February 5, 2023
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My personal interest in Practice Management consulting and coaching started with seeing colleagues’ 6-figure pieces equipment and 5-figure courses lying dormant, unused, or underutilized.  Cad/cam units and Lasers in a closet or up for sale on EBay, CBCT’s taken but not reimbursed, Dental Sleep Medicine underperforming, are all too commonplace.  Previously, when healthy production equated to healthy profits, one could afford such few misfires.

Today, the “WE WOES” of staffing shortages, insurance shenanigans and inflation, makes effective implementation of a profit-generating strategy is not a luxury but a necessity.  


With every threat comes opportunity.  It’s the Karmic way of the world; elusive doorways usually reserved for visionaries like Edison, Ford, Jobs and Musk.  

I hope to illuminate such a doorway present in every dental practice.  It’s an opportunity to re-energize one’s practice via a strategy that most will see as challenging, risky, and possibly even unprofessional.  These are only some of the excuses dentists give for not opening this door.

I remember the day when any marketing was considered unprofessional by most and even unethical by some.  In 1984, I got called to the Dean’s office at Columbia where I was on faculty to explain a copy of the first issue of my practice’s “Word Of Mouth” newsletter, which fell into his hands.  I had to convince him that it wasn’t really marketing because it only went to patients of record.  He bought it because he had no idea what marketing really was.  Of course, it was marketing!

The strategy I propose, as an antidote to dental WE-NESS, is used by many other businesses to maximize the fruits of their labor and ROI by giving people the choice of getting a “ME”experience that is more in line with their desires.  In today’s “WE” world that might appear to be discriminatory.  And, if you think that being able to fly first class, stay in a luxury suite, or watch the game from a skybox, is such an inequity, then such a strategy isn’t for you.  Continue watching your profits shrink.

In many hotels, there are a range of room options.  In restaurants, there are dishes of varying cost.  Many airlines reserve a portion of the plane’s cabin for higher service, greater comfort, and a more luxurious experience.  While all guests get a good night’s sleep, leave with a full belly, and arrive at their destination at the same time, some enjoy the experience more than others.

I’m not suggesting a different outcome for care.  As professionals we are obligated to giveeveryone the best possible outcome.

First or business class are utilized by 12% of travelers but can represent 75% of an airline’s profit.  Even though these seats take up more space, the return is justified.

Can a dental practice do something similar?

The answer is YES…but.

The BUT is big because to do this properly is not easy.  It requires a shift in attitude, process and action that might have previously contributed to other ‘failures to implement’. It requires a SHIFT from “WE” to “ME” thinking.

WARNING!  If you have experienced an implementation failure in your practice, this program might not be for you.

Implementing dental sleep medicine for many has been such a “failure to implement” example.  Many practices have tried to incorporate DSM in between and with the same processes as their routine dental care.  It doesn’t work!

Some have attributed their failure to:

Insurance (medical) involvement
Lack of team buy-in
Referral challenges
Limited profitability


Whatever the excuse:  If you keep on doing the same thing and expect a different outcome… you know the rest.

Don’t be CRAZY!

Only by segregating DSM, or TMJ, or other treatment ‘classes’, can they be implemented and become profit centers rather than time and profit suckers.

And implementing another insurance dependent service isn’t a solution either.  In fact, it’s another trap, ready to be sprung by a 3rd party payer that sees your practice as a puppet to be toyed with.

Insurance Companies and Government Agencies have made dentistry into a commodity.  You have the option of not playing that game.

The only viable solution to insurance dependency involves providing a non-insurance dependent service to people who are seeking a first or business-class experience and are willing to pay for it.  

Fortunately for dentists, there are many such markets and services.

Identifying the services and the right markets is only the beginning.  Designing a system that delivers a first-class experience is the real key to success.

Just like in an airplane cabin, there needs to be a curtain drawn between the different portions of the practice.  There needs to be better service, more personalized, empathetic care, more comfort, and even better speed. As many non-AI-like qualities as possible will enhance the value.

The exact benefits one delivers should be user-defined.  The question to be answered is:  What would this avatar-patient want from their experience with this service?

The next question is:  How can we deliver this experience with the existing…

1. Facility
2. Systems
3. Culture
4. Team
5. Leadership
6. Management
7. Schedule


What, if anything must change?

Answering these questions for an owner or practice member can be tricky.  One tends not to see one’s own flaws.

That’s the value of a secret shopper or recording/monitoring incoming phone calls.  It’s the reason Practice Perfect Systems conducts 360° interviews as a part of the diagnostic process.  By getting feedback from team members, patients, associates, vendors and referrers, a clearer, more objective picture can reveal opportunities to improve the patient experience that might not be readily apparent to the practice owner.

Want to deliver new, non-insurance-based services?  One of the first steps is to get your team on-board and up-trained.  That’s the objective of The Liberated Practice Program.  Check it out and get started on the path towards a more profitable practice.

Next week, I’ll discuss the scheduling considerations when implementing non-insurance-based, first-class services.

To your patients’ first-class, “ME” experiences,


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Dr. Michael Goldberg is one of the leading educators on dental practice management in the United States.

Michael ran and sold a prestigious group practice in Manhattan and has been on Faculty at Columbia University and New York-Presbyterian Medical Center for 30 years including Director of the GPR program and Director of the course on Practice Management.

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