Economy of scale.

I want to scale.

How do I scale effectively?


These are very hot topics these days among orthodontists and dentists of every stripe. What does it mean? What is the goal? What do we really want when dentists talk scalability?

Definitions will vary but from what I’ve seen it appears that when we say we want to scale, what we actually want is more and bigger without change and without surrendering any control. Essentially we want what we have only bigger – much bigger with more locations and more doctors and more staff. It’s our nature. We love detail and control and the idea of having complete information before making any decision. We are convinced there is a RIGHT answer. We are career students so we are also terrified of being wrong or failing. Like seriously, we are irrationally afraid of these things and as best I can figure it comes from the decades we spent being terrified of missed answers on tests, bad grades and “failure”. I’m not saying this fear is wrong or bad in and of itself, but I am saying that yielding to this fear and satisfying our need for control is a sure way to stifle growth and to prohibit your business from scaling in any meaningful way.

All this being said, it is import to point out here that large, traditional, owner-operator orthodontic practices are awesome. They run smoothly, patients, parents and dentists generally love them, they get referrals and they are very profitable. It’s a win-win-win. I ran one for several years and I have many friends who continue to do so. I mention this only to make two suggestions:

1) If you have such a practice, be very careful about trying to change and scale as you’ll alienate everyone who likes you for what you are presently and your referral base will tank. If you decide to change models you need to have a plan and an alternative source for new patients.

2) If you want to scale, really want to, then do not make the mistake of believing that you can have it both ways. Don’t get caught in between the models as I did (three times) before figuring out that you must choose one or the other and commit. You have to choose. Will you be owner doctor driven or brand driven? Will you have total control or freedom for growth?

Scaling, innovation and massive growth are messy, expensive and stressful – the opposite of the traditional practice. Again I’m not telling you this to dissuade you from scaling. I’m telling you this so that you know what to expect when you scale.

1) Loss of control to some degree and in some areas (and possibly to a huge degree and all areas if it goes that way).

2) Abuse of you and your business by employees who are not under your watchful eye 24/7.

3) Upset dentists and patients who expect to be treated like royalty instead of expecting to get their dental needs taken care of. People don’t like change – dentists and patients are worse than people when it comes to this.

4) Staff turnover. The only people who hate change more than patients and dentists are your staff members.

5) Wasted money and resources as you figure out what you’re doing.

6) Theft due to the lack of control.

7) Sleepless nights.

8) And on and on and on… You can expect a tremendous amount of unexpected things to pop up on you as you scale.

So why would anyone scale?

Well, really, the question is why wouldn’t you? There is a huge access to care issue in this country at all levels due, not only to financial status, but also to convenience, education and appeal (or lack there of) of the treatment modalities most popular with orthodontists and dentist. Most Americans do not enjoy optimum dental health or appearance. Not even close. That means there is a huge opportunity for those of us who are willing to fight through the messiness, expense and humiliation that comes along with scaling. An opportunity to improve the lives of our patients and potential patients, change the world for the better and to make a very good living. Someone has to do it. Why not you? Why not now? Let go of your control freak needs, make peace with imperfection and go for it. The rewards are exponentially greater than the challenges!

One thought on “Orthodontist vs. Scalability

  1. The way I see it, risk is proportional to reward. Doctors operate traditional practices because they are safe and predictable. Imagine there is a large stone wall and inside there is a large orchard of money trees. We spend many years training in order to learn our profession and get over the wall. This huge barrier to entry blocks every other guy on the street from going out and opening a dental practice. Most doctors like this wall and build more walls to section off their part of the orchard. They say, “I worked hard to get here, and I am great at collecting this money so I want to protect my trees and nurture them so they will produce for many years.” The doctor who scales his practice says, ” There are more than enough trees outside the wall, I may not pick every dollar off every tree personally, but my collectors will be busy and I will get to share in the group’s harvest.”

    Walls keep in, as well as keep out.
    They protect, but limit growth.

    The three big questions for the doctor who scales his practice:
    1) Why take the risk?
    2) Why did you go into the profession in the first place and has that mission changed?
    3) Who is glimitto design the process and supervise its implementation? How?

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