Today’s question involves a simple no-cost strategy for practice growth

Madow Brothers,

My practice seems to be a bit stagnant and I am worried about the trend, but don’t want to add a lot to my overhead either. What did you guys do to grow your practices that didn’t cost a ton of money?

Dr. H. Jebko
Provo, UT

Great question Dr. Jebko!

There is one answer that pops into our heads immediately. But first, let’s address something else. You say you want to help your practice grow but don’t want to add to your overhead, and that makes sense. But please don’t forget that there is a huge difference between adding to your overhead and investing in something that generates a positive return on your investment.

For example, if you go to your local dental meeting and some slick salesman talks you into buying a gadget that will supposedly take away your patient’s facial pain by holding it up to their TMJ, wiggling it around a bit, and reciting the “hamotzi,” well shame on you. You just added $20,000 to your overhead.

But if you were ready to invest in a new marketing campaign, a great clinical course that meets a true demand you were not previously servicing, or really effective coaching, the return on investment should be positive and you did not add to your overhead. Does that make sense??

Okay – now back to your main question. When we were both young practitioners, we actually lived on the same street. Not in a compound like The Kennedys, but a few doors down from one another. Even though our practices were separate, one of our rituals was to meet up every evening, even just for a few minutes, and discuss what happened in our offices that day. If something really worked well we would share it, and sometimes even more importantly, if something was a total disaster we would advise the other one to avoid it!

Little did we know it at the time, but we were doing a very early (and small) version of a “Mastermind.”

We went on to form a larger mastermind group with some dental friends, calling it the “Maryland Bridge Club!” We would meet at a local restaurant every month (and sometimes due to the punny name they would have card tables set up in anticipation of a bridge tournament!). There weren’t many rules – just that we were there to help each other (no typical catty dental competitiveness) and that nothing was held back. The spirit of sharing both triumphs and goof-ups was amazing, and we all benefited so much! The power of this group was so much stronger than the individuals in it.

So Dr. H – if you want to do something that will help your practice immensely without spending a lot of money – form a mastermind! You will also get a great feeling when your input helps others in the group. Call a few dental friends and set up the first meeting. But here is the warning – only get involved with people who truly understand the concept of the mastermind. If someone is there just to steal ideas and not help everyone else, the mastermind is poisoned.

And if you (or anyone else reading Coaches Corner today) is interested, in just a few weeks we are having our very own “Madow Mastermind” – and you are invited! You see, a few times a year we have masterminds for our private coaching clients, but every once in a while we hold one where you don’t have to be one of our coaching practices to be invited.

This is an incredible opportunity to share and learn with some fantastic dental minds from across the country, including us! It’s an amazing day that starts in the morning and doesn’t end until we cap off the night with a fantastic dinner filled with idea sharing, camaraderie, and laughter. (Last time we did this the ideas were flowing so fast and strong we stayed until the restaurant folks had to ask us to leave!!)

Wanna join us? Well hold on pardner – not so fast! You do have to meet one requirement. And that is – you need to be having some kind of struggle or challenge in your practice or life that you would like to share with the group. (Yes – personal struggles are welcome as well.)

It takes place on Friday March 16th in Baltimore, MD, and we are limiting it to eight dentists. We haven’t really announced it yet and four people are already signed up (and to be frank, we have turned down a bunch…)

The cost for the entire day, including lunch and dinner, will be $497. And of course you need to get yourself to Baltimore!


If so, then simply CLICK HERE TO RESPOND and let us know three things.

1. What you would like to accomplish during the Mastermind. In other words, what is your goal or your struggle that you need help with?
2. Your personal email address. Not your general office email. We need the one that goes directly to you.
3. Your direct mobile phone number.

If the link above does not work, the email address to reply to is

We would love to see you there, and spaces are truly limited. If you are interested, do it now!! See you at the “Madow Mastermind!”
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.

To sign up for our mailing list CLICK HERE

Forward this article to a friend


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.

To sign up for our mailing list CLICK HERE

My hygienist is retiring – what should we do?

Dear Madow Brothers,

After 21 fantastic years in the practice, my hygienist Susie is retiring. She has treated several generations of patients here and everyone loves her.

Should I send an email blast out to our existing patients (coming from her) telling everyone of her retirement, or just inform patients the day before their recall appointments that “Susie retired, Ms. Schtupalot will be seeing you today!?”

On one hand I don’t want my patients to claim I did “not inform them”, but on the other hand I don’t want to give them an opportunity to start calling around to find someone else “closer to home” for their cleanings.

Thanks for your advice,

Dr. Mitchell Josephs
Palm Beach, FL
Dr. J,

This is a great question, and the answer could go one of two ways.

You could just do nothing, and inform your patients when they come in for their appointment by saying something like,

“Mrs.Yenta, Susie has retired, and although we didn’t think we would ever be able to replace her, we were so lucky to have found Linda. She is fantastic and you will love her!!” To avoid the “you never told me” syndrome, you could also inform patients of this during their confirmation. 

Or….. you could use this opportunity to proactively introduce your patients to the new hygienist and get some excellent goodwill out of the situation!

Have an open house retirement party to honor Susie and introduce everyone to your new hygienist. Thank all your patients for their loyalty and friendship. Have some giveaways, etc…. After doing that, why would they go anywhere else?

The decision may rest on the character of your practice. Although this is a gross generalization, an insurance-dependent practice where most patients are there because of “a list” would be more likely to go with option number one. In a pure FFS practice – the second plan would work better.

The bottom bottom line is – if you have done all of the “little things” right and have developed a high level of patient loyalty, patients understand that changes in personnel happen, and should be more than willing to give the new hygienist a chance.

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.


Okay – time for another restaurant story. It’s a quick one that can have some serious implications for your practice!

At checkout in a local Baltimore lunch spot:

“Would you like anything to drink?”

“Yes – coffee please.”

“We don’t serve coffee here – but a lot of people ask for that.”

Okay – just for effect let’s repeat that line again.

“We don’t serve coffee here – but a lot of people ask for that.”

If there ever was a “duh” moment – this is it! Buy a commercial coffee maker for a few hundred bucks, or even easier, call a coffee service and tell them to set it up today!!

When our practices were young we both had a “policy” – no cleanings on the first visit. Yes – we knew that clinically that was the best decision. After all, how can you properly appoint a patient with the hygienist without an examination?

But after losing hundreds of new patients due to this policy, we both loosened up a bit and realized the number one customer service lesson in history –

Give the people what they want!

What do you hear yourself saying on a regular basis?

We don’t have Saturday hours.
We don’t take that insurance.
We don’t do cleanings on the first visit.
We don’t have a financial solution for you (so you can’t afford treatment).
We can’t get you in today or tomorrow.
We don’t do even simple orthodontics here.
We don’t do cleanings on the first visit.
We don’t.
We can’t.
We won’t.

Want your practice to grow?

Do. Can. Will.

A simple lesson. Yes.

The answer is “NO!” Now what is the question?

A short time ago we were at lunch with a coaching client at a Chinese restaurant near their office. (Some of the best ideas are generated during lunch meetings!) They were excited to take us there because they were a “regular” and knew we would get great treatment.

“The lunch special comes with an egg roll. Is it possible to get a spring roll instead?”


“Can the Szechuan green beans be made with no sauce?”


“Can brown rice be substituted for white rice?”

(Care to guess the answer?)

“NO!” (At least they could have said the classic “One dollar extra!!”)

No exaggeration here – this really did take place. And then it got worse.

Someone came in and asked, “Do you sell gift cards here?”


What if that customer bought five $50 gift cards for his co-workers? That would have meant a $250 sale. Then what if one of the recipients had never been there before, and loved it so much they became a regular customer, bringing in their family ten times a year for an $80 dinner? And then what if….you get the picture!

So, every time someone in your practice says “no” – you could be missing a similar opportunity.

Even if the answer is technically no, at least try to turn it into an opportunity. Here’s an example:

“Does Dr. Garvey have appointments on Wednesday evening?”

And he doesn’t. But instead of saying “NO!” – how about something like this.

“Oh – sounds like daytime appointments are tough for you, is that right? Well we start at 7:00 AM on Mondays and Thursdays, and our new doctor, Dr. Grant, sees patients on Saturdays. Which works best for you?”

A little creativity and positivity go a long way!!

One of the most typical examples is “Do you take my insurance?  It’s a PPO and I don’t see you on the list.” The typical response to this is “NO.” Then the conversation ends.

How about trying this instead?

“While we are not a member of that plan, we are an unrestricted provider with all insurance plans. That means you can still come see us, and we will give you the best dental care possible. You can pay us directly and we will help you maximize your insurance benefits with that company.

Would you like to come in for a no-charge consultation? That way you can meet the doctor, she can answer any questions you have, and we can explain exactly how we can make financial arrangements comfortable for you! Is tomorrow at 11:30 AM convenient?”

Granted – most people on a ‘list’ will say no to this, but nothing is lost. And sometimes someone will say yes, become a great patient, refer lots of others, and well – you can figure out the rest!

Sometimes it’s the simple, easy things that can help your practice grow. And to that we say “YES!!!”

His Fly Was Down

Recently our friend Sally got to meet a Nobel Prize nominated physicist.

She said that he was incredibly intelligent, articulate, funny, charming, and if that’s not enough, really good looking! But what was the main takeaway – the think she mentioned first and couldn’t stop talking about?

His fly was down.

There is a thing called “Negativity Bias” – a psychological phenomenon by which we have greater recall of unpleasant things than positive ones. It was first proposed and published by psychologists Paul Rozin and Edward Royzman in 2001 and has been confirmed by many follow-up studies. It’s why, for example, five minutes of turbulence and a screaming baby are what someone would remember from a five hour flight that arrived on time and landed safely.

It’s also why a cranky, unhappy patient is more likely to write a review online. And it’s why we have to do so many little things right, or the patient will remember mostly the bad.

Run late, cause pain, estimate insurance incorrectly, etc…. and there is a great chance negativity bias will undermine your otherwise excellent treatment.

What are you doing in your practice to cause negativity bias, and how can you correct it?

A simple thing to remember…

As dental people, we see all kinds of folks in our practices. And many (possibly most?) are extremely kind and appreciative.

But then there are others who are almost impossible to please. They can be combative, grumpy, or downright nasty. And that is why we always need to remember something.

Many of our patients would rather be anywhere other than the dental office – but that doesn’t mean they are bad people. And quite frequently we are seeing people at their worst.

So you can walk around all day calling people names, and asking things like “Why can’t every patient be like Mrs. Jones?”

But the thing is – the worst patients need the most loving – and when you give it to them you can transform their lives AND your practice.

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!!


Is there trouble brewing at your office in the form of patients not accepting their treatment? This may be the reason.

One hundred years ago, Schlitz Beer (remember Schlitz??) became the number one selling beer in the country by running a radical marketing campaign. Their ad detailed how Schlitz beer was actually made. Since no one reading the ad previously knew how beer was made, they assumed this was some kind of proprietary process – and Schlitz’s sales quickly rose to the top! It became known as “The beer that made Milwaukee famous!” (Or was it “the beer that made Mel Famey walk us?”)

Fast forward to 2017. Do beer ads describe the brewing process in detail? No way. They show attractive twenty-somethings at the beach. They show beautiful crispy-clear snow-covered mountains. They show majestic horses. The goal is to get a feeling attached to their brand, so when you pick up a six-pack of Budweiser you are transported from your dull, ordinary life to a place you would rather be. We all know it isn’t true, but with annual US beer sales topping $100 billion, it seems to be working!

So what’s the point? Your patient doesn’t want to hear about how the crown is made, how the implant surgery is done, and what their composite resin is made of. They want to know how it will look, how it will function, and how it will make them feel!

Get excited about how your dentistry will transform your patient! And if you can get them equally excited, go pop open a beer!

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.”