Playing the Credit Card Game

Gaming the Points

If you’re anything like me, you love to get a good deal. Since almost every expense these days is on credit cards, my love for “deals” also extends to credit cards and gaming their points.

For the past few years, I’ve had my go-to mix of Chase Ink for many expenses and then sometimes using Southwest Airlines, Hyatt, or United Airlines cards for certain expenses to keep my rewards tier status.  

However, sometimes the game to accrue, spend, and keep the levels can get really complicated. When it works, it’s amazing and you can sometimes get 3-4X the 1% value of normal points. When it doesn’t work…you sit on points that you never get to use. 


Our New Play

Recently, however, we were able to negotiate a deal with a Mastercard for the World Elite Card connected with Dental Success Network. This credit card is a nice change of pace because you don’t have to play the points game anymore. Here’s a few of the benefits:

If this interests you, you can check out how the card matches up to others at

Stressed out? Try this…

You are Not Alone!

Being a dentist is hard. Flat out. Being a dentist and owning your practice? Let’s increase the stressors of day to day life x10!

Having worked with dentists and practice owners over the last decade, I have watched as the little tasks, simple projects, and daily obligations (personally and professionally) pile up and make focusing on being a clinician and business owner daunting and overwhelming.

I was hired by Dr. Mark Costes in 2012 because of everything listed above and then some. He was practicing dentistry, owned multiple offices, was eager to start new businesses, and maintain some semblance of “work-life balance.” What was he looking for? Someone to delegate to.


Less Stress? More Productivity?

In my experience, first as his personal assistant and now as COO of Dental Success Network, successful delegation is the key not only to decreasing stress but also to increasing productivity.

Check out this clip from a webinar we did where we share exactly how to determine WHAT you need to delegate and then WHO that person should be. From delegating correctly within your current team or bringing on a new team member in the form of a personal/administrative or executive assistant, there are ways to maximize your time as a clinician and business owner.

For more information on the types of tasks you can delegate to a PA or EA fill out this form for my “What Can I Delegate?” PDF resource.

See you inside of DSN!

Internal Marketing is the Best ROI

Improving Your Practice

A recent survey of dentists showed some surprising results in terms of capacity in dental offices across the country. While some were “over-capacity,” sadly, only 38% of respondents thought they were at 100% of capacity; 13% felt they were at 90-99%; and, 25% felt they were above 80% of capacity. If you are in those camps, is it worth it to continually invest in marketing? The short and easy answer is yes. BUT, if you’re at max capacity, you should still market to get more “ideal” patients in the doors.  

If we are to focus on these goals, what sort of marketing should we do?

To start, we should go back to the ideal baseline budget. When thinking of your “marketing budget,” you need to think about the total spend percentage of revenues. Typically we teach that the entire marketing spend should be 4.5%-5% of the average month’s revenues; this includes spending on: internal, external, digital, and traditional marketing.

Typically when you use the word “marketing,” you think of external sources like billboards, radio, and Google Ads. While those items fall into marketing, it can be super constrictive to think of only those items. Unfortunately, this traditional thinking also leads us to spend money in the worst return-on-investment (ROI) possible. External marketing ROI is typically less than half that of internal marketing. So, what’s the difference?

Internal is working through all the branding, rewards, and patient experience details that create a “wow” experience for a patient.  When they become a “Raving Fan,” as Author Ken Blanchard would say, they will refer more patients to you and have lifetime loyalty. Because of this awesome power, internal marketing is the best dollars I’ve ever spent.  

When you do internal marketing correctly, you will see impacts in the following areas (trackable KPIs): 

Patients wear our T-shirts around town and more people see our logo and choose us as their dentist: even more new patients.


What Exactly is Internal Marketing?

In general, internal marketing is comprised of:

There’s probably even more that we’re forgetting, but this is a good list of what is needed to really look professional for every patient touch-point in the office. Internal marketing also includes scripting to make sure that the patient experience is choreographed to be high-service.

So, as you consider spending more on marketing to increase new patients and production, look inside the practice first rather than anything outside.

If you’re interested in all things marketing, we published our 5th of the DSN Manual series: The Dental Marketing Manual (you can purchase it here.).  You can see and purchase the entire series HERE.

The Disservice to Your Patients

What is Leadership?

Leadership is a buzzword that we hear far too often when we are talking about the attributes we want to see or develop in ourselves, our families, and our employees. It seems to be the holy grail of human behavior but most of us haven’t ever been instructed in “Leadership” in any significant way. We only have a vague idea of what leadership is, much less being able to accurately define it.

A quick online search gives us this definition: Leadership is the art of motivating a group of people to act toward achieving a common goal. In a business setting, this can mean directing workers and colleagues with a strategy to meet the company’s needs.

This seems overly and complicated to me and doesn’t address the moral obligations of leadership. My personal definition of leadership is a bit simpler: doing the right thing. Encouraging and creating a path for others to do the same.


Contagious Leadership

I was talking to my hygienist today between patients. She had a printed schedule and knew exactly which patients were due for BWX and Pans. If there were children on the schedule for that day, she would have known which ones were due to have sealants placed. She was mentioning that some assistants don’t like to work with her initially because she insists that they take the recommended radiographs at the recommended intervals. Or, she will request that the assistant have the sealant kit in the op and the mother presented with this option as soon as they walk in.

Now I’ve watched her “insist.” She’s nice and tries to be encouraging. She’s also done the “busy” work of researching each patient and has everything marked out for the assistant. After a while, most assistants appreciate the fact that they are doing the right thing for the patient and that they (the assistant) can be proud of the thoroughness of the work that they’re doing.

Now it wasn’t always this way. Initially, when this hygienist came to work for me, she just wanted to do a good job and have patients like her. She didn’t want to create any waves with the patient or the staff. The problem was that I required that radiographs be taken on a certain schedule and that we not bring patients back for a second visit if we could get their work done while they were here already.

Initially, these ideas were resisted. When she realized that, “They come here for us to take care of them and if we’re not doing that, we’re really doing them a disservice,” (her words not mine) it was adopted. Now, the standards are a source of pride.

During our conversation she commented, “Well you know that you made me this way.” I pointed out to her that she had become a leader in the office precisely because she held the standard and insisted on others not avoiding them. She had also helped to create a path for others to follow. It was all her. I was just holding the standard. thinking through this conversation, it occurred to me that maybe leadership is “caught” rather than “taught.”

I guess the question is: “What are others catching from us?”

We Screwed Up. You Don’t Have To.

The Problems

Extreme ownership is about admitting when you screw up. Maybe there’s a better 4-letter word for when it happens and costs tons of money. Admittedly, I’ve made hundreds of mistakes in my practices over the past decade.

When this happens it’s good to reflect and figure out where things went wrong.

Some examples of these failures?

  1. I hired a drug user as a dental assistant….who then did drugs before coming back to work after lunch.
  2. Front office employees didn’t follow up on collections because our systems weren’t tight.
  3. Accounts receivable went too long and became uncollectable.
  4. I didn’t do enough due diligence on a dental practice before purchasing (Turns out there was not much dentistry to be done).
  5. I failed to do a proper real estate assessment before purchasing a building (That $600k remodel was the pill we had to swallow).

Of course it’s easy to see when the problems were so egregious that we can point them out easily. But then there’s also problems that simmer below the surface and are obfuscated from our true understanding. Problems like:

  1. Employees not doing their job to 100% because they were unaware and we didn’t hold them accountable to their benchmarks for the first 30, 60, or 90 days.
  2. Lower collections rate because there are no systems to estimate payments, present payment plans, and collect at the time of service.
  3. Associates that are underperforming because we didn’t set them up for success from the first week.
  4. Not enough new patients because our marketing isn’t being watched and managed carefully enough.


The Solutions

These problems are basically why these manuals exist.

If you want to get systemized – We have the Dental Operations Manual.
If you want to buy an office – We have the Acquisitions Manual.
If you are going to do a startup – We have the Startup Manual.
If an associate dentist is your next hire – We have the Associate Dentist Manual. And if you need a better marketing plan – We have the Dental Office Marketing Manual.

Of course, if you need the entire package, you can buy 4 of them (plus some extra goodies) and save a huge percentage HERE.

These Manuals are filled with the wisdom to help you avoid mistakes, save hundreds of thousands of dollars, and become a bad-ass practice that runs sub-50% overhead. This isn’t a far-off dream, and you don’t need to learn the hard way.

We hope you enjoyed the long weekend–now it’s back to work and back to the obstacles that we encounter everyday!

SEO Experiment Update

Our Progress

If you remember my last tactical Tuesday post, my goal was to try and come up in the keyword ranking for “Dentist in San Diego” just by creating a landing page with the same url slug and linking it directly to my Google Business page. It’s still pretty early in the process and I haven’t seen a jump in my keyword ranking just yet, but oddly enough we added ourselves to the local pack in Google Mobile and Google for the TMJ and Botox keywords.

I’m still investigating this further, but what we noticed is that by creating the landing page and linking it directly in GBP, the traffic to the landing page is pretty impressive.


Modern Marketing

We tend to focus so much on web page design and optimization, yet marketers often overlook the low hanging fruit of the Google Business Page. I have yet to hear many “dental marketers” discuss how important this is, and instead try to focus on the importance of having a custom website that stands out. In my humble opinion, I feel that’s a very 2001 argument and I would challenge everyone to see just how long people spend on your site. Are they spending 5 minutes admiring the design of your website? Or spending a few seconds to digest the information that they feel is most important to them. In looking at the time spent on our site, it’s clear that people spend a lot of time checking out our fees. Which makes sense because people care about their money.

My next step is to track what pages potential customers are jumping to from our landing page. I’ll assume it’s Botox and TMJ – which accounts for most of our traffic and where we land in the local pack. I will continue to develop the landing page a bit more and try to redesign it such that it doesn’t have an expansion section so that the content is cleanly laid out and easy to read.

If you have any questions or would like guidance on setting up your own GBP page, you know where to find me!

Dental Practice: Cost Per Procedure


Every few months after a negative interaction with an insurance company, sometimes I get angry and state, “Let’s drop that insurance company!” to my front desk coordinator. Have you ever been in the same spot?!

While this anger is real, the outcome of that anger is usually a pretty random answer that may or may not be good for the practice. When I talk with dentists across the country, I (unfortunately) usually hear this problem quite often. At this inflection point, I usually ask about the ‘cost per procedure’ and whether taking the insurance write-off is still a good option.  

To calculate this “Cost Per Procedure”, we have linked a spreadsheet HERE.


True Cost

Go through each procedure listed on here and figure out exactly how much of each supply is used. Then go to the supply order to figure out exactly how much you’re paying for each of these items.  

The main goal of this spreadsheet is to calculate exactly what it costs to produce this dentistry; inclusive of the building, team costs, and supplies cost. After adding all this in, you’ll see the true cost for you to produce: and thereby, see the expected profitability on each of these types of procedures.  

After doing this exercise with different types of dentists all over the country, we have noticed a few things. The biggest thing is that rent and facility costs vary extremely wildly between metropolitan practices and those round in rural areas. This can sometimes be the single largest difference between two practices. Similarly, team costs in metropolitan areas are significantly higher, so that can sometimes create another big difference in costs. While these seem insurmountable, it is important to remember that sometimes these metropolitan practices also get paid significantly more than the rural ones, so sometimes the expected profit is still similar.

In order to truly see the range, the DSN team created a ‘Group Data’ spreadsheet that allows people to enter their own cost per procedure and see the expected profit, split up by state and whether the practice is metropolitan, suburban, or rural. We hope that this extra resource is helpful in getting a firm handle on the ranges you might expect in different locations!


Re-evaluate Your Anger

Rather than lash out in anger (like me), It’s always wise to do this cost per procedure every year to evaluate the financial impact of different insurance plans on your practice. If there’s a certain insurance plan that is paying less than your cost to produce this procedure, then you might need to re-evaluate your participation with that plan. Relying on the data in this area is one of the best things you can do for your practice; and, if you come to the conclusion that a certain plan doesn’t pay well enough, then let the data make the decision!

Dental Practice: RCT: Efficient Obturation

What’s the Hard Part?

Sometimes instrumentation of a root canal system isn’t the hard part, it’s the obturation.

So, you’ve accomplished a near miracle instrumenting a premolar with a deep bifurcation (it always seems to be a premolar). But, now you have to figure out how to obturate the canal system. How do you get the gutta percha sealed in each canal to seal the canal system?

What’s the best way to accomplish this?

First, let me say that I’m a single cone obturation guy. It’s simple, effective, and has as high a success rate as any other method of obturation.

Don’t let the dental supply companies tell you differently. Look at the research. Look at the position statements of the national endodontic societies. Look at the results, not how pretty it is on the radiograph. 

OK, end of rant. Moving on…


RCT Case Study

If the common trunk is wide enough to fit both GP points in simultaneously, then it’s relatively simple. Fit gutta percha (GP) in both canals. Now place sealer in both canals and obturate both canals simultaneously. Simple enough.

How about if the trunk is not quite wide enough?  Try placing a paper point in one canal and sealer with a fitted GP in the other. Sear off the first cone, pull the paper point. Now place sealer and the second fitted GP point in the second canal.

If you’ve ever had to re-clear the second canal when doing these previously, give this method a try. It’ll save you some time and frustration.

How about if the trunk is only wide enough for a single GP point at a time?  First, fit all the cones. Now, place the first GP point with sealer and sear it off down to the bifurcation. Now reclear the second canal and obturate with GP and sealer.

I’ve once used this method to obturate a trifurcated lower premolar.

What about a garden variety two canals that merge short of the apex? Is there a quick and accurate way to obturate that system?

In this case, fit a cone into each canal separately and mark the measured point on the cones with a crimp on each cone. Now, replace the cone that fits best first. Then, place the second cone which should now not go quite all the way to place. Measure between the previous crimp and the measuring point on the tooth and trim this length from the apical end of the second cone. Now when reseated, the second cone will go to place with the crimp coming into line with the measuring point on the tooth. Place sealer and GP to finish the obturation.


The Step You’re On

I once asked a dental school instructor which was the most important phase of root canal therapy. He, in all his wisdom, said “Why doctor, it’s the step you’re on.” All phases of root canal therapy need to be performed well but it’s important not to stumble before we cross the finish line.

Until next time.

P.S. Wanting to stop sending those lucrative RCT/Crowns out of the office? Join Dr. Aaron Nicholas September 16th, 2022 in Burtonsville, MD for his Hands-On One-Hour Molar Root Canal Buildup and Crown Course.

Dr. Nicholas developed this technique over decades of practicing dentistry and makes keeping molar endo in-house simple, predictable and profitable.

Click Here for more information or reach out to

Dental Office: Should I Buy My Building?

The Best or Worst Decision?

Recently, we had a question on DSN about whether or not a dentist should buy their own building or move and build a new building. Thinking of spending a few million on real estate, this person said, “I feel like it could be the best or worst decision I could make.”

I totally understand the hesitation; debt loads like this are pretty huge, and it’s a tough pill to swallow. But, let’s do the math to figure out the best scenario:


A Theoretical Exercise

Let’s pretend that you occupy ⅓ of a building, and you’re thinking about purchasing the entire building plus parking lot/land. You currently have about 2,500 square feet, and if you took over the entire building you’d have closer to 7,000 square feet.

Purchase Price on a building: $2 million

Current Rent + Triple Net Costs (Taxes, Insurance, Utilities) = $8,000/month

If you were to pay the $2M, spread it out over 20 years at 4.5% interest rate….your monthly payment on the loan would be $12,600, and then triple net costs might be another $3,000. In this scenario, you get 3X the space for only 2X the rent.  

What can you do on 3X the space?

If your clinic is collecting about $2 million annually with your first 2,500 square feet, the assumption is that you could possibly hire more associates, hygienists, and get to near $6 million on 7,000 square feet. At this level, your percentage spent on Facility in your budget would drop by about 33% once you achieve this level.  

When doing the math, it’s obviously good to look at the times when it works, but what about when it doesn’t work? In my mind, there’s three scenarios when it doesn’t work:

  1. You’re cash-strapped and struggling right now. If you don’t have the money or success to warrant expansion, then do not buy your real estate. Even though it looks sexy, you might be putting yourself in a position that you cannot afford to be in. If this is you, work on your operations first, get to a good profitability level, and then find real estate. 
  2. Your time horizon is less than 10 years. If you were to try to buy the building, build out the space, and sell out in the next 5-7 years….then this is a bad idea. You might not get the return you’re looking for. It might work out ok, but the risk profile for that time horizon is significantly different. If you are in your early 30s and you think this will be your dental home for 10 to 20 years, then this is perfect. Anything over 10 years pretty much guarantees that this will be a good financial decision for you.  
  3. You don’t want to have a larger clinic. This is totally person-dependant. Some of us like to have small profitable clinics where we work 2-3 days a week and take lots of vacations. Sometimes we don’t want to have to manage a large team. That’s OK! If that’s you, then don’t chase someone else’s dream. If you hate managing people, don’t hire 25 of them and build a mega-clinic.  

Overall, there’s lots of reasons to buy your real estate, and lots of reasons not to buy it.

Hopefully the information here helps you if you’re ever in this scenario!

The 1500th

A Milestone

Last Thursday, we celebrated the 1500th episode of the Dentalpreneur Podcast. We launched the first episode in June of 2015, and since then we have had nearly 7 millions downloads in over 150 countries. I have had the honor to meet my heroes in dentistry through this podcast. Today I wanted to share some of my top podcasts and share my favorite podcast of all time.


Top Podcasts

#952: Mastering Physical Health with Ben Greenfield: Trying to balance relationships, parenthood, business ownership, and clinical responsibilities leaves so many dental professionals stressed and overwhelmed; and, not surprisingly, one of the first things that gets neglected is our physical health. For a lot of us busy professionals it’s tough to keep up to date on all of the latest research on diet, exercise, sleep, and overall how to keep our bodies healthy and fully optimal. I was so stoked to be interviewing biohacking legend, extreme endurance athlete, and NYTimes Best-Selling author Ben Greenfield. We covered everything from supplementation, longevity, diet, exercise, and how to be the best version of your physical self.

#938: Mental Strength and You: I’ve got a weird question for you: are you mentally strong? I interviewed world famous psychotherapist and international best-selling author of the book “13 Things Mentally Strong People Don’t Do”, Amy Morin. Amy’s TedTalk is one of the most watched of all time with 13 million views and her viral blog post about mental toughness was read by over 50 million people, so she is kind of a big deal.

#907: Robert Kiyosaki on the Dentalpreneur: In 1997, I was a fledgling (food truck) entrepreneur by day and an executive MBA student by night. But with all of the lessons that I was learning in the “field” and in the classroom, there were still a lot of gaps in my financial education. Reading these two books by Robert Kiyosaki forever changed the way I viewed business, assets, liabilities, and investing. Bottom line: I learned more from those two $20 dollar books than I learned in two years of business school. I was honored to interview the most prolific business author of all time with over 40 million books sold. Check it out.

#1328: Peak Mind, Peak Experience: Dr. Amishi Jha is the best selling author of Peak Mind (a book I purchased for our mastermind members) and professor of psychology at the University of Miami. She serves as the Director of Contemplative Neuroscience for the Mindfulness Research and Practice Initiative which she co-founded in 2010. She received her Ph.D. from the University of California–Davis and postdoctoral training at the Brain Imaging and Analysis Center at Duke University. Dr. Jha’s work has been featured at NATO, the World Economic Forum, and the Pentagon. She has received coverage in The New York Times, NPR, TIME, Forbes and more. Check out my interview with her.

#1026: Dr. David Sinclair: Lifespan Pt 1 and Pt 2: Have you been testing out NMN or other nutrients? Intermittent fasting? Trying to feel better, more energy…? Some of us are always testing out the newest technology…Oura Ring, Whoop, supplements, etc…what’s been the best for you? To see what one expert says: Dr. David Sinclair is an award winning geneticist at Harvard Medical School, and was interviewed by Dr. Mark Costes. To hear more about longevity and his thoughts about increasing ‘healthspan’ and lifespan, check out my interview with him from 2020.

#1455: David Goggins On True Success: “Pain unlocks a secret doorway in the mind, one that leads to both peak performance and beautiful silence.” One of my favorite quotes from the inspiring Davis Goggins. Often referred to as the toughest athlete on the planet, David Goggins is the only member of the US Armed Forces to complete SEAL training (including THREE Hell Weeks), the U.S. Army Ranger School (where he graduated as Enlisted Honor Man), and Air Force Tactical Air Controller Training. But, David is perhaps best known for his superhuman feats of strength and ultra-endurance. After several of his friends died in a 2005 helicopter crash while deployed in Afghanistan, David honored their memory by tackling the 10 most difficult endurance challenges on Earth to raise funds and awareness for the Special Operations Warrior Foundation, which provides college scholarships and grants to the children of fallen special ops soldiers. Hence, began a most unexpected yet remarkably storied athletic career as one of the world’s most accomplished endurance athletes. Check out my one-on-one interview with him at the link above.

#916: Greatest Living American Hero: I had the privilege of interviewing one of humanity’s greatest living heroes, Robert O’Neill, the Navy SEAL (SEAL Team 6) who shot and killed Osama bin Laden. Check out this career:

He is an amazing storyteller and one of the most thoughtful and humble people I’ve ever interviewed.

#933: Business and Life Lessons from Astronaut Clayton Anderson: With all of the challenges we’re having down here on planet Earth, for me, the Space X launch of the Crew Dragon on May 30th, 2020 with veteran astronauts Bob Behnken and Doug Hurley was a really cool distraction and reminder of keeping things in perspective. Since watching All the Right Stuff and Apollo 13, I’ve been obsessed with Astronauts and space exploration. I’m super excited to have interviewed Astronaut Clayton Anderson. Don’t miss his behind the scenes perspectives on NASA, overcoming incredible challenges, and what it was like to spend over five months on the International Space Station.


My Favorite

#934: The Obstacle Is The Way – With Ryan Holiday Pt. 1 and Pt. 2: Here it is. My favorite interview of all time. I interviewed multiple The New York Times Bestsellers and one of my favorite authors, Ryan Holiday. We’ll dive deep into Stoic philosophy, marketing, writing, and how he was able to become the CMO of a billion dollar company by the age of 21. Now 32, Ryan’s discipline and life philosophy has made him uber-successful and we’ll discuss how he’s able to balance his fame, “obligations”, and personal life.

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