’s version of quicksand. It feels stable at first. Stay too long, and you sink. The case for staying deep in PPO participation is getting weaker by the year. Reimbursement rates are flat or declining. Administrative friction keeps rising. And the only people consistently smiling are the insurance executives protecting their margins. Dentists once saw PPOs as a safety net. They filled open chair time and brought in new patients. But the truth is that most of those patients are loyal to the network, not to you. The original pitch from “Mr. PPO” was simple: Take the discount, and we’ll send you patients. That worked when fewer practices participated. Today, nearly everyone participates. When every practice accepts the same plan, no one stands out. The supposed competitive advantage disappears. And here’s something interesting. Many practices that step away from select PPOs discover that far fewer patients leave than expected. Some find that the patients who stay are more engaged, more appreciative, and more consistent. When your schedule is packed with heavily discounted patients, you’re not running a premium practice. You’re operating a discount model with high overhead.
Higher profit per patient. Less stress. Stronger loyalty.
The greatest risk isn’t leaving PPOs. The greater risk is staying in them until your margins are buried. PPOs rarely improve over time. Reimbursements tighten. Documentation demands increase. Payment timelines stretch. Audits multiply. Meanwhile, overhead rises. Morale dips. Investment capacity shrinks. You work harder and keep less. And that is not a growth strategy. It’s a fatigue strategy.
Leaving PPOs is not about flipping a switch. It is about building a bridge.
Start with your payer mix. Identify which plans produce volume but destroy profitability. Create a deliberate transition timeline. Communicate clearly with patients. Offer alternatives such as in-house membership plans, flexible payment options, and transparent explanations of your value. Then shift your positioning from “we accept your insurance” to “we provide care worth paying for.” That mindset shift alone changes everything. Every business decision moves you toward freedom or deeper into dependency. For years, PPOs sold dentists a story of safety. The modern market rewards something different: clarity, confidence, and value.
Let’s look at the math.
You discount fees by 30%–40%. Then layer in rising supply costs, payroll inflation, and the hidden time cost of claims, resubmissions, and pre- authorizations. What’s left? Margins so thin they barely justify the effort. You can’t outwork bad margins. You can’t scale an unprofitable model into a profitable one. But many dentists stay in PPOs because it feels safer than changing. Dan Kennedy would call that security-based decision-making, and it quietly kills growth. Here’s what the insurance companies don’t want emphasized: The power dynamic is shifting.
So, ask yourself: Are you running your practice, or is your PPO?
One of you is protecting profit margins. If it isn’t you, it may be time to change the script. Just do it strategically and deliberately. I would never suggest abandoning every PPO at once. But I would suggest examining whether the story you’ve been told still serves you.
Patients care about convenience. Technology. Comfort. Relationships. Experience.
Stan Kinder - (703) 298-1690 · 9
THIS WAY, WICKED WINDS MAY BLOW
About six or seven months ago, my longtime dentist, who I thought of as a friend, in a small practice, his wife and dog manning the front desk, suddenly sold to a DSO and disappeared overnight. No letter, no call, nothing. Quite a shock, actually. I have given the new corporate bumbling idiots a fair chance. Two appointments for hygiene. New X-rays because nobody has gone through and organized all the old records. The hygienist and dentist I met the first time were replaced by the second time. The whole ship appears unstable. A buyer buying not ready to buy? The second dentist showed me several brewing trouble spots on the X-rays and prescribed what should be done at the speed of the Daytona 500, earning a score of -2 on a 1–10 chairside manner scale. For some unknown reason, he apparently thinks he can just tell patients what they have to do. More importantly, in these six months and two visits, nothing was done to create trust. Nothing. No shock-and- awe package of literature, a book, a video about the company now owners of the practice or about the dentist. No “ask” to go to a website for that information and introduction. No concern call after each hygiene appointment. No thank-you note for staying with the practice. NO-thing. I have a theory that people as dumb as boulders about one thing may be that dumb about other things, too. Accordingly, I have gone looking elsewhere, for a dentist, staff, and office that I feel — important: feel — I can trust. Not eager to do that. I have better things to do with my time than find a new dentist. On the list of goals for the year, it wasn’t there. The buyer taking over this practice must be clueless. They bought me but did nothing to protect what they bought. No asset ever protects itself. Sadly, most big companies are dumb companies, and the bigger they get, the dumber they get. But, bluntly, most dentists know next to nothing about internal marketing, patient reassurance and trust-building, retention, or referrals. One of my books, “No B.S. Guide to Trust-Based Marketing,” lays out a very detailed rationale and case for selling trust first, products or services second. If you haven’t closed that first sale, the second one is damnably difficult to pull off. One sign of this failure is made, but then come canceled appointments, case acceptance, and then a change of mind. Patients quietly disappearing. From the standpoint of selling a practice, if you do have your act together with this, you will, by necessity, be educating your buyer and including a sophisticated, organized trust-based marketing system. If you are going to hang around and help with a trust-based, trust-building transition, that has great value. But it is value that has to be explained and sold if you are to be properly compensated for it. None of this should be an “oh, by the way” or a “normal and customary.” I even suggest presenting the transition plan with everything you’re willing to do itemized in it. Present at an open house, present at a dinner for V.I.P. influencers, letter sequence, video in which you introduce the new doc, what else? Your I.P. has value, too, along with copyright, trademark, patent- protected content and media. The person or entity buying a practice (or any other business) may think or assume they are buying the numbers: revenue, net or EBITDA, and number of active patients. But none of that is guaranteed. Every patient transferred to a new dentist and new staff has the question: Shall I stay or should I go? So, what is really being sold and bought is an opportunity. An opportunity to start with a base of past and active patients who can be wooed, who will give their attention
and consideration to messages from the exiting doctor and the new one. And who, frankly, have been under-marketed to. There is the matter of “blue sky.” Often, even with a well-run, successful practice, the doctor has chosen not to exploit all his opportunities. To not do certain very doable things. He may not have been using sophisticated data analysis to identify past or present patients who, by known criteria, are likely prospects for a particular service, and then market to them. Or to use data-analysis-built avatars for social media to find matches for. These are the sort of things that Parthiv Shah does for dentists and are part of his Dental Growth Machine. The dentist may never have exhibited at the annual home and garden show or set up a kiosk in the mall. Or conducted outreach to health food stores, salons, spas, and cosmetic surgeons. There might be a big list of “never got around to’s” or “just didn’t want to do’s” that belong in a comprehensive practice-building plan. Researched and presented properly, this allows selling “plus revenue” that doesn’t exist yet. A seller with ego set aside can “confess to complacency” made possible by having such a good practice, but that could make it a GREAT! Practice. Almost every buyer, corporate or individual doctor, has to believe there is something (or many things) you, the present owner, are not doing as well as they could. They may judge your spending on this or that, or your overhead as a whole, as excessive, and think they will bring better, tighter control or cost efficiencies across multiple practices. They may think your tech is outdated. They may, however, be impressed with other things you’re doing that they aren’t. A dentist client of mine sold his exceptional practice to a DSO, and it immediately hired him for several consulting projects in marketing, even while they considered him a poor manager. Another blew a progressing sale when he and his wife hosted
the buyers for a social evening, and the wives got along like two feral cats thrown together in a small space. The seller’s wife then “couldn’t bear” to put their legacy, patients, and staff in Cruella’s hands. It’s best to keep your attitude unemotional
for this. Personally, you can think what you like as long as you spell my name right on the check for the agreed-upon sum.
—Dan S. Kennedy
Dan S. Kennedy is a much sought after direct marketing strategy consultant and copywriter, helping build brands and businesses like Perfect Smile® and Proactiv®, America’s #1 acne treatment, MiracleEar®, and Medicare Express. He is the author of the bestselling series of “NO B.S.” books, including the most recent “No B.S. Guide to Succeeding In Business by Breaking ALL The Rules.” As a speaker, his long career includes nine years on the largest public seminar tour in America, alongside four former U.S. presidents, countless Hollywood and sports celebrities, great marketing founder-CEOs like Debbi Fields (Mrs. Fields Cookies) and Jim McCann (1-800-Flowers), and legendary speakers including Zig Ziglar, Brian Tracy, Jim Rohn, and Tom Hopkins. His own seminar events have featured celebrity-entrepreneurs like Gene Simmons (KISS), Joan Rivers, George Foreman, and Kathy Ireland. The entrepreneurs’ organization he founded can be looked in on at MagneticMarketing.com. Over 30,000 dentists, chiropractors, and other health care professionals have been in his audiences.
10 · DentalGrowthAndExit.com
Cracking the Code of the Mysterious EBITDA
Adjusted EBITDA is one of the most important numbers in dentistry, and one of the least understood. It’s the metric institutional buyers use to determine what your practice is worth. If you ever plan to sell to a private equity group or DSO, you need to understand it. So, let’s strip away the jargon. First, What Is EBITDA? EBITDA stands for Earnings Before Interest, Taxes, Depreciation, and Amortization. In plain English, it measures a business’s core operating profitability before financing decisions and accounting conventions distort the picture. Think of it this way: If this practice operated purely as a business engine, independent of how it’s financed or how the owner manages taxes, how much cash would it generate? Interest reflects debt structure. Taxes reflect the owner’s personal situation. Depreciation and amortization are accounting entries. Institutional buyers remove those variables because they want to see the underlying economic engine. Now Enter ‘Adjusted’ EBITDA This is where the concept becomes especially relevant to dentistry. Most owner-operated practices include expenses that would not exist under institutional ownership.
After adjusting for excess compensation, personal expenses, and non-recurring costs, the true operating profitability may be $700,000 of Adjusted EBITDA.
That difference matters.
Why Institutional Investors Care Private equity-backed DSOs value practices using multiples of Adjusted EBITDA. Not collections or tax-return profit. Adjusted EBITDA. This allows buyers to compare practices objectively and estimate future cash flow under their management structure. If the market multiple is 6–8 times Adjusted EBITDA, the $700,000 example represents a valuation of $4.2–$5.6 million.
The same practice valued solely on reported net income could appear dramatically less valuable. That gap is enterprise value.
The Strategic Lesson for Practice Owners Your practice is not just a clinical operation. It’s a financial asset. Sophisticated buyers evaluate that asset using metrics designed to reveal its true economic performance, not simply the version presented to your CPA each April. Owners who understand Adjusted EBITDA early make better decisions about: • Compensation structure • Expense discipline • Associate productivity • Hygiene optimization • Operational efficiency They build practices that are attractive not only to patients, but to investors. And when the time comes to transition, that understanding can translate into hundreds of thousands — or even millions — of dollars in additional value.
Common examples include: •
Above-market owner compensation
• Personal vehicles or lifestyle expenses run through the practice • Family members on payroll with limited operational contribution • Discretionary travel or entertainment • One-time legal or consulting fees When sophisticated buyers evaluate a practice, they add these items back to EBITDA to calculate Adjusted EBITDA. The goal is to normalize profitability under professional management rather than reflect the current owner’s compensation structure or lifestyle choices.
All from mastering a six-letter acronym most dentists initially ignore.
For example, a practice may report $400,000 in profit on the tax return.
THE $10,000 APPOINTMENT
Every appointment is not worth the same.
Some visits cover overhead and little else. Others pay the bills, fund growth, and build real equity in the practice. The difference isn’t how busy the day looks; it’s what kind of dentistry is happening in the chair.
A single comprehensive case can be worth more than 10 low-value visits stacked back-to-back.
That’s not opinion. That’s math.
An implant case, a full-arch case, or a high-end restorative plan can generate 10, 20, even 50 times the revenue of a routine denture or a patchwork bridge. But the real difference isn’t just what it pays the practice. It’s what it does for the patient. High-value dentistry usually means long-term solutions instead of temporary ones. It means function that lasts, confidence that stays, and care that doesn’t have to be redone every few years. A patient who chooses a comprehensive plan isn’t just buying dentistry; they’re buying stability.
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Stan Kinder - (703) 298-1690 · 11
HOW CAN THE DG&E TEAM HELP YOU?
... continued from Page 11
Now look at it from the business side.
A low-value appointment uses the same resources as a high-value one: chair time, staff time, supplies, scheduling, billing, and follow- up. When that time produces minimal revenue, the margin shrinks. When it produces meaningful revenue, that infrastructure suddenly becomes profitable. That’s why some dentists work harder every year and make less. Their days are full, but they’re filled with low-yield work. High-value appointments change that. They allow fewer visits to produce more revenue. They create space in the schedule rather than pressure. They reduce the need for constant volume just to survive.
If you’re like most practice owners, a few questions sit in the back of your mind, even when the schedule is full, and production looks solid. What’s my practice truly worth? Am I building toward the exit I want, or just staying busy? If the right opportunity presented itself tomorrow, would I be ready?
Those questions typically get more pressing over time.
But they don’t happen by accident. High-value appointments are designed.
The purpose of the DG&E team is straightforward. We help you replace uncertainty with clarity, because clarity gives you leverage.
They start with a diagnosis that looks at the whole mouth, not just the complaint. They involve conversations that focus on long-term outcomes, not short- term fixes. They include time to explain options clearly and space for patients to think without feeling rushed.
The first step for most owners is understanding value. Nearly every dentist wants to know what their practice is worth, but very few have a current, accurate answer. As a reader of this newsletter, you are invited to receive a complimentary valuation analysis. This is not a casual estimate or a rule of thumb. It’s a real look at where your practice stands today and what would need to change if your exit goals require a higher number. Whether you plan to transition in 10 years or sooner than expected, knowing your starting point matters. You can schedule that conversation here: Calendly.com/eveythingdso/30min For those who want to go deeper, we can review your practice data and P&L in detail. Revenue alone doesn’t determine value. Margin structure, payer mix, hygiene performance, and operational efficiency all influence the final outcome. Every successful growth plan and every successful transition begins with an honest understanding of today’s reality. As a newsletter reader, this analysis is offered at no cost and without obligation. It’s simply a chance to see your practice through a more strategic lens. If growth is part of your plan, it makes sense to explore which kind of growth actually fits your goals and capacity. Parthiv Shah, the strategist behind “Dental Growth Machine” and “Sell More Implants,” is offering a complimentary consultation to help you determine what kind of expansion makes sense for your practice. This is not about chasing trends or adding stress. It’s about building growth that supports your long-term objectives. You can schedule a conversation with Parthiv at MeetParthiv.com And when legal decisions arise, especially those involving partnerships, associate agreements, or potential sales, having experienced counsel matters. Mandelbaum Barrett is one of the most experienced dental-focused law firms in the country, representing owners from formation through complex exit transactions. A brief conversation at the right time can prevent expensive mistakes later. You can learn more at: MBLawFirm.com At the center of all of this is a simple principle. When you understand your numbers, your options expand. When you understand your value, your negotiating position improves. When you understand your growth path, your stress declines. The DG&E team exists to help you think clearly, plan deliberately, and move forward with confidence.
Most low-value dentistry is reactive. A tooth hurts, so it gets patched. Something breaks, so it gets replaced. The cycle repeats. That model keeps people busy but rarely moves anyone forward.
High-value dentistry is intentional. It looks at where the patient is headed, not just where they hurt today. It connects today’s problem to tomorrow’s outcome. And when patients see the long view, many choose differently. The difference between a denture and a full-arch case is not just price. It’s lifestyle. One is about coping. The other is about restoring. When patients understand that, the decision becomes about value, not cost. For the dentist, high-value appointments create breathing room. Fewer financial fires. Less dependence on volume. More control over the schedule. More space to practice at a higher level. They also build a stronger practice asset. Revenue that comes from comprehensive care is more predictable, more defensible, and more valuable when the practice is eventually evaluated. This doesn’t mean every patient should become a high-end case. It means every patient deserves to see the full picture, not settle for a partial one. The $10,000 appointment isn’t about pushing big dentistry. It’s about giving patients a real choice, and giving your practice a real chance to grow without running faster every year.
Busy is easy. Profitable, stable, and meaningful takes design.
Because guessing about your future is expensive. Clarity, on the other hand, is profitable.
12 · DentalGrowthAndExit.com
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