Author: Frankie Holman, Jr.

Most practices reach a point where they are busy enough that the doctor considers the day full. The team is working consistently. Treatment rooms are active. The day moves forward without obvious downtime.

At that stage, it is natural to assume that growth requires expanding the practice or adding more clinical time or days. In many cases, that assumption is inaccurate.

Often, the real limitation is not referral flow. It is teamwork and operational factors. A practice can appear fully booked while still operating significantly below its ideal capacity. When that happens, growth quietly plateaus — not because of the market, but because of internal ceilings that have gone unexamined.

If you want to expand productivity without expanding stress, you must first identify where your growth ceiling actually exists.

In endodontic practices, routine can quietly take over. Diagnostics, treatments, scheduling, and collections repeat day after day. While efficiency matters, slipping into autopilot is one of the biggest barriers to long-term success.

Do the math: 5 patients a day, 180 days a year, equals 18,000 patient visits over 20 years. Without focus and intentional systems, those thousands of encounters risk becoming repetitions instead of opportunities for growth. The difference between coasting and thriving lies in how deliberately you run your practice. 

Five areas make the greatest impact:

We all know the ABCs of referrals – A’s are our lifeblood, the valuable few we cherish and fear losing. B’s are the middle ground sending enough cases at least that we count on them. And C’s? Well, they’re the wild cards who refer so infrequently that we’re probably just a backup option when their regular endodontist is unavailable.

What if there’s a deeper game to play though—one where your marketing coordinator takes a key role to drive referrer growth?

Think about it: A’s are crucial, so naturally, we task our marketing coordinator with nurturing those relationships like gold. But what if their efforts could go beyond just maintaining the status quo? What if, instead of just babysitting existing referrers, we empowered them to unlock growth? Even if your A’s are already referring diligently, there’s always room to elevate those connections. And let’s face it, if your A’s are shrinking, you definitely need a proactive strategy.

Beyond the A’s, imagine the transformative power of shifting just a few B or C referrers into the A category. What’s the immediate value when a doctor goes from referring a half dozen cases annually, to referring 12, 20 or more? Now consider the compounded value over five years if you consistently elevated even a handful of these relationships annually to the A category. The potential is immense.

The truth is, there’s a massive untapped opportunity in those B and C relationships, often hampered by a limited doctor-to-doctor connection. How do we move them so that we’re more than just a name on a list to becoming their preferred choice of endodontist? The answer lies in strategically empowering your marketing coordinator to cultivate personal connections with practices who haven’t yet experienced the full value you offer.

Your marketing coordinator should be primed and ready to seize every opportunity that could lead to an engaging face-to-face interaction between the endodontist and GP. This can include lunch meetings, dinner events, study clubs, open houses, “over-the-shoulder” opportunities, lectures, dental society events, charity activities, or even casual social opportunities.

This level of relationship-based marketing is based on strategically planned touchpoints to build genuine rapport between doctors. Making these initiatives a central focus of your monthly marketing meetings will transform your referral landscape and unlock unprecedented growth. 

As an endodontist, your schedule is carefully constructed to achieve practice and financial goals. But occasionally, life intervenes – a family emergency, unexpected illness, or an urgent commitment – and you need to cancel a day that was previously dedicated to treating patients.

At first glance, it may seem like the cost of that missed day is simply your average daily production. For example, if you typically produce $10,000 per clinical day and work 160 days a year, the immediate production loss as a percentage is:

• Daily production lost / planned annual production
  = $10,000 / ($10,000 x 160)
  = $10,000 / $1,600,000
  = 0.625% of your planned annual production. 

A little more than half a percentage point doesn’t seem like much, but that figure doesn’t tell the whole story — especially not in a procedure-intensive specialty like endodontics. Let’s break it down more accurately.

Your fixed costs — rent, staff salaries, equipment leases, insurance, and most administrative costs — don’t disappear just because you cancel a day. The only expenses you avoid are your variable costs, which in most endodontic practices are minimal and well under 10% of revenues. Even assuming a high rate of 10% for simplicity in this example, that means roughly 90% of the day’s lost production comes directly off your net income.

Here’s how the numbers look in terms of actual profitability, assuming your overall expense ratio is 50%:

• (Daily production lost – variable costs) / planned gross profit
  = ($10,000 – $1,000) / ($1,600,000 – 50% overhead)
  = $9,000 / $800,000
  = 1.125% of your net income 

So even though you’ve lost only 0.625% of your annual production, your bottom-line income takes a 1.125% hit — nearly double the impact.

In other words, if you miss two or three clinical days without making them up, your total production may look only slightly off at year end, but your take-home income will feel the difference. It’s the financial equivalent of practice-wide inflation.