Practice Profitability by Dr. John Nosti

Dentaltown Magazine

Changes in these top factors can help your numbers rise

by Dr. John Nosti

When it comes to profitability in your office, there are multiple factors to consider—much more than just cutting expenses. For the past 20 years, I’ve been fortunate to be in a dental partnership where our offices’ overhead averages 50% (and many years has been below this). All the while, my partner and I have practiced the way we wanted to practice, and used the latest and greatest technology and the materials that we desired. The following are some key factors I’ve come to understand that are crucial to develop a more profitable practice.

A strong foundation of education
If there’s one place to start (if you look at increasing profitability as a step-by-step process), education is that “must” first step. Dentistry’s variety of options and areas allows you to create a niche practice or to have a phenomenal bread-and-butter practice.

Even performing “just” bread-and-butter dentistry requires someone to be knowledgeable in prevention, restorative dentistry, periodontics, endodontics, and fixed and removable prosthodontics. To become more niche, you’d add specialties and subspecialties of orthodontics, implants, sleep dentistry, TMD, cosmetic dentistry and advanced prosthodontics that surpass the general fixed and removable genres and deal with full-mouth reconstructions. All of these are part of an ever-changing field, which requires constant education to remain at the top.

Being highly educated allows you to be more thorough, to create more options for the patient, and without a doubt to be more confident in the options you present. (Confidence in your plans is something I’ll circle back to later in this article.)

There are so many excellent opportunities to advance your knowledge of dentistry, through both live and virtual continuing education platforms. The investment I made in a high-quality program geared in advancing my education in occlusion and cosmetics have paid me a hundredfold over my initial investment and set the foundation of my practice focus.

With the explosion of the virtual world, hundreds of CE opportunities are available for you to watch and learn from the comfort of your home. Dentaltown’s online CE platform offers fantastic, cost-effective courses. Looking for something at no cost? Visit the dedicated message boards of the subspecialty of interest (cosmetic dentistry, removable prosthodontics, implants) and search through the thousands of threads available. Many threads are put there by the same educators who put on CE courses themselves, and are there to help advance your knowledge.

Don’t overlook the importance of training your team, too—after all, you’re only as strong as the team you surround yourself with. You can be a very highly educated doctor, but if your team isn’t on the same page as you because of lack of training, you’ll surely be spinning your wheels. Treat your team as you would yourself and make sure they’re masters in their fields. The best place for your team is most likely with the same education you have been focusing on. Does the program you took part in offer team training? If so, that would be an excellent place to start. Don’t just send your team to the free CE courses provided by insurance carriers in your area, or the local specialist office; choose their path as you would choose yours. Whether you want to be a rock-star niche practice, or the super general dentist, education is your jump-off point.

Presenting options
Patients love options! Being able to offer patients several options for their treatment not only makes you look like an expert but also increases your case acceptance, simply because you’ve offered the patient options to choose from. Countless times, I’ve heard from patients whom another practitioner had offered only one option; because I offered them several, they felt more comfortable with me and choose me to perform their dentistry. If you have a problem formulating treatment plans or providing options, continuing education focused on comprehensive dentistry and treatment planning would be an excellent place to start your education.

The second part of “presenting options” follows the adage “don’t judge a book by its cover.” Never assume what a patient wants, or that they want the cheapest option. I like to call this “Freedom in Presentation.” Allow yourself the freedom to present the moon and stars to the patient and allow the patient the freedom to choose the option that’s best for him or her without prejudice. I always say the best option is the one that is right for the patient, and who gets to determine that? The patient.

This will lead into our next topic: How do we know what the patient truly wants? Ask great questions to understand their values and desires. This will allow you to form a treatment plan with alternatives to their values.

Patient acceptance
This one topic always has mystique surrounding it, with lectures, articles and countless training seminars dedicated to it. It’s like the Holy Grail of dentistry. I’m here to tell you that, yes, case acceptance is crucial, and there can be certain nuances that affect the patient more than others; however, it isn’t as difficult to find as the lost city of Atlantis. I believe there are two or three crucial areas that will have your patients saying “yes” more often than “no.” Here are the top two.

Case acceptance starts with being knowledgeable about the patient’s condition(s) and the options for treatment. This is why your education level and your ability to present options precede this topic: These factors increase your confidence in how you talk to patients and present their care. In my opinion, your confidence alone will have the single greatest result on your case acceptance percentage than anything else. With knowledge comes a level of confidence, and with experience this confidence will grow.

Second is your ability to ask questions and understand your patient’s “why”—why are they there? why do they want the treatment?—and your ability to communicate why they need the treatment. Questions lead the way.

For example, a common interaction that occurs in my office surrounds the cost of treatment. When I present a fee, I often hear the response from the patient being, “I didn’t expect it would cost that much.” Now, you can respond and justify your reasons why treatment costs are what they are, but I’ve found it to be more effective to respond with a question. Politely and nonconfrontationally, I ask, “May I ask what cost you had in mind?” Very commonly, they respond, “I have no idea,” to which I reply, “Well, there must have been a figure you had in mind, if my cost is expensive.”

Quite often their response is, “I really had no idea,” to which I jokingly add, “Maybe my treatment is too cheap!” All through the interaction, I continue to ask the patient additional questions to better understand them. (A great book on this topic is Change Your Questions, Change Your Life by Marilee Adams.)

Once the ice is broken to how much your treatment costs, regardless if it’s a single crown or a full-mouth reconstruction, a great question to ask next is: “If we can find a way to fit this treatment cost into your budget, is this treatment something you would like to complete?” This is a yes-or-no answer.

• If the patient says yes, then it’s up to you—or, more likely, your treatment coordinator/office manager—to figure out a way for the patient’s treatment to fit into his or her budget. You should have several options, including third-party financing or a local bank that works with your patients, as a solution for treatment costs.

• If they respond with “no,” then circle back and make sure patients fully understand your recommendations and why they need the treatment you’re recommending. Refrain from questions like, “Do you understand what/why I recommended?” because patients will almost always say yes to this, even if they don’t understand, because saying no implies they don’t understand or aren’t intelligent enough to grasp your explanations. A better question to use is, “Did I explain that well?” This allows the patient to freely say no and for you to come up with another explanation to the “what and why.”

Evaluating expenses
Expenses in the dental practice are always more than meets the eye. Sure, we have fixed costs, such as staff salaries, rent and materials; however, I believe these are fixed expenses that quite often can’t be changed or don’t greatly affect profitability. The commonly misunderstood expenses I love to talk about are down time/open chair time, procedure times for the dentist and hygienist, lab remake percentage, and procedures that the dentist is performing that should be handled by auxiliary members.

The doctor and hygienist are arguably the two highest expenses in a dental practice … and considered by many to be the only producers, as well. An important team member not to overlook is the dental assistant, who can reduce the time patients spend with both the dentist and hygienist by being the one to break down or set up the room and take radiographs. Likewise, depending on your state, dental assistants should be performing as many procedures as possible to become a third producer in the practice. Procedures like study models, night guards and bleaching impressions, bleaching trays, retainers and night guard fabrications—as well as placing direct restorations, if your state allows—change your assistants into producers.

Are you performing enough indirect dentistry? When evaluating practices, consultants want to see that 7–10% of your overall overhead goes to lab expenses. If you’re running higher than this—for example, a prosthetic office should be at least 15%—then you may have a phenomenal practice performing a lot of indirect dentistry. If you are operating less than the 7–10% range, you should evaluate and potentially look to increase these services as a way to both add an underserved area in your practice and increase overall profitability.

Evaluating capacity and systems is a subgroup that should fall under expenses. Many doctors are overstaffed or have far more hours than necessary in their hygiene or associates scheduled, based on the number of true patients they’re caring for in the practice. Doing a careful analysis of how many patient hours are needed for hygiene and ensuring you are maximizing your producers’ schedule by having effective systems in recare, scheduling, case follow-up and follow-through, and managing cancellations is an important consideration in optimizing profitability. 

Cutting chair time is often overlooked as a way to increase profit and decrease overhead. This isn’t just about being “fast,” which can result in sloppy work—it’s about becoming more efficient. How long does it take to seat a crown? Are you using an electric handpiece to optimize your performance and speed? Are you familiar with the procedures and materials to increase your efficiency and prevent failures? There are systems to add that will allow you to perform more efficiently, which will in turn reduce chair time and overhead.

Are you unsure how long procedures should take? Ask other dentists. There are tons of chat boards, social media groups and online learning platforms to use as a resource for this. Dentaltown’s message board is an excellent source for this, as well as the magazine. Are you aware you can perform searches for magazine articles and message boards for the topic you desire?

Marketing plan
Whether you want to have a niche practice or the best general practice around, it requires an effective marketing plan. Gone are the days to hang up your shingle, or having a website alone, and expect to have a full schedule. You now require an efficient marketing plan that involves both internal and external marketing.

If you want a niche practice, do the walls and area of your practice speak its language?

• Do photo albums, pictures or articles on the walls let the patient know that your office is the go-to for that particular service?

• Do you have patient testimonials, or videos of them sharing their stories?

• Does your website have the same stock photos as other dentists, or is it filled with your actual cases?

Having a social media presence cannot and should not be overlooked. There are companies that specialize in running these venues for you at reasonable rates; better yet, one or two of your employees must have a great handle on Facebook or Instagram. Give them a bonus to be the media representative of your office. Post recently completed cases, new patient experiences, a child’s first visit, etc. Even print media, such as magazines dedicated to your practice, can be very effective.

When I speak with many individual practice owners, the most common plan is not having a plan at all. According to experts, the average small business comparable to a dental practice should spend a minimum of 4% of gross revenue on marketing, with many experts recommending a spend of 7–8% on gross revenue. How does this compare to what you are currently spending?

It’s true that there is no cookie-cutter process that builds a highly successful practice, but one also can’t stand still and hope that a practice magically becomes more profitable. Decide what you’d like your practice to be and create an action plan to achieve it. With these simple steps and guidelines, your practice should be able to continue to grow and increase your profitability year after year.

Check it out!

Discover more about practice success and earn CE credit
In his course Keys to Your Success, Dr. John Nosti shares concepts that have helped him practice with less than 50 percent overhead. To learn more and earn 1.5?credits of CE, head to

Author Bio
Author Dr. John Nosti practices in Mays Landing and Somers Point, New Jersey, and Manhattan with an emphasis on functional cosmetics, full-mouth rehabilitations and TMJ dysfunction. Nosti is the clinical director of the Clinical Mastery Series, geared toward advancing knowledge in occlusion, aesthetics and restorative dentistry.


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