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Let’s talk about metrics the way a real owner learns them—not from a spreadsheet, but from a gut-punch story.
Imagine you own the kind of old sports car that makes no sense and that’s exactly why you love it. It’s loud. It smells like gasoline. It’s fast in a way that feels almost illegal. Getting in and out is a workout. The doors don’t seal, so when it rains outside, it rains on you inside. It’s impractical, uncomfortable, and perfect.
Except for one thing.
The speedometer doesn’t work.
And you’d think, “Fine, I’ll fix it.” So you throw money at it. You ask specialists. You replace parts. You try everything. Still broken.
So now you’re on the highway with no idea how fast you’re going.
What do you do?
You do what everyone else does.
You match the flow of traffic, hoping that “normal” equals “safe.”
And the moment you feel exposed—brake lights, a cop on the shoulder, a sudden slow-down—you don’t calmly adjust. You overreact. You slam the brakes because you never had the data to make a small correction earlier.
That is exactly how most practices operate.
No speedometer. No check-engine light. No dashboard.
So the practice just moves at the speed of the crowd. It copies competitors, copies what the last consultant said, copies what “seems to be working.” And when something goes wrong—collections dip, schedule looks thin, staff feels overwhelmed—leadership hits the brakes. Suddenly we’re in emergency mode, changing five things at once, yelling about urgency, reacting instead of steering.
Metrics are how you stop being that driver.
Not because numbers are sexy. Because numbers are steering
The “Sad Funnel” That Explains Why Busy Practices Still Feel Broke
Here’s the depressing truth: most practices are not struggling because they lack demand. They’re struggling because they leak opportunity at every step of the patient journey.
Where are these leaks?
Stay with me. You spent a lot of money in medical marketing so you have 100 new phone calls coming in.
- Only 68 get answered (which reflects market average).
- Of those answered, less than half actually schedule (many are shopping around or your team is a bad closer).
- So instead of 100 opportunities turning into 100 appointments, you get 29.
Already brutal. But it keeps leaking.
Of those 29 appointments, only 41% result in a real diagnosis—something identified, owned, and presented.
Now pause. Now, think like a dentist in this regard.. What percent of humans walking around would benefit from something clinically? Preventive care, maintenance, improvement, treatment? Almost all of them. Meaning, all of these 29 patients, you could have identified something. Does that cavity need a filling? Does that eyelid glands need lipoflow?
Yet the average practice diagnoses less than half of the people it actually sees. Not because patients don’t need it. Because the practice isn’t consistently finding it, framing it, and converting it into a plan.
So here is the math thus far and it’s embarrassing. 100 calls → 29 appointments → ~12 diagnoses.
Of those 12 patients who get a diagnosis, in the world of dentistry, they are presented with $1600 dollars worth of care. This means this totals about $19,000 in total.
And then the last leak: only about 43% of presented dollars actually get scheduled.
So out of 100 calls, the average practice schedules about $8,000 of work.
That’s what it feels like to run without instruments: you’re moving all day, but the speedometer would reveal you’re not actually going anywhere.
Track Your Metrics. Fix the Dashboard, and You Don’t “Grow.” You Transform.
Now take that same 100 calls and tighten the system—not with genius, not with luck, just with competence. These are metics from a dental group utilizing a strong system (aka the Scott L method).
- Answer 95% of calls.
- Convert 81% of those into scheduled appointments.
- Now you’re at 77 appointments, not 29.
- Diagnose on about two-thirds of those visits.
- Now you have 51 real presentations.
- With a higher average plan size (say $2,500) you’re presenting $127,500.
- And when your presentation + follow-through is strong, you schedule around 73% of those dollars.
That lands you at $93,000 scheduled from the same 100 calls.
This is why some practices look like they’re playing a different sport.
They aren’t “busier.”
They’re tighter.
And here’s the part your team needs to understand: that difference doesn’t come from one heroic move. It comes from turning several small knobs that multiply each other.
If you improve one knob, you feel it.
If you improve multiple knobs, your whole life changes.
That’s not motivational speaker talk—that’s compounding.
Stop Thinking of Your Practice Like a Messy Web
A lot of owners treat the practice like a chaotic cobweb: everything is connected, everything is sticky, problems pop up randomly, and your job is to swat flies all day.
The better mental model is a machine with gears, in a specific order:
Calls → Answer rate → Schedule rate → Diagnosis rate → Presentation → Case acceptance → Collections → Retention
When one gear slips, the whole machine underperforms. And when you tighten one gear, the downstream gears suddenly get easier.
That’s why dashboards matter. They tell you which gear is slipping so you can stop punching the entire engine.
“Our Case Acceptance Is Good” Is a Comfort Blanket
Owners love to say, “Our case acceptance is good.”
That’s like saying, “My health is good.”
These are terrible metrics. Your health is good? Really? Okay… compared to what? What’s the number? Is it trending up or down? What’s the benchmark? What changed?
And there’s a deeper truth: the better you get at diagnosing real problems, the harder acceptance can become.
If all you diagnose are easy, low-cost, low-emotion items, people say yes all day.
But if you start diagnosing big cases like life-changing cases, people hesitate more. That doesn’t mean you diagnose less. It means you build the systems that make big cases schedulable: trust, clarity, financing, sequencing, follow-up.
Sometimes improving one gear adds pressure to another gear.
That’s not a reason to avoid improvement.
It’s a reason to run the whole machine like an adult.
Financial Health: The Myth That Keeps Owners Trapped
Here’s where the guru gets spicy.
A lot of “industry experts” normalize 60–70% overhead and call it dentistry.
That story makes people feel okay about being exhausted and underpaid.
But healthy practices aren’t built on excuses. They’re built on margins.
Benchmarks in this model look like (again for dentistry, but stick with me)
- Supply costs under ~4%
- Lab under ~5%
- Staff under ~25% (some models can tolerate a bit more)
- Owner take-home normalized above 50%
- Which means overhead under 50%
How are dental practices who follow Scott’s dental model doing well and have lower overhead? They earn more.
That’s right, they earn more. One thing I struggled with early on is understanding that the biggest way to LOWER your overhead percentage is to earn more.
What does that have to do with overhead?
Your gloves cost the same whether you charge $1,000 or $2,000. Your assistant costs the same. Many inputs are flat while revenue per procedure rises. So higher fees naturally make cost ratios healthier.
That’s why scaling a low-fee, high-overhead model is dangerous.
If your schedule is packed but the margins are trash, adding another provider doesn’t save you. It often makes you busier and poorer at the same time because the second producer usually generates less than the owner while complexity, staffing, and fixed costs expand.
The move isn’t “expand the chaos.”
The move is “fix the economics,” then expand from strength.
Attrition: Patients Don’t Leave Because They’re Mad. They Leave Because You Let Them Drift.
Ask a room why patients leave and you’ll hear:
they moved, they died, they got expensive, insurance changed, they didn’t like the doctor.
Some of that happens. But the big leak is boring and brutal: They were never reappointed (meaning having their follow up appointment scheduled). So, these are the metrics you need to track.
They didn’t necessarily “fire” you. They just disengaged. And nobody wakes up six months later thrilled to remember, “Today is the day I call the office.”
If people leave without the next appointment locked, they evaporate.
One stat that should scare any owner: the average practice might gain ~41 new patients a month and lose ~50. Marketing becomes a treadmill while retention is bleeding quietly.
The fix is not “hope they call.”
The fix is default scheduling.
You don’t ask: “Would you like to schedule?”
You state: “We’ll see you in six months. We’ll reach out two weeks before to confirm this still works.”
And if someone leaves without an appointment, the office audits the day, schedules it anyway, and sends a message with the time and an easy option to move it.
The system works because it doesn’t rely on perfect memory—from patients or staff.
The People Problem Is Usually an Environment Problem
Here’s the most freeing idea in the entire section:
Most teams aren’t “bad.”
Most teams are driving without a dashboard.
When you install the environment—clear numbers, clear checklists, clear audits, clear expectations—average people start performing like the top 5%.
That’s the whole point of metrics. Not to micromanage. To make excellence repeatable.
When people know what “100%” looks like, and they have a simple playbook to hit it, they rise.
That’s how you build a practice that feels like a Ferrari even when the driver isn’t a race car legend.
My Quick Summary and My Action Items
Get a real speedometer. I need to master ModMed and RingCentral Metrics.
I need to follow my funnel. To do so, I need to have metrics for Calls → Answer rate → Schedule rate → Diagnosis rate → Presentation → Case acceptance → Collections → Retention
Be specific. Don’t say you have good patients. By what metrics? How many premium lens conversions.
Lower your overhead by earning more. Set higher fees. If you are overbooked, adjust your fees. Don’t scale up a high overhead practice.
Build Systems. For example, retention. Don’t lose patients. Instead of would you like to schedule, say we will make your appointment in 6 months today. Don’t worry if it wont work. We can reschedule when we confirm 2 weeks out.
In our next post, I talk about how it’s possible to master being a business owner and take home 1 million dollars.
