If you’re happy with your results, keep doing what you’re doing. If you’re unhappy with your results you need to change your actions (and probably your mindset) if you want different results. As we all know there are a plethora of options when it comes to potential changes so how do you know where to start? 

Easy.  Start by implementing the things that are free (or very close) first!

Things like:

• Pending letters/emails
• Pending parties
• Care calls
• Doctor visiting referrals in person 
• Smile
• Run on time
• Stop taking on stupid hard cases without charging a stupid high fee
• Complement team members 
• Clean up the clutter and crap on the front desk
• Make sure the office, bathroom, windows, parking lot, etc are spotless, smell good and look good
• Clean up your overtime patients NOW
• Ask fors
• Same day starts
• Make sure you treat every lead you get like gold and follow up in a timely manner with a smile! 
• Make sure at least one of your employees speaks Spanish or any other non-English language that is common where you are (and cater to that community)
• Go through your office and open every drawer, cabinet and closet, pull everything out so you can see it and be horrified at how much stuff you have that you paid for and didn’t know about! You probably won’t need to buy supplies for 6 months. 

The equally effective converse is to start by getting rid of anything that costs money, has little to no DEMONSTRABLE return and is not essential (essential is rent, electricity, bank note and the like).

• Stop using expensive brackets and associated expensive supplies. Your TOTAL COST per bracket case should be less than 50 dollars. Total cost includes everything you use to treat a case – glue, etch, primer, brackets, wires o-ties, disposables, elastics, etc
• Seriously consider why you use things that cost more than regular old brackets – Aligners, accelerators, TADs, self ligation, custom brackets, wire bending robots, etc 
• Cancel all your credit cards (and get new ones) to remove all monthly recurring charges and stop all non-essential recurring charges on your checking account. Essential charges are things like rent and power BTW. There are usual tons of little charges that add up but you’re not aware of. 
• Get rid of postage machines, copiers, uniform services, towel services, doormat services, etc. contracts as soon as possible.  
• Consider why/if you need on hold service for your phone (you can get your own device cheap), financing facilitator services who take a percentage (you only start a few cases a week), people who chat to patients for you (you don’t have that many people utilizing it), etc?
• Find out, in detail, exactly what are you getting for your SEO, marketing, website, services you’re paying for. If you cancel them would you notice a difference? How many hits, leads, chats a month are you getting? We get over 100 leads a week from our Smiley Face marketing and we spend 9-12 k a month in a brand new, startup practice. We track and know exactly what we are getting. Be sure you do the same and that you question your service provider for details and expect more. 
• You don’t need recurring orders from Amazon or Staples for supplies. This generally leads to oversupply and over spending. 

Every little 300 bucks a month adds up. Every couple percent of revenue you give up to a vendor adds up. If you’re getting great results then what you’re paying is worth it and you should keep paying it. If you’re not getting the results you want then you need to make a change! So… implement what is free and cancel things that cost money but aren’t essential (things that are not ESSENTIAL for running the practice or getting new patients in the door). Then sit back and see what happens. Odds are you won’t miss the subscriptions you cancel and you’ll see great growth based on the new, free stuff you implement AND you’ll keep more money. To help insure that growth happens, take most if not all the savings and spend it on effective marketing that produces leads, day in and day out, AND hold your marketing people accountable for producing leads AND treat every lead you get like gold! (if you don’t follow up on the leads your marketing people send you and do your part of the equation then it’s all for nothing). I’ve given you some specifics but the real point of this article is to get you to think about every dollar you spend and demand results from your vendors. You work hard for your money and you need to keep as much as possible. Above all you need to spend your money on the most important thing there is – helping those who want your service find you! If you can’t get new patients in the door then none of the rest of this matters after all…