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Going Fee-for-Service in Manhattan: Bold Practice Moves in a Tough Market | Dr. Fatina Shtivelman | 600

Going Fee-for-Service in Manhattan: Bold Practice Moves in a Tough Market | Dr. Fatina Shtivelman | 600

3/26/2026 6:42:11 AM   |   Comments: 0   |   Views: 53

I just had the founder of a boutique pediatric dental practice in Manhattan on the podcast: FaTina Shtivelman

From the outside, it looks like clarity and control.

Behind the scenes, it was years of second-guessing, empty schedules, hiring mistakes, and rebuilding the business model entirely.

Here’s what I learned:

        
  1. “Busy doesn’t mean productive, it just means occupied.”
        A full schedule can still hide a broken model.
        Being busy with the wrong patients or low-fee insurance can create more stress, not less.
  2.     
  3. “Fear disguises itself as strategy more often than we admit.”
        Most owners delay hard decisions because they’re afraid of short-term loss.
        Staying in-network “just in case” kept the practice misaligned longer than necessary.
  4.     
  5. “Your business grows at the speed your team stabilizes.”
        The first five years are less about dentistry and more about people.
        Hiring, training, and retaining the right team is the real operational challenge early on.
  6.     
  7. “What you tolerate early becomes what you manage forever.”
        Settling on team standards early creates long-term problems.
        Tolerating lateness or poor fit to fill gaps leads to constant turnover and friction later.
  8.     
  9. “Clarity removes more friction than motivation ever will.”
        Job descriptions, checklists, and expectations reduce conflict more than constant reminders.
  10.     
  11. “Unused time doesn’t disappear, it compounds into anxiety or progress.”
        Unstructured downtime becomes stress... structured downtime becomes growth.
        Empty schedule gaps were reframed into marketing actions, content creation, and systems work.
  12.     
  13. “Your team listens less to your words and more to your state.”
        Owners often underestimate how much their emotional state affects the team.
        Stress, tone, and body language directly influence culture and performance.
  14.     
  15. “The right patients don’t cost more, they value more.”
        Patients don’t leave because of price, they leave because of experience.
        Moving out-of-network reduced volume but increased quality, loyalty, and profitability.
  16.     
  17. “The simplest ask, delivered at the right moment, outperforms any system.”
        Asking directly still outperforms systems for obtaining reviews.
        Review requests converted significantly better when the doctor asked, not the team.
  18.     
  19. “Letting go isn’t losing control, it’s upgrading how control works.”
        Delegation isn’t about doing less, it’s about thinking differently.
        Letting go of control required trust, systems, and the right people, not just more effort.

Listen to the full episode here: https://thedentalmarketer.site/podcast/600

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