Dental Practice Heroes

The $2 Million Ceiling: Why Most Dental Practices Plateau (and How to Break Through)

• Dr. Paul Etchison • Episode 608

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Feeling trapped on the dental treadmill? That plateau between $1-2 million in practice revenue isn't just common—it's a critical crossroads in your ownership journey.

Dental practice owners typically hit this wall after establishing their core team (usually two hygienists, two assistants, and two front desk staff), then find themselves unable to push beyond despite working harder clinically. The fundamental problem isn't your clinical skills or work ethic—it's that you've reached the ceiling of what one dentist can physically produce while simultaneously trying to run a business.

I experienced this firsthand when my practice hit $1.8 million back in 2015. Despite efficient systems and block scheduling, growth seemed impossible without clinical burnout. I was constantly trying to squeeze in one more same-day patient while lacking the energy to handle the essential business responsibilities. The breakthrough came when I realized that most dentists don't actually own a business—they have a really good job. A true business continues generating revenue when you're not physically present, while most dental practices stop producing the moment the owner stops performing dentistry.

Breaking through requires four transformative mindset shifts: transitioning from dentist to owner, building a leadership team, systematizing operations, and developing problem-solvers within your team. By implementing these changes, I was able to bring on my first associate, reduce my clinical schedule, and unlock unprecedented freedom—taking 18 weeks off last year while my practice continued thriving.

The path beyond $2 million isn't about working harder; it's about working differently. Ready to stop being trapped by your practice and start enjoying the freedom of true practice ownership? Visit dentalpracticeheroes.com to schedule a strategy call and discover how our coaching can help you build the systems and leadership that create both profitability and freedom.

GRAB THE FREE PLAYBOOK HERE - Discover 30 proven strategies top-performing dentists use to increase profits, cut clinical days, and finally enjoy the freedom they originally built their practices for.

https://www.dentalpracticeheroes.com/playbook

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Paul Etchison:

The very first milestone that you will pass as a dental practice owner is the $1 million mark. That's $83,000 a month. It's a round number. It puts you at a million dollars a year. Usually, at this point you'll have two hygienists, you'll have two assistants, you'll probably have two people at the front and then it comes to where you start to slow down. Most owners will, and a lot of owners. They're going to get stuck around 1.2 to 1.5. Some people get to 1.8. Some people make it to 2 million, but somewhere between 1 and 2 million the practice starts making enough to survive and you're doing well, but by no means are you thriving. You get stuck and you plateau. Today I'm going to teach you how not to get stuck between this one and two million mark. I'm going to talk about how it happens, why it happens and what you need to do as a practice owner to get yourself to the next level, because that next level is a great place to be. That's when you start enjoying the freedom like a true GPH practice and you start backing yourself out clinically. Let's get to it Now.

Paul Etchison:

You are listening to the Dental Practice Heroes podcast, where we teach dental owners how to thrive in their practices, through practice ownership, through creating a team-driven practice that allows them to take off a lot of time and do what they love. I am your host, dr Paul Etcheson. I am the author of two books on dental practice management, a dental coach and the owner of a large group practice in the south suburbs of Chicago. I want to teach you how to live an amazing life by first foundationally setting up an amazing practice. So let's get into it. Let's talk about this plateau between one and two million. Like I said, this is enough to survive. Practices stay here for their whole career. That's totally cool, but if you want more, if you want to thrive, you've got to push through it.

Paul Etchison:

For me, this was 1.8 million. We hit that. That was about 2015 when we did that, and that was after we had implemented block scheduling. We were efficient. We had a lot of systems in place. We were efficient. We had a lot of systems in place. We didn't have a lot of systems documented, but we had a lot of systems in place and it was like, no matter what, the only way for me to crank more was to get more production per day. I was busy from morning till close.

Paul Etchison:

Every single day that I was practicing, I was the solo doc and it was like that thing between we keep pushing more and more and more, try to fit one more same day patient and we were just running so hard on roller skates. There were parts of it where it was exciting and I was making a lot of money and my team was bonusing like crazy. But honestly I'd go home and I was so just like completely tired that I was like, is this even worth it? And then the thing is is like when you have a practice that's doing well, as dental practice owners, at some point we need to run our business. We need to do the things that are not clinical. And when you're producing at that level of dentistry which I think 1.8 million down back then is like, I mean, the equivalent of shit, I don't know 2.5 nowadays. It's so weird to talk about how much money has lost its value since I started practicing 13 years ago. This is making me feel old to even talk about it. Like how my grandpa would be, like you know what a nickel would buy. You used to buy a box of Cracker Jacks for a nickel or some shit like that.

Paul Etchison:

But anyway, you need to find time to do this as a practice owner. You got to run your practice and you just don't have the energy to do it when you are practicing at that level. Do it when you are practicing at that level. So you get stuck there. You don't have a leadership team, your systems are patchy, they're inconsistent, they're not documented and the owner becomes the bottleneck. You become that bottleneck because you're making all the decisions just like you were, you're taking on a lot of the responsibilities, just like you always have, and you're stuck and you're not going to be able to push past it. The only way to push past it is either one you got to put in more hours, you got to put in more grind. That has a ceiling as well, and that is the fastest way to burn out. The other way is to start putting in the principles in your practice of scaling. Start scaling.

Paul Etchison:

So what are the shifts that require the breakthrough to the next level? You need to make a mindset shift from dentist to owner. You need to stop trying to produce your way to growth. You need to learn how to run a business. Most dentists, most dental owners, we don't have a business. We have a really good job. The difference between a business and a job is that a business will continue to make you money even when you're not there. It doesn't require you all the time. You're not trading time for dollars. You are, as a dentist, producing. You are trading time for dollars. If you stop producing, the business stops making money. So that's not a business, that's a job. So you need to start implementing the things that are going to take you to the next level, which is documenting your systems, building your leadership team and starting to expand your team. So the second mindset shift we need is from lone leader to leadership team. We need to empower others to share the responsibility so that we can focus on the things that grow our practice. Now there's a great idea I always thought was really cool, and this is from Mike Michalowicz. This is from his book Clockwork and essentially he's talking about the QBR.

Paul Etchison:

The queen bee role Talks about the queen bee in the hive. What is her job in the hive? She lays the stinket eggs. Every day she's laying eggs. That's how she grows the hive. That's why she's so important. She's the only one in that hive that can lay the eggs, so she has to lay those eggs.

Paul Etchison:

Now what happens when Bart the bee comes into the queen's chambers and wants to talk to the queen about hey, I think there's some pollen over here to the northeast. We're going to take a team. Do I have permission to do that? Queen Bee? And she's like yeah, bart, go for it. And then the next day, betty the Bee comes in and she's like I really think we should get a bee changing station in the bathroom. Can we get that? Queen Bee? Can we afford it for the hive? And she's like yes, yes, betty, please. And then Bobby, bobby the bee comes in and Bobby the bee is super pissed off because Bobby the bee just found out that Benny the bee has more PTO than Bobby and Bobby has been at the hive much longer than Benny and he wants to talk to queen bee about it. But before he talked to queen bee, he told all the other busy bees about it. So everybody's pissed off now because that person's got so much PTO and the queen's just sitting there like dude. I just want to lay my eggs. Can somebody take care of this stuff so I can lay my stinking eggs? I don't care about this, I only care about laying my eggs. And does this sound familiar? Does this sound like what your practice is run like.

Paul Etchison:

This is the thing is you need to have a leadership team around you that can insulate you from these day-to-day fires, because you need to start focusing your time on the things that grow the business, and you can't do that when you're handling every single fire. So you've got to build a leadership team. You got to set the expectations, you've got to train them, show them how to do it, but then you got to get out of the way. Now the third mindset shift is you need to change from reactive to systematic. Everything starts to run on processes, not on personalities, and this is how we do it. You need to tell your team for every situation. This is the way that we do it. These are the goals of this part of the system. This is how it affects the whole. This is how it's in line with our goals, with our mission. All this stuff.

Paul Etchison:

You start to build all these processes and all these systems in your practice, and this is exactly what we walk our clients through when you reach out to us for coaching. We teach you how to do all of these things so that you can enjoy a DPH practice, so that you can thrive and take a ton of time off and start to live a better life. So if that's something you want help with, dentalpracticeheroescom, set up a strategy, call with me, we will discuss. But once you start deciding how we do things and the way that things are done by creating these systems, it becomes very obvious to you when somebody doesn't do it the way you're supposed to because you said this is how we do it. If you don't do it this way, you did it a different way and we're going to talk to you about why you're not doing it the way that we wanted you to do it. And it helps you when you start to onboard people into proper systems and I can tell you from having a systematized practice. I get new employees come in all the time to our practice and they say man, I cannot believe how well this place is run. It's not me, there's nothing special about me. It's that I put in the time to build the systems and build the leadership team. This is what makes a practice fun to work at, because a practice like that it might sound like it's very over the top, maybe it's very controlling of the employees. It's not. The employees will appreciate the order and the fairness that is created by having a systematized practice, and not that we do it for this reason, but your bank account is going to appreciate it too, because you're going to become way more profitable.

Paul Etchison:

The fourth mindset change that you have to do you need to create problem solvers out of your team members, and you do this by stop being the answer person. When people bring something to you and they say, hey, what should we do, you know, like that Queen Bee, like, hey, queen Bee. They say, hey, what should we do? You say, what do you think I would do? And they go I don't know. I mean that's why I'm asking you what kind of dumb question is that? And then you go I know, but what do you think I would do? I mean asking you and you say, well, I want you to do what you think is best, and if it works out, great. And if it doesn't, we'll talk about it and try to see if we should have came up with something different.

Paul Etchison:

And you say that a few times to a few people and you don't say it mean like it's kind of something that you laugh about. I mean you're being polite, but eventually they stop asking you questions. It's one because they know that you're not going to help them, but two, because they know that you trust them and that you want that sort of behavior. You need to encourage that behavior and say somebody really screws something up. Still, you want to recognize that they didn't bring it to you and they made a decision and they did what they thought was best for the practice. Maybe it wasn't the best decision. You don't want to shame them for it, but recognize people for taking that risk and doing the things that they think is best for the practice. You cannot scale if you're making every decision, so you need to encourage that in your team. So these were the changes that I did in my practice when I brought on my first associate. And when I brought on my first associate, I went down to three days. It gave me the time to continue to step into that business owner role, to continue to work on the business and do the systems, do the training, do the documentation, lead my leaders, teach my leaders how to lead.

Paul Etchison:

And I've had a lot of bad days as a dentist. I've never had a bad day working with my team, so that's all I can say about it. Maybe you might have a different experience, but I've had bad dental clinical days. Bad things have happened and they really stress me out. This team stuff I get stressed out too from it. But the thing is is that there's always solutions for team issues and they're always rooted in communication. I know you guys get sick of me saying it, but so many of our issues are communication related and if we could just bring these conversations into the light so that they happen and we can have them with the right mindset and with empathy and compassion, all these problems solve themselves.

Paul Etchison:

So what happens when we get past 2 million? Most people that get past 2 million are bringing an associate. I know there's somebody out there like I'm a solo doc. I'm doing 2.4. Awesome, I bet you hate your life. That's a lot of dentistry for one dentist to do.

Paul Etchison:

So the way to scale past it in a way that's not going to burn you out is you bring on an associate. You put that associate into a systematized practice so that they can do well. You make sure all the elements are there for your associate to be successful and then you just reap the rewards of it. You have more time, you have more freedom you might go from once you have an associate. I remember my first year having an associate, I took eight weeks off, okay, and my second associate, I was taking 12 weeks off. Last year I took 18 weeks off of the practice. Like 18 weeks I didn't even show up, and I'm actually recording this from a hotel right now because I haven't been in my practice in 25 days, which is awesome, but it's just a testament to what can happen when you scale your practice. But it's just a testament to what can happen when you scale your practice.

Paul Etchison:

So here's your tactical takeaways for this episode. Number one identify your bottlenecks. Where are you still the sole decision maker in your practice? Number two build a leadership team. Remember that queen bee role. Protect yourself from handling the day-to-day things by building a leadership team around you so that you can focus on your queen B role, which, as far as I'm concerned, it should be on anything that grows the business Building systems, training your team, communicating with leaders, communicating with your team. Number three systematize your practice one area at a time. Maybe work on scheduling, maybe work on case acceptance, maybe work on phone skills, maybe work on your cancellation policy, or maybe sign up for one of our coaching programs and we'll take you through all of them and we'll provide you with all of the ones so that you don't have to start from zero.

Paul Etchison:

Number four invest in yourself as an owner. Read, learn, take courses, join a group, hire a coach all these things. Invest in yourself. One of the best things you can do is invest in yourself in this manner, because these are the things that you'll have for the rest of your career. The earlier you do it, the better.

Paul Etchison:

And number five stop chasing production. Focus on scalability, not on chair time. You need to do the things like dialing in your systems, not another crown. You don't need to squeeze in another crown. You need to find something that scales. That's not another patient. So, like I said, the $1 to $2 million plateau, that's totally normal, but it is not a prison. Breaking through it requires shifting your identity from a dentist to a business owner.

Paul Etchison:

So I want you to ask yourself am I running my practice or is my practice still running me? I think chances are for most of us. Our practices are still running us, but that doesn't mean that we can't get out of that. We just got to put in a little bit of extra work. And it's not that we need to grind harder. We need to work smarter and do the things that take us to the next level. That is how we scale and I hope you can start reaping the rewards of having a very functional high profit practice that runs without you very soon. Thank you so much for listening to the podcast. Thank you for taking time out of your day to spend it with me. I really appreciate it and we'll talk to you next time.

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Dr. Paul Etchison

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