Mountains and Valleys: The Ups and Downs of Managing Your Dental Practice

Dr. Tyler Williams


“Circumstance does not make the man. It reveals him to himself.” – James Allen, As A Man Thinketh

The tallest peak in Utah where I currently practice is Kings Peak, which is about 13,000 feet above sea level. The lowest point in the state is Beaver Dam Wash, which is just 2,000 feet above sea level.

In the same way, our careers and businesses have lots of hills and valleys. Sometimes things going just the way we want them to, and sometimes they just plain don’t.

Finding and keeping long-term team members is one of the most interesting dichotomies in dentistry. For years, I’ve heard practice owners talk about finding the right people, turnover, managing compensation and benefits, etc. According to the American Dental Association as well as most business journals and reports, the majority of practices (and all businesses for that matter) are experiencing some type of labor shortage right now.

You may also experience this as well, with hygienists and assistants, being the most difficult to attract and keep in many parts of the country.

Right now, the problem that is that classic economic equation: demand is exceeding the supply of people who want (dental) services. But the same goes for many other businesses and industries as well. When I took a flight earlier this spring it was awesome. Tons of open seats, great service, and a more clean and comfortable plane that I’ve ever flown on before. Now the service stinks and planes are overcrowded as the demand has resumed for travel yet there is still an extreme shortage of labor to help equip and serve the planes and airports. So, how will we overcome this challenge in private dentistry? I will share with you six keys that have helped in our office stay productive during this interesting time.


Ensure that you have virtual help, where you can’t have in-office help. There are many excellent websites, such as Upwork, as well as local staffing agencies that can help you find virtual or temporary office or admin team members, as well as personal assistants. This will help to offset the shortage of team members in your practice. We have at least two or three virtual assistants going at any given time and they are a lifesaver when it comes to data entry, graphic design, typing articles etc.

There are a couple of reasons we do this. First, they are independent contractors, so we don’t have to worry about labor laws or benefits, etc. Second, they get paid for what they do. And third, we can pause or resume at any time.


You may want to look within your existing team, or people who previously worked for you. See if you can move them to a different role, where they are more needed. Such as an assistant becoming a treatment coordinator or a hygienist becoming an office manager.


Right now, it is not a time to be working more for less. You have to make sure your fees are in line with the value of your services. You should not be stepping over dollars to pick up pennies. Instead, make sure that the procedures or services you are offering and can add more value to your patients, are fair and in line with what you see fit. In my opinion, dentistry is a huge bargain and a very high-value service compared to hospitals, and surgery centers. Where can you get a set of tires for $1500 that will last 5, 15 or even 40 years compared to a ceramic crown?

Of course, insurance doesn’t cover all major services that most dental patients need. But from a big picture view, dentistry, adds so much value to the lives of your patients. And there are many financing programs available today and you can look at an office internal financing program as well.


Reduce your hours as needed. This is not a time to overwork yourself. Following the 80/20 Pareto principle, you should spend 80% of your time on the 20% of your procedures and services that you’re good and most profitable at. If it’s of high value to your patience and you make a good profit at it while having fun, then continue doing it. Refer out or delegate to another provider in your practice services that do not meet the criteria.

You may find that fir example mornings or afternoons are the least desirable for your patients, or maybe Monday are usually slow. Turn those into training times, meeting times, or time off for your team. It’s important not to overwork those who you do have, or they will burn out.


If you hire someone who’s not the right fit, don’t string it out or give them the perception that they’re going to magically get better. The truth is, all of us have our best behavior and best attitude when we’re applying for a position or trying to get something we want. It simply doesn’t get better from there – it’s human nature. Of course, you should be able to develop the skills and talents of your team over time to get better. But if the attitude isn’t there within the first few weeks, you need to free that person up back into the marketplace. Otherwise, they will sabotage the culture, and drive in your practice.


Get rid of your bad patients for people who don’t want to pay, aren’t responsive, don’t keep their end of the deal. For those who cancel and reschedule constantly, outsource them or refer them to another office, where they will be better served. If you run a production report, you will see that these people cost more than they bring in due to wasted chair time and unnecessary and preventable write-offs.

How to become an Insurance Independent Practice!

There are two reports, you should run in your software to determine if you have a membership office or an insurance drive office. The first one is running over-the-counter collections. This is a report that tells you how much you receive payments and non-insurance payments each month. For example, personal checks, credit cards, and third-party financing such as Care Credit or in-house financing payments.

The second report you should run is a production report, based on insured patients vs non-insured patients. This report will elaborate on an important comparison. For example, production and collection for your cash, self-pay, or membership plan patients each month as compared to how much you produce and collect each month with your insurance-based patients.

Why are these reports so critical? Because if you have a very high insurance dependence in your practice then you shouldn’t go cold turkey on dropping tons of insurance plans at once. If you have a high amount of cash pay and/or membership patients then you may want to be careful about adding insurance which could compromise the level of service in your office or your cash flow.

Insurance Plans

In my practice right now, we currently accept two dental insurance plans. Currently, we are planning to phase out one soon. We are confident that we can do this and still grow. How do we know? Because, as of right now, two-thirds of our collections come from our patients each month, rather than insurance. There is only one reason for us to accept insurance right now in my option, which is to get new patients.

Remember, that over the years, many of your patients will either go in and out of insurance or insurance networks, or eventually retire and lose their insurance altogether.

So, while on the front end, you may accept a loss, with an insurance discount, or write off. You can gain that on the back end through referrals and non-covered services. And also, when your patients lose their insurance or change jobs eventually. The key is to have data, and as the saying goes, “the data will set you free.” Right now, if 90% of your collections come from insurance each month, then a membership or no insurance model May not be a quick-fix option. Doing so may just choke and kill your practice. However, if 50% or less of your collections come from insurance, then a membership model or phased approach could be a fantastic option for you.

ABC: Always Be ‘Cruitin’

Prevent yourself from keeping all of your eggs in one basket. If you haven’t learned this already in dentistry someone in your office at any time could be going back to school, getting married, moving, getting divorced, having a baby, or going from full-time to part-time or part-time to full-time. This means you can’t rely on any one person including yourself two stay in the same position forever. People make us who we are and how we serve our patients. But people’s situations are more and more fluid these days and continual ly prone to change.

By doing these six things, you can ensure the rest of your year goes smooth and remains steady in a future of uncertainty. Dentistry is here to stay and demand for dental services remains high. Even where many of us are suffering from shortages of qualified team members in certain areas of the country. When I first graduated from dental school, I remember there were not enough dental related jobs. We would receive applications all the time from hygienists, doctors and office staff. Sometimes the pendulum swings the other way and it will eventually swing back once again in our favor. In the meantime, show appreciation and thanks for your patients, your current high-performing team members, and continue to prosper.

Some sources say the average hygienist burns out after seven years. There are several reasons why that may be true. But I’m providing a practice that continues to grow and continues to offer the most value for your patients. Especially for those who accept large treatment plans, in-office membership, or savings plans. You can build stronger relationships with them. Also, you can have a great year without working yourself to death, and as you continue to hire and add new team members. Remember the adage to fire quick and hire slow.

As a final thought, keep in mind the famous Prayer of Serenity used by the Alcoholics Anonymous group. “Lord give me the courage to change the things which can be changed, the serenity to accept the things which can’t be changed, and the wisdom to know the difference.” (Alcohol anonymous prayer of serenity).

If you’d like more information on how to do this, simply shoot me an email, and I’d be happy to send you our one page template on setting up a profitable, (PPP) Pre-Paid Practice in your office.
Have a great month, and I’d love to hear your feedback or comments. You can reach me at or on the Pinecrest Practice Growth Youtube Channel.


Dr. Tyler Williams is the founder of both Pinecrest Dental and Pinecrest Practice Growth. He is a proud husband and father of three.

He has written numerous articles for the Utah Dental Association, Dentistry Today, and Dental Economics. He is the author of three books, The Owner’s Guide to a Productive Dental Practice: 7 Pillars Every Dentist Needs to Grow in the New Economy, Reason to Smile: 11 Keys to your best oral health ever, and The Consumer’s Guide to Dental Implants: 3 Keys Every Adult Needs to Know About a Smile Transformation which can be found at major bookstores and on He is a real, “wet fingered dentist,” and has completed thousands of dental implant and restorative procedures.

Dr. Williams has been featured on ABC’s Good Things Utah, NBC News Radio, the ForbesBooks Radio podcast, The One Thing marketing podcast, Sirius XM Radio, UK Health Radio, KTALK Utah radio and in several national dental research publications, including reviewing articles for the Academy of General Dentistry’s General Dentistry journal. He has several published articles in online and print journals, including: Dental Economics, Dentistry IQ, ADA News, Dentistry Today, and The Profitable Dentist.

He has also been recognized as one of the most influential dentists in Utah by Kleer’s list of Most Influential Dentists in America. He also hosts a bi-monthly podcast called The Practice X-Factor.

He is currently the owner of Pinecrest Practice Growth, which helps practice owners create a prepaid dental practice, free of insurance dependency and poor financial health.

(To contact Dr. Williams, please email him at, text/call (801) 268-2323, or visit


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