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Howard Speaks: Lean and Mean Dentistry by Dr. Howard Farran, DDS, MBA

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Categories: Practice Management, HR and Accounting;
Howard Speaks: Lean and Mean Dentistry

How low overhead, smart systems, and patient-centered care can transform your practice

by Dr. Howard Farran, founder, CEO and editor-in-chief of Dentaltown magazine
Each Howard Speaks article is written by Dr. Howard Farran with the assistance of AI. Every piece is developed, reviewed, and refined under Dr. Farran’s direction to ensure it reflects his authentic voice, insights, and experience.
Dentistry has always been a balancing act between quality care and business survival, but the recent economic climate has made that balance even tougher. Many dentists with 20-plus years in practice are seeing stagnant or even declining growth. Enter Lean and Mean, a practice management philosophy built around efficiency, lower overhead, and relentless focus on new patient flow.

Lean and Mean is not just another corporate dentistry playbook. Think of it as dentistry’s “E-Myth,” designed with the end in mind. Dr. Rick Kushner, the architect of the system and founder of Comfort Dental, has long argued that corporate dentistry only gained traction because private dentists ignored the basics: controlling overhead, simplifying systems, and creating patient-friendly access. When dentists ran bloated, inefficient offices with 80 percent overhead, businesspeople in suits saw opportunity. And they were right.

Lean and Mean offers a different path. The model emphasizes a steady stream of new patients, expanded office hours covered by partners rather than overworked solos, and a financial policy of “no pay, no work,” collections at the time of service, not months later. Emergencies aren’t disruptions; they are the fuel of the practice. Hygiene is reimagined as a profit center, supported by in-house membership plans and assisted by NERD doctors (New patient, Emergency, Recall, Diagnosis) to keep production flowing.

The philosophy is simple: low overhead, high efficiency, and teamwork. Comfort Dental has proven the concept, building the only dentist-owned franchise in the country, with equity partners rather than associates. Instead of selling out to corporate chains, older dentists can transition into Lean and Mean groups by selling partial equity to younger colleagues, creating win-win partnerships. Younger dentists, crushed by student debt, gain ownership opportunities without the trap of low-paying corporate jobs.

Patient communication is central. Lean and Mean offices use consult rooms instead of operatories for first interviews, take time to learn why a patient left their last dentist, and send handwritten welcome letters and referral thank-you mugs. Staff are trained to never say “no” on the phone. Do you take insurance? Yes. Do you take Medicaid? Yes. Do you have payment plans? Yes. Barriers are eliminated, trust is built, and patients feel like the practice is on their side.

Of course, not everyone warms to the model. Some dentists bristle at the expanded hours or the idea of giving up solo control. Others want pearls, not wholesale change. Yet time and again, those who adopt the system find themselves busier, more profitable, and better able to serve patients across socioeconomic lines. As one doctor put it, Lean and Mean isn’t about doing less for patients; it’s about structuring your practice so you can actually afford to do more.

Dentistry is, at its core, a team sport. With the right systems, four average dentists can produce what a superstar solo dentist might do, but with lower stress, lower overhead, and more sustainable profits. For new grads and seasoned veterans alike, Lean and Mean provides a practical, tested framework to build a future that doesn’t depend on corporate control.

So here’s the question: If you could redesign your practice today, would you choose the Lean and Mean path of lower overhead, partnerships, and patient-centered systems, or stick with the traditional solo model and hope the old way can survive the new economy?
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