HELP! My dental ship is sinking…

Dear Madow Brothers Coaches,

Things are so bad in my practice I don’t even know where to begin. I am producing close to a million dollars a year and collecting around $750K. This is considered really good for my mid-sized Midwestern town. But I am earning practically nothing. My hygienist and my associate are both earning more take-home than me.

Our new patient flow has collapsed, and we are losing patients to two new practices that have opened nearby. It gets worse.

My lab just cut me off because I owe them over $50,000. I owe money on two credit cards, and am still paying off a practice construction loan (when I can). Sometimes I feel like I am the captain of the Titanic and my staff is the orchestra, just blindly playing as the ship sinks. Can you help?

Dr. Jay
Somewhere in Ohio

Dr. Jay-

Wow – you sure have a lot of things going on there. So first of all, let’s make this clear. There are no coaches or consultants in dentistry who can wave a magic wand and fix your practice. Not us, not Roger, not Cathy, not Lois, not Mayer, and certainly not those people who call you every day, belittle you, and scare the shit out of you until you sign up. But the good news is, based on our years of experience, there is light at the end of the tunnel and it can be found. 

There is an old saying – “How do you eat an elephant?” “One bite at a time.” And while we are certainly not recommending or condoning eating elephants, this will be the way you need to approach things. That said, here are a few questions and starting points for you.

When you say that you produce close to a million and collect 750K, does that mean you are writing off a ton of PPO stuff? That is not necessarily bad, but the fact is, if you agreed to a PPO fee schedule you never actually produced at full fee. So that figure is a fantasy. If you are not talking about write-offs, you have a seriously bad collection problem that is adding considerably to your overhead.

If your associate is out-earning you, what is the point? Not every practice needs associates.

Why are you being beaten by those new practices? Our guess is that you are doing little about this, trying to depend on your reputation and word-of-mouth, Hint: It’s 2018. 

We can guess (and we are right) that you do not have an effective system to reconnect with your patients who have not been in for a while, do not have a hygiene appointment scheduled, or have diagnosed but untreated dental needs. And remember, any old system is not necessarily an effective one. 

Has an outside expert (such as an accountant who specializes in dental practices) reviewed your expenses and debt issues? It is pretty safe to say you are missing a lot here.  

Just a guess here (again based on experience) that if we called your practice posing as a new patient your front desk team would not make the appointment. We cannot even tell you how many times we have heard “Oh – my front desk person is fantastic!” only to call and be connected with Clueless Claire. 

And here is where it gets a little deeper. We have found that when we work with someone with a practice similar to yours (and we have done that lots of times) the problems are not just with the dental office. We always start with a pretty intense interview process, and nine times out of ten when someone has a similar situation there are factors that go WAY beyond new patients, collections, etc.

Yes – that means that there are some screwed-up things going on in their lives that are negatively affecting their practice. (Not to brag here, but we are the only dental coaches that go deep like that!) Of course that is not always the case, and we are glad to work with “just the practice.” But again, experience shows that outside factors typically contribute to this kind of stuff.

Bottom line – you need some help! This is not a situation you can fix yourself. Keep doing what you are doing and it is just a matter of time before there is a padlock on your door and a “For Rent” sign in the window. Let’s make sure that doesn’t happen!!
Coach Rich
Coach Dave


Dr. David Madow and Dr. Richard Madow are actual dentists who have been helping dental offices become more successful for over 28 years. They are down to earth, real people who personally connect with their clients and are proud to call them friends. If you have a question for this column, please write to them at We are now offering a complimentary 30-minute coaching session! Please CLICK HERE to schedule yours. Doctors only please.

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Slightly disappointed

Yes – we are slightly disappointed. In your office? Maybe. But it’s okay – it’s not too late.

You see, a few weeks ago we set out to call a bunch of practices that have attended“TBSE – The Best Seminar Ever” recently to get their opinions on some things. But the project was pretty much a flop. Why?

Fewer than half of the offices we called even answered their phones! And this was during normal business hours. Instead we received voice mail messages like:

“If you are hearing this message during regular office hours, we are currently serving other patients.”


“We are currently at lunch.”


Sorry to tell you – this is simply not acceptable. The phone is where 99% of your new patients make their first contact with your office. Way too many people tell us they need more new patients, but more often than not, that is not their real problem. If your phone isn’t answered EVERY time it rings during normal business hours (and yes – that means during lunch and during your day off) you are losing new patients you never even knew existed.

How do you make this happen? That’s a lesson for another day. And honestly – you are smart enough to figure it out!! But for now, listen to our friends from Sugar Ray, and answer the phone!!

Say this, not that…


“We would love to see you as a patient in our practice! Would tomorrow at 3:00 PM or Tuesday at 11:00 AM be better for you?”


“Would you like to make an appointment?”


“I know what the problem is and I can help you.”


“This tooth needs a crown.”


“Would you mind if I place you on a brief hold? I’ll be right back and able to give you my full attention.”


“Dental office – hold please….”


“We have some fantastic financial options to help make the cost of treatment more comfortable.”


“Sorry – it’s not covered by insurance.”


“Hello Mrs. Costello, I’m Dr. Luther. What may I help you with today?


“Open wide please…..”


“Thank you for calling Hill Valley Family Dentistry, this is Lorraine – I can help you!”


(Voice mail answers) “If you’re hearing this message during normal practice hours, we are busy treating other patients…”


“When you return for your next cleaning and examination in three months, we want to pay close attention to that area on the lower right to make sure the inflammation is under control.”


“You’re due for a check-up in six months.”


“If you were a member of my own family, that is the treatment I would recommend.”


“If you can’t afford a crown we can always do a large filling.”





Think about it

Picture this. You are presenting a treatment plan to a patient. Everything is going great. You think you have it wrapped up. But then they pull out the dreaded excuse…

“Let me think about it.”
You know from past experience that whenever you hear this objection there is a 99% chance this patient will turn into a ghost, not to be heard from in ever again.

Up until now you have tried all of the crappy comebacks that the two-bit consultants have taught you over the years but you know in your heart they just don’t work.

Today we are going to give you a new response to “Let me think about it” that should take care of this problem once and for all. It has proven to be very effective in our testing.

Can you guess what the best response to  “I need to think about it” may be?

Here is our suggestion:  DO NOTHING!

That is correct. When a patient tells you that they need to think about it, you know damn well it’s simply a stall tactic. There is something else on their mind but they are not saying what that is. Maybe it’s financial. Perhaps they are worried about the actual procedure. Pain. We are not sure.  If you just let them go and tell them it’s ok to think about it, you will not hear from them in 99% of the cases.

So try this. When they tell you they need to think about it, don’t say a word. That’s right… just keep quiet. You can look at them or look down a little bit. Or a combination of the two. Your body language must convey that you are concerned. But remember…

Do not say anything!

So what will happen next?

After a short time, your patient will feel very uncomfortable with the dead silence. Human nature is such that we want to fill in silence with words. So he or she will begin talking.

Once he begins talking, he will normally make his objection very clear and oftentimes come up with a solution without you even getting involved.

For example after a period of silence he may say “I don’t have the money at the moment but I am getting a fairly nice inheritance in October so would it be okay to wait until then?”

Bingo! You win.

Your response is “Sure Mr. Jones, why don’t we have Madge set you up right now for mid October?” Then have Madge give Mr. Jones two good options on dates and times and you are all set. You have treatment scheduled that in the past never would have happened.

Understand this. The silence at least gets them talking. Then it’s up to you to take the objection that comes up and turn it around and come up with a solution.

Will this work 100% of the time? Of course not. But we do guarantee it will increase your acceptance MUCH MORE than what you have been doing up until now.

Did you like this tip? Our goal is to make you more profitable! Please stay tuned for more answers to some of the most common objections in dentistry! We want you to be incredibly successful, and knowing the best responses will be a tremendous help to you and your practice! Stay in touch!

Stop Cancellations On The Spot!


It’s a constant problem in dental practices – a patient calls at 10:00 AM to cancel their 2:30 PM appointment. What do you do?? Can the appointment be saved?


What you DON’T want to do is get into a fight with the patient or start asking them a million questions about why they can’t keep the appointment. They will most likely get defensive and nobody wins.


So what do you do? Here is an amazing trick that is simple to do and actually saves around fifty percent of your last minute cancellations!! When the ubiquitous Mrs. Jones calls to cancel, simply say:


“Mrs. Jones, please allow me to put you on a brief hold while I retrieve your patient record.”


This is pretty much the ONLY time we recommend putting a patient on hold. Keep them there for around two minutes while you look at their record and have a brief conversation with the doctor or hygienist if necessary.


They are now listening to your great on-hold message, getting a little squirmy, and feeling kinda guilty. Then come back and say…


“Mrs. Jones, thanks for your patience. It looks like we have you scheduled for a thirty minute appointment to do a tooth-colored filling restoration on the lower right. Dr. Sardonicus is CONCERNED that if you don’t get this taken care of as soon as possible, the decay can grow and cause an even bigger problem which will need more extensive treatment. Is there any way possible you can keep this appointment?”


Do the same for hygiene, but say something like…


“Your hygienist Becky is CONCERNED about the area of inflammation and infection on the upper left.”


Amazingly, using this technique saves around fifty percent of those pesky last minute cancellations. That is good for your patient, good for your schedule, and money in the bank!!

This Dental Practice Is Transforming Lives

A short time ago we received a Facebook message from Becky Kaiser with Discount Dental Services in Denver. Hearing a message like this makes it all worthwhile. We felt we had to share this with you! Please enjoy.
Dear Madow Brothers,
I wanted to tell you a little something about the new office Dr. Nack started last April. I love the concept and want to know what you think.
Dr. Nack had a ‘very’ successful practice in Parker, CO for many many years. I was his office manager. My daughter his EDDA. In 2010, Dr. Nack retired as the ripe old age of 53. I retired as well, but was much older! He and I remained friends. After a few years of missing our ‘calling’ we decided to open a low cost dental office. Dentistry had been good to us, now it was our time to pay it forward!!
The challenge we faced was how could we do this with little cash to start a dental office? Dr. Nack spread the word. Soon, he found other offices willing to donate things to him, including chairs, a Pano, x-ray machine, sterilization machines, etc. He was able to find a low cost office across the hall from a doctor who feels the same about medical as we do about dental.
BUT, Dr. Nack wondered, how do you pay a staff when you are 95% Medicaid? He brainstormed and prayed on it. Eventually it happened. EVERY person working in our office is paid a small percentage from collections! Not production, which isn’t much! We are NOT employees, we are ALL independent contractors, working at the office because this is where we WANT to be. It definitely is not for the small pay check! We come in and work our own days and hours. No one has a set schedule, except Dr. Nack, who is there from 9:00 a.m. to 7 p.m.
You would think he wouldn’t have many “independent contractors” willing to do this, working for cents on the dollar, rather than a salary! I thought the same thing at first. When the word got around, we had more people than I ever dreamed who wanted to come and be part of “our team.” Dr. Nack makes it SO fun and rewarding, that people just WANT to be there.
I am proud of what Dr. Nack has done. I have seen him take former drug addicts with “meth mouth” who always had a constant reminder of their past every time they smiled, and has given them a new smile and a whole new outlook on life and their future. These people come in with broken spirits. Dr. Nack helps to convert them into functioning, happy, and productive individuals.
I just wanted to let you know that in these times of greed that there are still many great dentists who genuinely care. It’s so much fun to watch people transform their lives in just the little bit we do for them. I wanted to share our story with you, because you both were part of Dr. Nack’s inspiration. Please use this as an open invitation to come visit our beautiful office anytime you are in Denver. Thank you so much.
Becky~ from: Discount Dental Services in Denver, CO…(we were formally Soft Touch Dental in Parker, Colo.)
Becky – thanks SO MUCH for sharing such an inspirational story. It sounds like you, Dr. Nack, and the rest of your great team have the knack (sorry but we couldn’t resist) for opening your hearts and giving back to your community in a big way. Stories like this make us feel so good. Keep up the good work. We hope to see you guys again at TBSE later this year. We would also love to feature this story in our TBSE program.

Why Patients Leave

Mrs. Johnson is a relatively new patient in your practice when a lingual cusp on a lower molar snaps off, necessitating a crown. She trusts your practice, so she goes ahead and schedules the crown even though her best friend Gloria tells her that another dentist in town has a crown fee that is two hundred dollars lower.

The appointment for the prep and temp goes well, but at the insert visit the crown has a slight open margin. The decision is made to do a new impression and reappoint. The patient comments how difficult this is with her schedule, but has no choice but to make the appointment.

The second try goes well and she leaves with a beautiful new crown, but Mrs. Johnson has some moderate (yet typical) post-op discomfort. She didn’t realize at the time that a little pain after any dental procedure is not unusual.

No one hears from Mrs. Johnson until four months later, when a confirmation call is made for her upcoming hygiene appointment, at which point she says:

“Oh – I won’t be coming back in anymore. My new office will be calling for my x-rays.”

So what went wrong?

Were your crown fees too high? Was she disappointed in the clinical abilites of the office because the first crown didn’t fit well? Was it that the second impression and insert was too much of an inconvenience? How about the post-op pain?

According to international consulting giant Bain & Company, “A customer is 4 times more likely to defect to a competitor if the problem is service-related than price- or product-related.”

So while this patient probably wasn’t too happy about several things, if a few simple service-related procedures were done correctly, they probably would have stayed.

The doctor didn’t call the night of the crown prep to check on the patient. They didn’t properly explain that while it was possible to cement the first crown, to get it really perfect would mean a new impression (while apologizing for the inconvenience.)

And a patient-centric office would overplay the fact that there would be post-op pain. That way, discomfort is expected and no discomfort makes you a hero!

So before we let you go for today, let’s just repeat the lesson of the day:

“A customer is 4 times more likely to defect to a competitor if the problem is service-related than price- or product-related.”

How would you read this sentence: “I think you need that crown.”

We all love email. And we love social media! We have been recommending regular communication with your patients for quite some time now, right? One thing we never discussed is how careful you need to be with your words in an email or anywhere else online.

Question: Do you know how to read music? If you do, you know that when you’re reading music, you’re actually reading at least two things simultaneously. Written music tells you what note to play and when to play it.

Written language, on the other hand, only tells you one thing – what letter to pronounce. Of course, punctuation helps indicate pacing – pause at a comma, stop at a period (no one is sure what to do at a semicolon), but it’s still up to the reader to interpret how the author wanted the piece paced.

Look at the sentence below:

 “I think you need that crown.”

What does it mean to your patient?

Be careful, because it may mean different things to different people.

For example, read the following sentences aloud and place the emphasis on the bold-faced underlined word. You’ll see how the pacing and the meaning can change based on where you choose to place the emphasis.

I think you need that crown.

think you need that crown.

I think you need that crown.

I think you need that crown.

I think you need that crown.

I think you need that crown.

You see, written language does not retain the intonation or have the inflection that spoken language has.  That’s why sarcasm and irony seldom works well in print or static online advertising. (Be careful with your Facebook posts – we have likely pissed many people off without meaning to do so!)

It’s one thing for you to add your own inflection to a treatment plan presentation when you have the patient right in front of you. But if you are communicating in writing or electronically, please be super careful.


We Hope You Don’t Have This…

Eric Clapton had the “Bell Bottom Blues.”

Bob Dylan had the “Subterranean Homesick Blues.”

The Rolling Stones had the “Stray Cat Blues.”

Jim Croce had the “Workin’ At The Car Wash Blues.”

And too many dental people have the “Sunday Night Blues.”

How did you feel yesterday? Bummed out? Did you have a negative feeling about coming to the office today?

Is you attitude ever “Two more hours to go” or “Thank God it’s Friday?”

If so, you may have the Sunday Night Blues. Can it be cured?

First of all, it certainly can’t hurt to wring all the fun possible out of your weekends. Do your favorite things – whether they be outdoor activities, immersing yourself in music or art, visiting neighbors, cooking, attending a sporting event – it doesn’t matter. The main thing is to make sure you don’t mope around the house feeling sorry for yourself.

But the main cure for the SNB is to realize that you spend a heck of a lot of time at work, and it should be fun!

There is no denying that dentistry is a very stressful profession for both doctor and team. But the more successful your practice, the more you truly love and help your patients, and the more you work on making sure that your practice runs well, the happier you will be. Life’s too short to have the Sunday Night Blues! If you are a sufferer, you owe it to yourself to figure out why and most importantly – do something about it!!

Watch for an upcoming blog post that will truly help the entire team beat the Sunday Night Blues!!!