The One Question

December 5, 2021
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My purpose and role in coaching / consulting / teaching, something I’ve been doing for 44 years, both here, in dental schools, and privately, is to point things out that, as an outsider, from a dental, business, non-emotional, experience, and outcomes-based perspective, might be of value.

That’s the challenge that sparked my relationship with The Spencer Study Club and building Practice Perfect Systems.

I’ve studied business, marketing, healthcare and dentistry.  I’ve practiced and made money in each area.  But Dental Sleep Medicine presented some unique challenges.

1.​Medical/Physician Collaboration and referral pathways.

2.​Medical Insurance/Billing

3.​Record-keeping challenges

4.​Non-Surgical Clinical Model

5.​Different Marketing opportunities

6.​Unique and different KPI’s

The good news is that business is still business.  Certain fundamentals such as; cash flow, profitability, HR, follow-up etc., must be attended to regardless of the differences DSM present.

We’re still learning about these challenges and developing effective coping strategies and tactics, some of which I’ve shared with you over the past 2 years.

As everyone wants a FORMULA, we’re just beginning to develop some ideas about “best practices” in a generalized manner.  For instance, in a DSM or TMJ practice;

What’s the ideal ratio of administrative to clinical staff?
At what point is it best to outsource insurance/billing?
What impact does telemedicine have on patient flow, operatory usage, and staffing needs?
How many operatories, and of what type are ideal for a projected $  goal?
What % of collections should lab costs be?

The single most important question to be asked when embarking on any business is:


That question is rarely the motivation for a dentist’s getting into the DSM field.  Most of us do it because of the transformative results we can get and other, non-financially motivated reasons.

Some practitioners, realizing that the answer, based on their existing practice model, is NO give up and retreat back to what has been profitable.  That is, if they haven’t killed the “goose that laid the golden egg”.

DSM suffers from a reputation that “you do it for love, not money.”

Some try to recoup profit by adding TMJ therapies, which is a good idea for other reasons as well.

DSM profitability, just like with any other business, has to be planned from the get go. DSM can’t be grown organically within a general dental practice and yield automatic profits.  It needs strategy,  preparation and successful tactics implementation.

For these reasons, dentist’s in the DSM world are more prone to get rich quick schemes.  Some fall for FORMULAS that promise profit at the expense of ethics or worse.

I’ve tried to help guide you here.  I’m thankful for your attention.  And now, I’m shifting gears.  Jamison has given you all the tools you need to build a profitable DSM/TMJ practice.  He’s given you a “Do It Yourself” model, SSC Mentoring, and 2, “Do It With You” models, Business Essentials and Business Elite.

I’m going to continue to post in 2022 but on a more limited basis.  If you want more, you’ll have to go to and either read the blogs, or schedule a personal conversation, where I can better answer the questions that are relevant to you.

You can also download some valuable ebooks, which contain tools to help you focus your efforts and plan for 2022.

To your excellent imagination, clarity and success,


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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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