Endo Mastery




Even though all endodontic practices are essentially engaged in the same business and deliver the same services, there can be vast differences in the level of practice success. While some of the differences can be chalked up to demographic variations between communities, even two practices in the same community can show dramatic differences.

It is the practice owner’s personality that is often the key variable which determines how successful a practice is likely to be. Some doctors have a personality and natural leadership ability that stimulates growth and success. For other doctors, it takes more effort to get to the same level (more about this at the end of the article).

In a world where unlimited knowledge about practically anything is just a Google search away, attitude is the differentiator. Here are some key personality factors of an owner doctor that contribute to making a practice more successful:

  • Passion and push
    When you love what you do, there are follow-on effects: a desire to be good at what you do, having fun and enjoying every day, and a work ethic to be focused and productive with your time spent meaningfully. That passion and the innate drive to keep pushing yourself to improve keeps a practice owner moving forward.
  • Curiosity and enjoying the game
    Business has an economic result, but the experience of business ownership is an intangible benefit to be enjoyed. When you are curious about how to keep growing and optimizing the business, then roadblocks and limits are seen as opportunities. It’s a fun game of possibilities to play where learning and growth inspires persistence to succeed.
  • Future-Focused Priorities and Decisiveness
    You see the limited results of GP-performed endo all the time: missed MB2 canals that blow up, retreatments, separated instruments, and cases where the doctor simply realizes they are in over their head. Every time they refer a case where they get in trouble, it’s an opportunity to help them realize endodontists provide a faster and more predictable clinical outcome with a significantly reduced risk of a failed case or need for retreatment. It’s generally not possible for them to rise to your level: They lack the clinical techniques plus all the specialized technology and tools we have in our practices, such as CBCT, microscopes, etc.
  • People-based investment mindset
    You need others to help you reach your goals, which means surrounding yourself with people who have the skills to support you. That means investing in people to align themselves with you. Whether it’s your team, your referrers, a mentor or coach, or other professional advisors, building relationships where you can amplify and access the expertise and resources of others is vital.

It’s easy to see how these leadership factors work together to create a positive, happy, engaged, forward-looking practice. When the doctor embodies these qualities fully, it creates a culture for the entire team. The full force of growth potential becomes unlocked. 90% of practice growth is driven by the team, and the team’s attitude and mindset reflect the doctor.

Upping your game

It is estimated that only 10% of people have natural superlative leadership qualities. Another 20% are within reach of being very effective leaders. What does that mean for the 70% that agree in principle but haven’t found the knack of putting leadership into action?


Everyone can take stock of their strengths and weaknesses. You might be great at vision but limited when it comes to motivating your team. Or you might be great at creating an enjoyable work environment, but weak at building referrer relationships to drive growth. Or you might provide excellent clinical care but have trouble staying on-time with your schedule.


Many doctors focus on their leadership strengths but gloss over the impact of their weaknesses. That inattention to certain aspects of business ownership dilutes your success far more than you would think and compels you to work so much harder to achieve the success you want.


The secret is put the right delegation, systems and accountability around your own limitations as a business owner. Having a coach support you with a 360-degree approach to your team and practice systems could be all it takes to achieve your next level of success.




For every endodontic case that you complete in your practice right now, there are at least two other potential cases in your patient community that could be referred to your practice. That’s a significant opportunity for growth if you can tap into it.


However, even though that opportunity is available to you, it is also available to every other endodontist in your area too. Why? Because over two-thirds of endodontic cases are completed in GP practices without being referred. Truly, the competition in endo is not with other endodontists.

Factors that drive referral relationships

The question we are really facing is what moves a GP to prefer to refer endodontic cases rather than completing those cases themselves? If you think about your best referrers and analyze why they are great referrers, then you generally find they have one or more of the following mindsets:

  • They like you and see you as a trusted interdisciplinary partner.
    Everything begins with the doctor-to-doctor relationship, which is established both socially and clinically. If you look at the top GPs in your community who have busy and successful practices focused on high-value comprehensive care, none of them reach that level without embracing an interdisciplinary philosophy. That means they have optimized comprehensive treatment around a team of trusted specialists with whom they feel aligned clinically and that they enjoy working with.

  • Treatment in your practice is more convenient for patients and less stressful for the GP practice.
    While most endodontic practices typically have a schedule that plans for a certain number of emergency same-day treatments, that is not the case in the GP practice. The typical productive GP is usually scheduled 2 to 6 weeks in advance. They often have two hygienists seeing patients every day, which require hygiene checks in addition to the patients scheduled in the doctor’s chairs. It’s very difficult to carve an hour or more out of those tightly scheduled days for an emergency endo, and it’s easier to refer.

  • Treatment in your practice results in better clinical outcomes.
    You see the limited results of GP-performed endo all the time: missed MB2 canals that blow up, retreatments, separated instruments, and cases where the doctor simply realizes they are in over their head. Every time they refer a case where they get in trouble, it’s an opportunity to help them realize endodontists provide a faster and more predictable clinical outcome with a significantly reduced risk of a failed case or need for retreatment. It’s generally not possible for them to rise to your level: They lack the clinical techniques plus all the specialized technology and tools we have in our practices, such as CBCT, microscopes, etc.

  • Endodontic procedures dilute the GP’s productivity.
    GP practices grow differently than endodontic practices. In endo, we grow by focusing on efficiency because most of the core procedures that we perform have relatively the same economic value. In a GP practice, at a certain point adding more patients does not result in any more growth. There is an upper limit to how many patients can be retained in hygiene, after which GPs need to focus on case acceptance for less frequent but larger cases, such as quadrant dentistry, esthetics and discretionary care, and full mouth cases. These cases feed into the interdisciplinary mindset mentioned above, but it also results in the understanding that any GP time spent on endodontic treatment would be more productively utilized on comprehensive restorative care.  So, for economic reasons, it is better to refer out endo.

It is all about the relationship

While we think about GP referrers every day, GPs rarely think about us in the same way. We’re part of a treatment plan generally, but they don’t usually view the success of their practice as dependent on referring to us.


The most important things you can do is provide excellent, responsive and timely patient care (especially for emergencies), build up your doctor-to-doctor relationships through personal interaction, and back that up with a great marketing system to stay top-of-mind with referrers.


When we can nudge GPs over time by understanding what leads them to prefer to refer endodontic care, we become the specialist for all their endodontic treatment needs, which potentially triples the number of referred cases they send now.


It’s less than 60 days until the busy holiday season begins. Many doctors will send referrers a gift for the holidays as part of their annual marketing strategy, but they fail to make the most of the marketing opportunity. Here are some key questions and recommendations. 

Are gifts necessary or recommended?

It depends on your current marketing strategies. If you have a great marketing coordinator with a systematic approach to visiting all your referring practices throughout the year, your referrers are probably fairly well informed all year long that your practice appreciates them. It’s really a personal choice for you as part of your doctor-to-doctor relationship with the GP.


If you don’t have a marketing coordinator following a systematic approach, then your marketing activities throughout the year are probably quite minimal or sporadic. In that case, a year-end gift could be very important and probably advisable.

How much should you spend?

There are two camps of opinion on how much to spend. The first camp says that if you have a good marketing system where you are investing in marketing activities, including doctor-to-doctor activities (such as taking a referrer to a sports game or other activities), then a flashy gift at the end of the year is probably overkill. A personalized message along with a thoughtful gift like a nice bottle of wine or gift basket is completely suitable.


The other camp says that the gift should be obviously meaningful in the context of how much an individual GP referred during the year. A GP who refers 50 cases to you deserves some special recognition (and extra spending) versus a GP who refers 6 cases to you. It is a slippery slope though because once you set a precedent with a high value gift, it’s hard to back down from that in the future.


Overall, we lean toward having a great year-round marketing systems and then, if you do send a year-end gift, that it be modest without being extravagant.

When is the best time?

The whole point of a gift is to communicate a message to the referring doctor that you appreciate and value your relationship with them. If you wait until the second or third week of December (or later), your gift is going to get lost in the mix. It’s the busiest time of the year with their family. Everyone else (from their accountant to other specialists they refer to) are also sending gifts at the same time. Yours will be one more on the pile.


The best time to send this kind of gift is right around Thanksgiving or just before, which is well ahead of the masses of cards and presents from others. It gives you a head start, and your gift could very well be the first one they receive of the season. So, it will get noticed, which is what you want. Also, a gift of appreciation and gratitude ties in very nicely with the theme of Thanksgiving. That means the best time to start budgeting and planning your gifts is now, especially if you are going to try to give personalized gifts for your key referrers. It takes time for those ideas to percolate.

How should it be delivered?

If you don’t have a marketing coordinator, then you will probably need to mail gifts to your more distant referrers or have them delivered from where you ordered the gift (such as for a basket). If you have a marketing coordinator, it’s best that they hand-deliver gifts for those referrers that are a distance away.


For referrers that are closer to you, it is recommended that you personally visit those doctors, which is something you should do at a minimum at least once a year. It gives you a chance to connect with the GP’s front desk team, have a few minutes of face time with the doctor to generate goodwill. This is especially important if you are not face-to-face with them any other time during the year. In one day, you can probably drop in on 15 or so practices without too much effort.

Remember that 90% of marketing is teamwork

Year-end gifts can be a nice touch in a marketing system, but no gift is as influential as your practice team. What they do throughout the year by communicating with referrers and taking care of patients effortlessly guides the entire referral relationship. And a great marketing coordinator makes sure that practice-wide effort by you and your team is noticed throughout the year.


An unhappy patient spreads their unhappiness. They report a poor experience back to their referring doctor or clutter up your Yelp and Google reviews with 1-star ratings. If you scan those reviews, most of them are the result of factors within the control of the endodontic practice. Here is what you and your team need to avoid:

Failing to address their fear

The word “specialist” generates a certain level of anxiety in every patient. Anything that requires the care of a specialist sounds complicated and serious. The phrase “root canal” generates an even higher level of concern. Root canals have a historical connotation of discomfort that no longer matches our clinical processes but endures in the public mindset as dental mythology.


Certainly, an endodontist’s chairside manner is vital to calm fearful patients and bring them down from their anxiety orbit. But the mistake that most practices make is assuming that it is only when the patient is in front of the doctor that their fear can be dispelled.


Addressing the patient’s fear needs to begin from the moment that patient calls the practice to book their appointment. It is absolutely essential the administrator receiving that call has a warm and caring demeanor. They have to project calm confidence, superb knowledge and totally informed certainty about every concern or hesitation the patient has. Reassure the patient that the doctor is the best endodontist, and they will receive treatment easily and quickly.


In this way, starting with the phone call, the team can telegraph calmness to the patient, so the patient feels “these people know what they are doing.” Done at the highest level, even before the patient walks in the door they will feel gratitude and privilege to be taken care of by the best.

Lack of same-day appointments

Americans are not people who like to wait in line, whether that is for a coffee, to check in at the airport or hotel, or to get a root canal. Furthermore, when they are in pain, their tolerance for any delays virtually evaporates. And with endodontic pain in particular, even one day of delay (and a sleepless night of discomfort) seems like an eternity.


A patient in pain wants the pain addressed immediately, and a referrer with a patient in pain wants the pain addressed immediately too. That should be the #1 awareness that your scheduler should always have. Your team needs to be adept at assessing and triaging the patient’s level of pain in the first phone call. They need to show empathy for the patient’s pain, so the patient knows their pain is your priority and you’ll take care of them as quickly as possible.


Then, your scheduling strategy and template needs to have the appointment openings built into every day to accommodate necessary same-day treatment emergencies. No doctor likes to see openings in their schedule, but strategically leaving time reserved for urgent care means that emergency patients will be thankful, not annoyed by waiting. Plus (importantly), when referring doctors know they can count on you for same-day treatment of pain, it is the greatest practice- and relationship-building strategy ever.

Financial surprises

Just like the word “specialist” invokes the feeling in patients that care will be complicated, it also invokes the feeling that it will be expensive. Patients need total financial clarity in advance so they can be prepared.


Financial clarity particularly requires your team to be experts at determining the patient’s insurance benefits for treatment, so you can give a very close estimate of their co-pay prior to the patient’s arrival. Even if the patient is just coming in for a consult, they need to be prepared for treatment on the same day, so the estimate needs to be prepared in advance.


Remember, if the patient is undergoing treatment at the GP concurrently, insurance limits can shift benefit payouts overnight. An expert practice administrator stays abreast of every detail for the patient. Patients truly don’t understand the ins and outs of their insurance.


The two biggest mistakes when it comes to finances are 1) not giving patients a co-pay estimate until they are in the practice, and 2) giving them an estimate based on inaccurate insurance information and then surprising them with a higher required co-pay when treatment is performed.

90% of marketing is teamwork

Great practice marketing is far more than just doctor-to-doctor outreach. It means involving the whole team in marketing goals and getting every individual on your team to be aware of how they influence patient and referrer satisfaction.




For the last two weeks, I’ve been on my honeymoon in the Caribbean. It was magical to have that time with David after the busy time leading up to our wedding a month ago.

But we did have an unexpected surprise on our trip: the resort that we booked was a bit more party-focused than romance-focused at this time of the year, despite the beautiful photos on the website of couples lounging alone on a pristine white sand beach. We made the best of it though. We moved our room away from the pool sound system and, in the end, created our own one-on-one experience that was memorable.


The situation made me realize that in today’s world we see a lot of “Hollywood reality” and hear a lot of stories that tell us what our lives should be like. We are always tempted to compare our daily experience with glossy polished brochure images. In the day-to-day busyness of our family and practice lives, sometimes we can feel very distant from those dreams.


In fact, if we give in to those comparisons, we can end up talking ourselves into an equally deceptive story. If David and I obsessed on what the resort wasn’t, rather than what we could make from it, we would have come home with a different story. But we focused on all the pluses: we were in the Caribbean on a beautiful island, there were so many interesting things to see and do everywhere, and we were with each other. That was more than enough to have a wonderful honeymoon!

The need for leadership perspective

When you look at your practice, it’s tempting to focus on the problem areas. You might have a team gap, marketing gap, financial gap or some other concern. You might feel a lack of excitement or that you are going through the motions without making any progress. The truth is that doctors are, by necessity, problem solvers. You solve problems every day for patients, for referrers, for your team, and for yourself.


But that perspective is not the whole story. Your whole story can only be seen from outside your daily experience, which is a very different perspective and different story: You’re a credentialed accomplished professional with a successful operating practice. You have a team to support your goals, and you have the foundation of all the essential practice systems. Perspective shifts your mindset from seeing liabilities to seeing assets that can be empowered to create even higher success.

Finding your perspective

Getting outside your bubble is a leadership technique for everyone. I found, returning to work this week, that I was more charged up and inspired than ever, and more laser-focused on the assets we have at Endo Mastery to advance our vision for endodontists.

Overall, endodontists are the least likely among dental specialities to give themselves the away time and vision time that they need for perspective. You worry about your referral sources suddenly being seduced over to another endodontist if you’re out of office and not available for emergency care.


I encourage you to think about your leadership perspective and plan to give yourself the benefit of that viewpoint … whether that’s taking a vacation or organized around professional events where you can get inspired by a new vision for your practice assets.


One option that Endo Mastery offers is our 2-day seminar, which is coming up in September in Philadelphia. Many doctors have used this seminar to re-energize and put their practice on a new path to incredible success. You can hear some of their stories here:

I promise you; these are not slick marketing videos filled with unrealistic brochure images. It’s real doctors, talking about how they changed their perspective, found their true focus, and transformed their practices and lives.


The starting pitcher is the star of baseball. They are the preferred choice and are entrusted to deliver the best results. As a dental specialist who relies on referrals, your goal is to be the starting pitcher for GP referrers: their preferred and trusted choice for all their endodontic referrals.


Relief pitchers are second choices, and they are brought in during the game when the starting pitcher needs to come off the field (if they are tired, injured, having a bad day, or for strategic reasons). Since your referrers need somewhere to refer patients (especially emergency patients), you might be their second-choice relief pitcher if their usual endodontist isn’t available … such as when they are away on vacation.


This is a marketing opportunity, but it’s a special one. Remember that your endodontic colleagues are not your competition. Don’t think that you are in a turf war with other endodontists for GPs in your area. When you’re called up as the relief endodontist, you don’t want to appear like you are actively campaigning to persuade the referrer and steal them from your colleague.


However, it is a moment to market passively, which comes down to providing a really great patient and referral experience, and then allowing the referring doctor to draw their own conclusions. You don’t have to push them in any way because if you offer an exceptional experience, the advantages of referring to your office become clear. Here are some of the ways that your office can shine:

  • Ensure your team’s communication with the referring office is warm, welcoming, professional and focused on making the referral process as easy as possible for the referrer and their patient.
  • Schedule emergency patients the same day they are referred.
  • Ensure patients have total financial clarity before they arrive so there are no surprises.
  • Provide patients an exceptionally smooth, efficient and comfortable experience so their feedback to referrers is overwhelmingly positive.
  • Speaking positively about the referring doctor to the patient.
  • Act as a clinical partner to the referring doctor in delivering quality care by reflecting the GPs treatment philosophy and supporting their treatment plan.
  • Ensure patients are appointed back in the GP office for restoration at the completion of treatment in your office.
  • Send reports, film and case documentation on a timely basis (i.e., the day the patient’s treatment is completed).
  • Obviously, provide clinically excellent care with a successful outcome.

These factors speak louder than any words or marketing ploy. Taken together, they define your brand and reputation as an endodontist. When achieved on a high and consistent basis, referrers will recognize and choose that level of quality. They will want you as their starting pitcher!


Your marketing coordinator should be scanning the schedule and referral reports for these kinds of patients and referrers. They should make your whole team aware so that everyone can make their best efforts when the patient arrives.


As a final note, one thing you can do as the doctor is find a reason to reach out to the referrer for a conversation … especially a clinical reason. Again, you don’t want to appear to be marketing, but you can begin the process of building a professional doctor-to-doctor relationship. That, ultimately, is the heart of any referral-based practice.


“Poppin’ by to say hi!” … that’s an easy one, and one that everyone loves. Popcorn snacks are a great favorite, and you can provide them in different ways:

• Microwavable bags
• Pre-popped snacks from the snack aisle
• Individual cellophane sleeves
• Barrels and tubs
• Different flavors
• With a movie or online rental gift card



It takes a lot of effort to get your practice set up the way you like. Once you have achieved an acceptable level of operational and financial success, it’s a great relief. The pressure is off, and each day develops a predictable routine. At the end of each month, you take home enough income to live well enough. Welcome to the comfort zone.


While the comfort zone feels like you’ve successfully passed through all the great hurdles of practice ownership, it’s very deceptive. It’s actually one of the riskiest stages of a doctor’s career. That’s because the comfort zone lulls you into a state of inertia, and you can end up being caught at that level for decades. Your comfort zone has become your greatest limiting factor.

Comfort zone limiting factors

In my view, there are 4 primary reasons why the comfort zone takes over your mind and limits your future potential:

  • The first reason is that you develop a motivation vacuum. Since the comfort zone is defined as having your needs fundamentally achieved, there isn’t anything external that is pushing you to keep moving forward. It is true that a certain percentage of people are naturally self-motivating, but most people are motivated responsively: we act more when we feel a need to address, rather than a want to pursue.
  • The second reason is that you become risk averse. If you have it made, why upset the apple cart? In the comfort zone, anything that has the potential to create a disturbance or disruption to the established routine is viewed with skepticism. Research shows that people tend to overestimate potential risks by double and underestimate potential benefits by half. That’s a recipe for saying “no” to things, even those that are a good bet.
  • The third reason is that you develop organizational habits. Every business, group or organization develops an internal culture around how things get done. In practices, doctors and teams get settled into a certain way of doing things. This occurs as a result of past training, inherited processes, or simply repetition. Once habits are established as the “norm” for the team, any change can be met with resistance.
  • The fourth reason is that you suppress your deserve level. Most doctors, once they are in the comfort zone, are doing well enough financially that they are probably the highest income earner in their extended family. Endodontics is a very rewarding career, even in the comfort zone. So, many doctors downplay and suppress their desire and belief that they deserve more because they already feel advantaged compared to most people.

Of the 4 factors listed above, organizational habits and deserve level are the most insidious. They can quickly sap you of any motivation you have and make steps to growth seem riskier and not worth it.

Deconstructing your mindset

Years in this mode of thinking progressively weaken you. As life goes on, your needs evolve but your practice becomes more fossilized around a lower-level comfort zone of the past. It’s not unusual for doctors who have been comfortable for many years to suddenly find themselves feeling frustrated, worried or unsettled:

  • I need to earn more income for my financial goals.
  • I need to take more time off for work/life balance.
  • I need to have more fun at work with less stress.
  • I need to modernize my practice and team.
  • I need to reconnect with my colleagues.

These are signs of responsive motivation (to emerging needs), and they are usually accompanied by risk concern (to the possible steps to resolution).


At some point, action will need to be taken because worry becomes stress, stress becomes anxiety, anxiety becomes distress, and distress becomes pain. The only question is at what point you decide to take action, and how effectively you find your new vision and path to future success.


What goes better with summer than camping? And what goes better with camping than delicious s’mores? Surprise your referring offices with this summertime classic! You can package up the ingredients in a small cellophane package:

Add a tag that says “To many S’MORE good times and great patients! Thank you for your referrals!” You can also add a note about how s’mores can be made in the microwave at work (about 20 seconds).


What are the chances that your GPs tell their patients, “It’s very important that you see Dr. X. They are the best endodontist in the city, and I’ve personally chosen them over all other endodontists.”


For some referrers, that may be true. But most of your referrers, it is likely that you are just one of several endodontists taking them to lunch. Their patients are told they need a root canal by a specialist, and it’s left to the team to give the patient all the details. In many practices, patients are asked to choose the endodontist they want … often by who is nearest to where the patient lives or works.


Ideally, you want to develop referral relationships so that you’re more than just one of several options. You want to be the preferred endodontist. That preference is best developed doctor to doctor, but it can take time. However, there is a backdoor into becoming the preferred endodontist, and that is through the team-to-team connection.


Everyone in your practice who talks to a GP team member in any capacity should remember that they are building a relationship. They are not dealing with an impersonal nameless employee that is far flung. It’s likely someone just down the street, so your team needs to be in relationship-building mode:

Projecting this kind of energy, even just on the phone, makes people feel closer to you. When it is supplemented with the goodies and pop-by marketing gifts organized by the marketing coordinator, a strong sense of goodwill and friendship develops.


Then, when the patient is given their endodontic specialist options, a team member might spontaneously suggest, “If I was choosing, I would definitely want to go Dr. X’s practice. The team there is incredible, and I like them a lot.”


That’s enough to nudge a patient’s decision in your favor since everyone else on the list are just names that they don’t know. They know something very specific about you: you have an amazing team, and you are recommended by a team member in the practice they trust to take care of them.


Everyone in the endodontic practice is part of your marketing team through their daily interactions with patients and referrers. It’s not just your marketing coordinator toiling alone. Always remember, 90% of growth in your practice is driven by the team.