Endo Mastery

Why endo practices stop growing

William S. Burroughs said, “When you stop growing you start dying.” Growth is what keeps an endodontic practice healthy and rewarding. When growth stops, it’s a warning sign to do something.



It’s a familiar pattern that we see often in endo practices. Growth is strong at the beginning when the doctor is young, eager and hungry. They often have pressing debt to service, including education, practice and mortgage payments. Growth is a necessity because these bills need to be paid, and so new practice owners are ready to hustle.  


As growth continues and cash flow strengthens, most doctors reach an equilibrium point where they are earning enough to have a somewhat decent lifestyle while continuing to pay off their debt. It’s not quite a comfort zone yet, but it’s a manageable phase when doctors balance their financial stress with the realization that they’re not going to be bankrupted overnight by their financial commitments.  


During this time, growth often slows or becomes intermittent because the doctor is busier with patients, spending less time on marketing, and they are no longer walking a financial tightrope. Because the “edge” is off, it is often the start of a settling process where many doctors begin to program their brains with what “normal” is for their practice.  


Once doctors reach mid-career accompanied by their “normal” expectations, this is when the comfort zone really kicks in. If the practice stays within range of “normal”, there is little external motivation to spur on the pursuit of growth. Doctors and teams become creatures of habit, repeating long-established patterns. Growth can be negligible except for fee increases, which is pared down by inflation on costs, so it’s not true growth in real dollars.  


If unchallenged, the comfort zone can deepen and last a long time—sometimes decades. Some doctors never get past it and so the last decade in practice before retirement often shows the practice shrinking. Doctors start to prioritize more time off, sometimes they slow down clinically, and some of their top longstanding referrers start retiring around them (and stop sending cases). That’s when the comfort zone can lead to a slow gradual decline.

The challenge to grow 

The paradox of the career stages I’ve just described is that growth seems to become harder the longer that you practice. Why is it that younger endodontists (who have the least experience in business, referral relationships and clinical endodontics) can create steady growth?  


You might, for the sake of argument, suggest that growth is easier for someone starting on the ground floor, and so younger doctors have nowhere to go but up. It is true that many young practice owners are able, within a few years, to grow their practices to the level of the average endodontist (3 to 4 cases per day). Young doctors who get Endo Mastery coaching often grow well above average in the same period. 


To me, this clearly shows how big of a blockage is created by the “normal” mindset when doctors are in their comfort zone. There is no valid reason that mid-career and older doctors (who have the most experience in business, referral relationships and clinical endodontics) can’t create the same growth as a younger doctor who might open a practice two doors down the street. 


Here’s a challenge for anyone who is currently in a no-growth comfort zone for 2 or 3 years or more: Mentally put a lid on your current practice. You’ve already done that with your “normal” mindset. Now, start a new practice. I don’t mean a physical practice, but conceptually “a second practice within your first practice”.  


Put yourself back on the ground floor as if you just opened with no concept of what “normal” should be. Just like that young doctor two doors down, you have no referrers in that practice yet. Unlike that young doctor, you have the advantages of more experience, a positive reputation and visibility among GPs in the area, an experienced and trained team, and all your costs are already paid for in your first practice.  


In a few years, can you grow your new practice to produce 3+ new cases per day? And if you did, what would be the financial impact when you combine both practices? You’ve probably at least doubled or even tripled your net income. 

Prioritizing growth 

Doctors will come up with many reasons why they can’t make progress on growth. Most of those reasons are mindsets: expectations are fixed around their current practice dynamics, they have a low deserve level, they believe it will be too difficult, etc. 


I would tell you in response that bringing a growth motivation back into your practice will re-energize you, strengthen your team, make endodontics fun again, and keep your referral base vitalized. Growth is one of the most exciting things that Endo Mastery helps our clients to achieve.  


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