Problems in the Practice: 4 Things Holding Private Dental Practices Back (and How to Fix Them)

When was the last time you took a full week off and didn't check your phone once?

If you own a private dental practice, I'm guessing you had to stop and think about that one. 

I've spent more than 25 years in dental offices. I started as a hygiene assistant and ended up running a FFS practice as its practice manager for 18 years. The same few problems showed up in almost every office I worked with or mentored, so this fall I started a weekly series called

 Problems in the Practice: Let's Talk About It. 

Each week I picked one problem I see in practices all the time and talked about how I'd fix it. This post puts the whole series in one place, with more detail than I could ever fit into a social post.

Here's the short version... The four problems I see most in private dental practices are:

1. The owner can't step away because the office manager was never trained to run things.
2. New owners were never taught the business side of dentistry.
3. The front office has no written systems, so results depend on who's working that day.
4. The schedule is full, but production isn't growing.

If you're a practice owner, or the office manager trying to help one, keep reading.

Problem #1: Why can't I take a vacation from my dental practice?

Most practice owners can't truly step away because their office manager was never trained to run the practice without them. So the questions and the problems all land back on the doctor.

I hear it all the time. 

The owner is answering staff questions and fixing the schedule between patients, or even worse, while on vacay. 

There's usually an office manager in the building, and she's often working really hard. But having the title is different from having the training and the authority to make decisions.

Before I started LW Excellence in Dental Management, I spent two years as an Office Manager Mentor with a DPO, traveling to practices to train new office managers. It's the same work I do with private practices now.   

WHAT FIXES IT:

• Coach the OM into a true #2. 
  • Your office manager needs to know how to lead the team, handle the everyday stressors, and make decisions without walking into your operatory every ten minutes for your OK.
• Keep the owner in the loop on things that really matter. 
  • Even with an all-star OM, it's YOUR practice. You still need to know what to watch in your numbers and your team, so you can step back without losing track of the business.

The goal is REAL time off, physically and mentally. Your OM gets a career out of it, and you get your head back.

Problem #2: What business skills do new dental practice owners need?

New practice owners need to understand their numbers and know how to lead a team. Dental schools don't teach either one, so a lot of new owners learn the business side by trial and error.

Dental school taught you to do a beautiful crown. 

Nobody taught you how to read a P&L or handle a team member who's testing you. 

So a lot of new owners figure it out at 10pm with a spreadsheet and a lot of guessing. That's a lonely way to run a business with your name on the door.

WHAT FIXES IT: 

• Start with where the practice really stands.
  • Before we build any plan, we look at your numbers and your team together. That way, the plan is built around your practice and the problems you actually have. 
•  Have someone in your corner between the big moments
  
  • New owner coaching works best with steady check-ins. I do biweekly calls, and owners can reach me between sessions when something comes up. If your spouse is involved in the business, they're welcome on the calls too.

Dental school doesn't teach you how to run a practice.    I DO!

Problem #3: What are "systems" in a dental office?

Dental office systems are the written, step-by-step ways your practice handles its everyday work, like scheduling and collections. When they're documented, anyone on the team can follow them and get the same result.

A potential client once said to me, "Everyone says you need systems, work on your systems... but what does that actually MEAN?!"

Fair question!

People hear the word and picture something technical.

Here's how I explained it to her: 

Picture a chocolate cake. 

In your office, that cake is a well-run front office. You already have the ingredients on the counter: your software and your team. But if nobody wrote down the recipe, everyone's guessing at the measurements and the oven temp. 

Every cake comes out a little different depending on who's baking that day.

Systems are the recipe. 

Most owners have lived through this. A great front desk person leaves, and everything she knew walks out the door with her, because the recipe only lived in her head.

WHAT FIXES IT:

• Map what's really happening now. 
  • I work with you and your OM to see how the front desk actually runs today, which is often different from how everyone thinks it runs. 
• Write recipes that fit your practice, then keep them going. 
  • We put your systems in writing so a new hire can learn your way in week one. Then I coach your OM to keep them up to date, so the schedule and collections come out the same whether your best team member or your newest one is at the desk.

Problem #4: Why is my schedule full but production isn't growing in my dental practice?

A full schedule with flat production usually comes down to how the schedule is built. 

When the day fills up with whoever calls first, the bigger, more productive appointments get pushed weeks out, and diagnosed treatment never makes it onto the books.

You know the feeling. 

The schedule is booked out three weeks, and the team is worn out by Thursday. Then you pull the production report, and it looks about the same as last year. 

That one stings.

When I dig into this with practices, I usually find some mix of these:

• The schedule fills first come, first served, so larger cases wait weeks for a spot.
• Diagnosed treatment sits in the system and nobody follows up on it.
• Hygiene is booked solid, but there's never time to talk about perio or the treatment the doctor noted last visit.
• Nobody looks at the daily goal until the month is already over.

Busy and productive can look a lot alike from the operatory.

WHAT FIXES IT:

• Build the schedule around a daily production goal.   We set a daily goal together and block the schedule so the bigger treatment has a home.
• Put a follow-up system in place for unscheduled treatment.  Someone owns the list and makes the calls every week. Then I coach your OM to keep it running so it sticks.

Here's a timely tip: most patients' insurance benefits reset January 1st. Pull your unscheduled treatment list now, before December fills up.

What do these problems have in common?

All four come back to the same root: the practice depends on the owner to hold everything together. 

When the office manager is trained to lead, and the front office runs on clear systems, the owner can finally focus on dentistry and on growing the business.

That's the work I do. 

I help private practice owners run their offices without the office running them, and most of it happens remotely, so you don't need me in your building.

• The LW Standard for Private Practice Success is for owners who want the whole operation looked at and rebuilt, starting with an assessment of how things run today.
• The LW Dental Leadership & Development Program is coaching for new dental practice owners and office managers who are ready to become practice leaders, and for new owners learning the business side of the practice.

If any of these problems sounded a little too familiar, or there's a different one in your practice you want me to tackle, let's talk about it.

Book a free call or send me a message.

Frequently asked questions

What does a dental practice management consultant do?  A dental practice management consultant helps owners improve how the business side of the practice runs, including the team and the front office. My focus is developing new practice owners and office managers into leaders and putting front office systems in writing.

How do I get my office manager to run the practice without me? Start by giving your OM real training in leadership and in your practice's numbers, then hand over decision-making authority a piece at a time. Coaching speeds this up because your OM has someone to learn from who has done the job.

How long does it take to put systems in place in a dental office? It depends on where your practice is starting. Writing the first systems can happen in a few months, but keeping them current is ongoing work your OM owns.

Do you only work with practices near Chicago? No. I'm based in the northern suburbs of Chicago, Illinois, and most of my coaching and consulting is done remotely, so I work with private practices across the country.  I travel nationwide for in-office visits and speaking engagements, as well. 

Do you work with DSOs? My work is focused on private practice owners who want to grow and stay independent.

About the author

Laura Webber is the founder of LW Excellence in Dental Management, a practice consulting and leadership coaching business for private dental practice owners. She has more than 25 years in dentistry. She started as a hygiene assistant and went on to serve as Practice Manager at Village Green Dentistry from 2007 to 2025. She also trained new office managers as an Office Manager Mentor with a large DPO. Today, she helps owners turn their office managers into true operational leaders. Laura is based in Chicago, Illinois, and works with practices remotely.