Most dental practices don’t struggle because they lack opportunity.
They struggle because opportunity quietly leaks out of the building as they grow.
When owners talk about inefficiency, the conversation usually jumps straight to marketing spend, staffing shortages, or technology choices. Those things matter but in my experience, they’re rarely the root cause. The real damage happens in the gaps between systems, people, and accountability. And those gaps don’t announce themselves early.
At one practice, inefficiencies feel manageable. You’re close enough to the day-to-day that you can compensate personally. You jump in. You smooth things over. You make it work.
Scaling removes that buffer.
When I expanded into an associate-driven practice, I learned quickly that systems that felt “good enough” when I was present every day didn’t always hold once distance was introduced. The same small issues we had tolerated didn’t stay small. They multiplied quietly at first, and then all at once.
Growth doesn’t solve inefficiency. It amplifies it.
Phone Calls: The Most Ignored Efficiency Lever
One of the first places these leaks show up is the phone and it’s almost always underestimated.
Most owners think they have a scheduling problem. What they actually have is a phone problem.
There’s an important difference between missed calls and mishandled calls. Missed calls are obvious. Mishandled calls are harder to see. They’re the rushed conversations, the lack of confidence, the “we’ll call you back” that never quite closes the loop.
As practices grow, call volume increases, and that volume can create a false sense of security. The phones are ringing, so it feels like things are working. But volume hides quality. If the person answering the phone isn’t confident, clear, and aligned with the practice, opportunity leaks even when every line is technically answered.
Scripts alone don’t fix this. Patients can hear uncertainty immediately. If the person on the other end doesn’t fully understand the “why” behind what they’re offering, the call often ends politely but momentum is lost.
A simple but uncomfortable diagnostic is listening to your own calls. Not to criticize your team, but to understand what the patient is experiencing. Phone calls aren’t an administrative task. They’re the front door to the practice.
The Underdeveloped Manager Problem
Another major leak tends to sit right in the middle of the organization.
As practices scale, managers often get promoted because they’re reliable, loyal, and good at getting things done. What they don’t always get is development. They’re asked to manage complexity without being taught how to think in terms of outcomes.
This creates a dangerous dynamic.
Underdeveloped managers tend to own tasks, not results. They stay busy, put out fires, and keep things moving but they aren’t protecting systems. Problems get escalated upward instead of solved. Decisions become inconsistent. The owner ends up acting as the glue holding everything together.
From the team’s perspective, this shows up as confusion. From the associate’s perspective, it shows up as disengagement - usually quietly. Associates rarely disengage loudly. They stop offering ideas. They stop pushing for better outcomes. Not because they don’t care, but because they don’t feel ownership anymore.
This is one of the hardest conversations for owners to have, because it involves acknowledging that someone you trust may not be fully equipped for the role they’re in. It’s easier to add meetings, dashboards, or software than to slow down and build leadership fundamentals.
But scale has a way of exposing what training and clarity haven’t covered.
You Don’t Solve Problems - You Trade Them
Early in ownership, it feels like the goal is to eliminate problems - to fix the thing and get back to calm. Experience teaches you something different.
Problems don’t disappear as you grow. They change shape.
Leadership maturity isn’t about having fewer problems. It’s about choosing which problems are worth having. The problems of growth are different than the problems of stagnation. Both are difficult but only one moves you forward.
Growth isn’t relief. It’s responsibility.
And the real work of scaling is deciding which responsibilities you’re willing to own next: systems, people, decisions - instead of hoping the next solution finally makes things easier.
Some of the biggest growth opportunities I’ve seen didn’t come from doing more. They came from paying closer attention - to phone calls, handoffs, ownership, and leadership layers that quietly shape outcomes every day.
If you’re scaling and feeling more friction instead of more freedom, that’s not a failure. It’s a signal. And it’s worth listening to.
If you’re navigating growth and trying to decide which problems you’re willing to trade for the next stage, I’m always open to honest conversations about what that really looks like behind the scenes.
Sometimes clarity starts by simply talking it through.