Revenue Mix as Strategy: How Comprehensive Care Drives Enterprise Value (E.166)

“At some point that busyness volume game stops working because it doesn’t translate into profits.”
– Victoria Peterson

Brief Overview of the Episode

This conversation unpacks a problem many practice owners feel but cannot always name. The practice is busy. The team is working hard. Revenue may look strong on paper. But profits keep tightening, the doctor feels trapped, and growth starts to feel heavier instead of more rewarding.

Victoria and Kari show why this happens. They explain how PPO dependence, underused comprehensive care, weak clinical calibration, and poor schedule architecture quietly limit both profitability and practice value. They also show what changes when a practice moves from volume-based growth to intentional, system-driven growth.

What This Episode Reveals

• Why practices between roughly $1.5M and $2.5M often plateau even when production stays high
• How PPO write-offs, restricted reimbursement, and rising labor costs erode margin
• Why comprehensive care only creates value when the whole team is calibrated around it
• How schedule design, reactivation, and service mix control directly impact enterprise value

What You’ll Learn

• Why revenue mix matters more than raw production alone
• How comprehensive diagnosis supports both patient care and financial health
• What keeps doctors emotionally stuck and how to begin changing it

If This Sounds Familiar

• Your practice is busy, but profitability feels tighter than it should
• You are producing more, but not taking home more
• Insurance is dictating too much of what gets diagnosed, scheduled, and paid
• You feel like the practice is running you instead of you running the practice

Next Steps

If you want help seeing your practice accurately, book a 30 minute clarity call with Victoria.

Get honest about where leadership, communication, and systems are creating drag in the practice. Stop trying to solve internal problems with external tactics.

 

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TRANSCRIPT

[00:00:00] Victoria Peterson: At what point does a successful $2 million practice quietly become stuck? When your schedule is full, when your team is working hard, and yet your profit margins keep getting tighter and shrinking. This is not random. This is architecture. Hi, I’m Victoria Peterson. If you felt the squeeze of rising payroll increase increased supply cost and shrinking PPO reimbursements, well, you’re not alone, and I’m sure you’re wondering why working harder.

[00:00:34] Victoria Peterson: Is it creating more freedom? In this episode, we’ll give you clarity and a framework for what actually moves the needle. Today I am joined by the one and only Carrie Miller. She is a senior business advisor in our investment grade practice consulting team. Carrie, welcome. I’m so glad to have you here today.

[00:00:54] Kari Miller: Oh, I’m so happy to be here. Thank you for having me. 

[00:00:58] Victoria Peterson: Uh, there’s so many ways we could [00:01:00] take this conversation. You’ve been a, gosh, I knew you before. You were a coach with PDA when you were an office manager in a real high level aesthetic practice in downtown Seattle. How long have you been with PDA? 

[00:01:13] Kari Miller: Um, I’m working on my 16th year, so 15.

[00:01:16] Kari Miller: This’ll be my 16th. 

[00:01:18] Victoria Peterson: Oh, wow. We were babies when we started. 

[00:01:20] Kari Miller: I know. Oh, I don’t know what you mean. I still am. 

[00:01:24] Victoria Peterson: That’s right. Well, you have a wealth of knowledge. You have worked with hundreds of practices these last dozen or so years, and I’m gonna be picking your brain in particular about that place where doctors get the practices is above 1.5 million.

[00:01:41] Victoria Peterson: Easily, they probably have brought on an associate or are thinking about bringing on an associate. Uh, their service mix is really good. You know, they’re doing more than bread and butter dentistry, but they’re kind of plateaued. So that’s a conversation I wanna get into with you today. So let’s, let’s start [00:02:00] with data.

[00:02:00] Victoria Peterson: Let’s nerd out. When you see a practice like this and you’re evaluating it, what do you consistently see? What does the data show you? 

[00:02:10] Kari Miller: Well, really when we start looking at it, you know, PP write off or PPO write offs are really between 35 and 55%. You know, revenue has flattened line flatlined. So they’re, they’re becoming pro really productive, but they’re not taking home more.

[00:02:29] Kari Miller: Hygiene labor costs, they’re not able to keep up with, you know, the diagnostic, you know, kind of three to one ratio because of the insurance reimbursements. So there’s higher labor costs that are associated with it, and they’re really expanding their service mix. They have a really great service mix in place.

[00:02:49] Kari Miller: However. Insurance is still dictating what they can charge for each of those. So it’s still restricted on what they’re able to do for those. So although they’re [00:03:00] expanding their service mix, they’re still getting, you know, minimal reimbursement from the insurance carriers. 

[00:03:08] Victoria Peterson: Okay, so, and I see that path too.

[00:03:11] Victoria Peterson: We use in-network plans, I mean, everybody’s on Delta, not everybody, 5% or not n yay for the 5%. But you know, we’re on multiple plans and that’s a great growth strategy, right? If you’ve got no patients or you took over a practice or the early days of your practice, you wanna get volume, you’ve gotta get above 1200 patients of record.

[00:03:32] Victoria Peterson: You’re moving to 2000 patients of record by the time. You’re at this level, maybe 3000, but at some point that busyness volume game stops working because it doesn’t translate into profits. That’s what I’m hearing you say. 

[00:03:47] Kari Miller: Exactly. And you know, they’ve built that stage one of growth through the volume and now they really need to hone in on the precision of stage two.

[00:03:58] Kari Miller: And that really takes [00:04:00] kind of the nuance and really looking at it, you know, clinically and kind of through, um, a, a, an eyeglass. 

[00:04:08] Victoria Peterson: I am so glad you’re here with me today. On the last few podcasts, I’ve been telling doctors I’m gonna keep telling you, you’re not broken. You don’t need his personal self-help, uh, class.

[00:04:17] Victoria Peterson: This isn’t really about you. What’s generally happened is that the business is built around you and not for you. So Carrie, what I’m hearing you say is if we can fix the structure of this a little bit, Dodgers will start to feel the freedom, like the business that works for them. They don’t have to work five days a week.

[00:04:39] Victoria Peterson: You don’t have to put out every fire. You’re not the HR culture ambassador, plus the financier, plus the clinician. 

[00:04:47] Kari Miller: Exactly it. It couldn’t be more true with what you said. It really is like they start to take ownership where if the practice isn’t running them, they start to run the practice and start to see where [00:05:00] there’s opportunities.

[00:05:01] Victoria Peterson: Okay, so I wanna move into something that’s counterintuitive, and it may not seem apparent at first when we’re talking about data and profit and numbers. But from what you and I have seen and, and Dr. Baird, you know, we co-founded this company on this premise that. Telling patients everything that, you know, doing comprehensive diagnosis and doing it in a way that they don’t go screaming out the back door.

[00:05:30] Victoria Peterson: Right? That’s the key is the communication skill. But diagnosing by risk factor is really one ethically sound. It’s in the a DA code of ethics. It’s called veracity. You know, being honest and telling them everything. So before we can even get to, should we renegotiate our PPO? Schedules, we need to take a deeper look.

[00:05:53] Victoria Peterson: And you said something really interesting that by the time you’re in, you know, 1.52 million, 2.5 [00:06:00] million, you’ve got a strong clinical mix. But what I’ve seen is, does everybody on the team. Know what that is, right? So what is our philosophy of care? How do we know? You know, when I see a hole in the tooth, how do I fix it?

[00:06:18] Victoria Peterson: How am I gonna prevent it? What are the risk factors that got the patient here? So I. I think you and I would say a common theme is that almost everybody we work with say we wanna do great patient care. We wanna do what’s best for the patients. We wanna do what we would do in our own mouth. I hate treating one tooth at a time.

[00:06:37] Victoria Peterson: I hate treating just the emergencies. But, um, what do you think holds them back from having that like modern Health Paradigm diagnostic standard? You know, what do you see as holding them back in this pinch point? 

[00:06:59] Kari Miller: Well, I [00:07:00] feel a lot of it is where they’re not calibrated on, you know, and there’s inconsistency with how every team member is talking about things in the same way.

[00:07:10] Kari Miller: So I wanna make sure that that’s something that we’re very intentional in when we look at it clinically. We wanna make sure our hygienists, you know, diagnosing differently than the doctors. Are we really evaluating risk factors? You know, we see inconsistency throughout. Each one of the different, you know, um, departments.

[00:07:31] Kari Miller: And so really getting solidified on how do we wanna care for patients because this is the mindset from what insurance covers versus what we actually believe in the care for our patients. And so we need to just, that’s the team. Heavy lifting is getting very, you know, conscientious about what do we want to do.

[00:07:54] Kari Miller: Because dentistry’s evolved over time, you know, with oral systemic airway, you know, [00:08:00] the, um, preventative, so many of these things, we need to make sure that we’re calibrated as a team so our value stays there, you know, that we, we can really stand behind what we would be charging our patients if we weren’t restricted by what insurance covers.

[00:08:16] Victoria Peterson: And you know, that’s showing up in some of the trend data that I’m seeing right now, like the average periodontal, periodontal. Boy, it sounds like I can’t talk or that I was never a hygienist. The average periodontal code utilization across the country is about 7%. And when you ask clinicians, they’ll say no.

[00:08:37] Victoria Peterson: For adult patients, it’s. 30, you know, 25, 30, 40%. So there’s this differentiator, and you hit on it earlier, like there’s a scheduling kind of block. So what happens if you do have the capabilities? I mean, this must be so frustrating for doctors. Yes, I can place implants, I can do full mouth rehab, I could do quadrant [00:09:00] dentistry, I can do aesthetics, we can do, um.

[00:09:03] Victoria Peterson: Preventative. We can have modern biofilm therapy for our patients, but they’re not saying yes, that’s one problem. But the bigger problem is they say yes, and now we’ve gotta bill it through insurance. What happens there? 

[00:09:17] Kari Miller: Oh, well if the documentation, I mean, you really have to fight for the, the patient you know of what you’re wanting to do, and it becomes a very heavy lift for your administrative team for going through that and making sure, well, do we have the right documentation?

[00:09:34] Kari Miller: Is this all under what insurances guidelines are, even though. You’re the doctor and you’re creating what parameters and protocols you believe your patients should go into. Insurance is dictating something much different. And so you really have to fight, which takes up time where we could be doing, you know, face-to-face patient care versus, you know, working with the insurance as far as trying to get ’em reimbursed for what’s truly going on in their [00:10:00] mouth.

[00:10:01] Victoria Peterson: Gimme an example of what that looks like in real life. Let’s say I just. Extracted some teeth, put in a denture. I have my fee for service fees. I throw ’em in there, it goes to insurance. What happens to that? 

[00:10:13] Kari Miller: Oh, well, I mean, if we’re talking about this, let’s just say you wanna bill out an interim denture so they have something that’s going on, you know, uh, or have teeth at least, you know, after their appointment.

[00:10:25] Kari Miller: Well, insurance usually only covers one denture, so it’s either the interim or the final. And so you’re now placed in this. Position of, well, which one do I bill out for? Because truly the best patient care is for both of them. And then we have to, you know, have a conversation around the patient of your insurance will not cover the second one, and they won’t allow you to charge the patient.

[00:10:51] Kari Miller: The, the second additional one, which is really the, the biggest challenge when you’re in network with a lot of insurances. So it just takes that. [00:11:00] Huh. You know, the frustration and you’re not really able to provide the best care. It starts to dictate the type of care you’re able to give. 

[00:11:07] Victoria Peterson: That doesn’t even sound like a write off.

[00:11:09] Victoria Peterson: That sounds like I’m paying the patient to come in. 

[00:11:12] Kari Miller: Absolutely. I worked with one doctor and when we did, started to do a, a deep dive analysis, um, he was working with a, a denture patient. Lab cost, you know, of what it was around $600 for the, the denture he was getting reimbursed, five 50 for the actual denture.

[00:11:34] Kari Miller: And that is like he’s paying the patient not to mention the chair time, not to mention the overhead for. All of those things that add up and the numerous appointments that, you know, come with delivering a denture and making sure that it fits right through the healing process. The he, he’s like, I just can’t even provide this service that my patients want, but I can’t afford to do it.

[00:11:56] Kari Miller: I’m paying them for it. 

[00:11:58] Victoria Peterson: It’s costing him a thousand bucks and [00:12:00] he collects five 50. 

[00:12:01] Kari Miller: Yeah. 

[00:12:02] Victoria Peterson: And it’s so hidden. I, it’s, it’s not obvious and it’s not, even if you have a really high level office manager having the time and the expertise to put all these numbers down and analyze it, it, it can be somewhat time consuming.

[00:12:17] Victoria Peterson: I know you’re always at it, but, um, it just seems crazy. And, you know, we’re seeing dentures now, but the same formula flows for. All on fours, your ins, your prosthetics, everything, the numbers just get bigger. So that’s, that’s, so step one, you’ve given us two clues here about why we may have plateaued.

[00:12:39] Victoria Peterson: Number one, our race to revenue and our volume strategy may have peaked. Like we, we filled all the chairs. We filled all the time. We’re peaked, but now our write-offs are getting bigger and bigger. They’re all bundled in a network of an umbrella, so it’s hard to see. Maybe we get that analyzed every two [00:13:00] years, every four years, uh, if you’re really on top of it.

[00:13:03] Victoria Peterson: So it’s easy to see from the data that it shrinks, but then there’s these hidden, softer things of, um. Even if we are comprehensively diagnosing and treating, the reimbursements are so low that it actually costs us, it’s, you can’t afford to do that sometimes in this environment. Um, I was chatting with a practice, uh, recently and they have four doctors and six hygienists, and we were talking about diagnosis and I said, well, what, talk to me about the exam and what triggers the diagnosis?

[00:13:39] Victoria Peterson: And they said, well, usually the patient has a complaint, something that they’re, you know, concerned about. We take a look at it and they ask if insurance will cover it. And I say, yes, and that’s where we start. I said, are there, do you ever notice that there are other things going on in the mouth? Oh yeah.

[00:13:57] Victoria Peterson: And do we talk about that? Not usually. [00:14:00] So I think what’s happened is we’ve unintentionally, and this could be part of the burnout, it could be part of the fresh, it’s part of that constriction. Like, why I just wanna be unrestricted. Let me do what I do as a clinician. Right? So that tension there between I know what is right.

[00:14:17] Victoria Peterson: But I know I can’t, I won’t be in business if I deliver that. It be, we become insurance educators. Ah, patient advocates. 

[00:14:27] Kari Miller: Victoria, you’re hitting that on such, uh, an important piece. And it’s so crucial when we start to really frame of when we start speaking insurance language, we’re doing everything that the insurance companies are wanting.

[00:14:41] Kari Miller: Oh, let me check to see if your insurance covers fluoride. Instead of bringing it back to the actual risk factor as to why we want to do fluoride, whether insurance. Reimburses it or not, and that is where we need to really be hearing ourselves. How are we communicating with the insurance? What is that verbiage that we’re [00:15:00] utilizing?

[00:15:00] Kari Miller: Because if we’re educating our patients, exactly what you said on. Let’s see if your insurance covers this. Oh, let me pre authorize this. It’s still needed, whether it’s authorized or not. And so this is that part of really just taking, you know, your ownership of, I’m going to be giving you the best care.

[00:15:20] Kari Miller: Insurance is a, you know, form of payment, not a form of treatment. And so you really wanna make sure that you start to utilize that verbiage in the very beginning, hearing your team doing that when you start to really focus on being unrestricted. 

[00:15:35] Victoria Peterson: I love it. I’m gonna take that one step further. Insurance is a form of payment.

[00:15:39] Victoria Peterson: I would say insurance is a form of marketing, and right now you’re spending 35. You’ve got a 35% marketing budget. 

[00:15:47] Kari Miller: I actually just talked with, um, a doctor and we’re doing a analysis right now, and when I said, imagine what you could do with a hundred thousand dollars marketing [00:16:00] budget for the services you truly wanna do every month, what would that look like?

[00:16:05] Kari Miller: Different, because that is what the. You know the insurance is costing you at that. Now 

[00:16:11] Victoria Peterson: you’re writing off a hundred thousand dollars a month. 

[00:16:13] Kari Miller: Yes. That’s 

[00:16:14] Victoria Peterson: 1.2 million of your life force energy. Whoop. 

[00:16:19] Kari Miller: And, but they’re producing, you know, and it’s like, oh, I’m just, I’m trying to outproduce it. And this is where you just start to see like, this is that wheel.

[00:16:28] Kari Miller: You’re just not able to get off until you just start to think of it in a different way. And that’s what I’m encouraging everyone who’s listening start thinking about it in a different way, because it doesn’t have to be that way. 

[00:16:40] Victoria Peterson: And we, we really are not, I don’t, I don’t see insurance as evil. It is a construct and you have to know when it works for you and what the tipping point is for when it doesn’t, and how to pull some different leaders.

[00:16:53] Victoria Peterson: So, let’s talk about internal marketing. Mm-hmm. I know that you work with our Phoenix Dental Agency and do a lot of [00:17:00] internal marketing, and in this. Situation. It sounds to me like you and Sarah would probably sit down and have a powwow, and step one would be, let’s look at the patient demographics. So we have 50% that are fee for service.

[00:17:13] Victoria Peterson: We have 50% that are in network. I’m gonna take the part where we’re going to work with someone to renegotiate and get better fees. Figure out how we’re gonna restructure. Sarah, could you work on the piece of how we reactivate outstanding treatment for our fee for service patients? Am I getting that right?

[00:17:34] Kari Miller: Yes, absolutely. 

[00:17:36] Victoria Peterson: How much, so how much unscheduled treatment do you typically see in the shelves when you analyze a practice? 

[00:17:43] Kari Miller: Oh, I mean, let’s just take a one year timeframe and I, I love doing this exercise with a lot of offices of just asking them, where do you think you know, your unscheduled treatment lies?

[00:17:55] Kari Miller: And what I am seeing is upwards, you know, of. A [00:18:00] million up in that, um, conservatively, let’s just say, you know, like at, at a minimum 550, you know, to 800,000. Um, but it is, there’s a lot sitting on that table, you know, to, to do it. So it’s a wonderful thing to get these patients reengaged and start to, to find out why didn’t, why weren’t they able to say yes to begin with?

[00:18:24] Victoria Peterson: Now, I remember 20 years ago when you were an office manager, you were like the queen of reactivation and like no one, no one got out without their next appointment. And if they did, you had your call list, you had your one to 31 file like you were on it, doggone it. But I think things have changed here.

[00:18:44] Victoria Peterson: And from 20 2006 to 2026, in just the volume of workload on the administrative team, I hear doctors say, what’s your reactivation plan? And they go, well, when the hygienists have downtime, [00:19:00] they make calls. Okay. I’m gonna be blunt. That’s not a plan. Hygienists will never have downtime if they have, I was a hygienist.

[00:19:10] Victoria Peterson: I’m gonna give you the secrets here if I know I’ve got an opening. My next appointment, boy, this is gonna be a really difficult prophy and that patient’s gonna be a gagger, and I’m gonna note all of that, and I’m gonna take about an hour and 15 minutes on that patient instead of an hour. And then of course, I need to clean up.

[00:19:29] Victoria Peterson: And then of course there’s some chart notes. So that hour you think that I have to make a phone call is not there. 

[00:19:37] Kari Miller: Well in the administrative time and you know, clinical time, we want that to be focused on patient care and the patient experience, not on, you know, really kind of following up on unscheduled treatment.

[00:19:51] Kari Miller: It is an. Absolute important system that we must do, and so then it’s like, how can we alleviate that? Which is why I love [00:20:00] the re-engagement, is that a lot of times it’s the time that we don’t have. And so when we get someone to help support that actual system with, all right, they’re specific. Cases that you want, whether it’s crowns, whether it’s implants, that you can actually follow up, whether it’s hygiene to fill, that they’re working that system behind the scenes so you can really focus on patient care.

[00:20:25] Victoria Peterson: Do. Are you seeing more and more offices at this level? Just outsource that to like a fractional marketing person or partnering with a marketing group? Because it’s not just reengagement, it’s like reengagement of restorative. It’s getting the new patients back on the book. It’s reappoint. The right patients in hygiene.

[00:20:45] Victoria Peterson: It’s getting the reviews, getting the raving fans like that has become an entire job or a big part-time job, and I don’t think we have the staffing for that inside the practice right now. 

[00:20:58] Kari Miller: No, this is where we really [00:21:00] look at being able to look at third party and, and for having those people that can help support that to allow the time for, you know, the face-to-face care.

[00:21:11] Kari Miller: And so when we look at that, it absolutely is helpful and it pays and. Babes because then it’s like, alright, you don’t have to be the expert in your reactivation software. You don’t have to be, oh, the, all of the phone calls that are going out, you don’t have to do. It’s very easy to be like, here’s the system, you know, here’s the patients we reach, here’s what they scheduled for.

[00:21:33] Kari Miller: This is our another at bat. To getting them to Yes. Which is like, that’s the brilliance of being able to have a, a relationship, you know, within some of the companies that you work with. 

[00:21:46] Victoria Peterson: I love that. And if you’re, if you’re like me, as you were talking, I was, my brain went to like some old school answering service person kind of reaching out or some robotic voice going, Dr.

[00:21:59] Victoria Peterson: Uh, [00:22:00] Carrie, this is Victoria from blah, blah, blah. You’re due, call us back. Fine. It is not like that. It’s like having a warm Carrie Miller on the other end that understands your team, understands your practice. So don’t be afraid of that. Doctors, there’s, there’s a million reasons why you want to really be intentional.

[00:22:19] Victoria Peterson: So if you’re using 35%, write off as your marketing plan right now. Maybe take. 2% of that and hire somebody to help you with internal marketing ’cause that’s where your next million’s gonna come from, and it’s gonna be fee for service and it’s gonna be unrestricted. 

[00:22:37] Kari Miller: It’s not gonna add stress to the rest of your team.

[00:22:41] Victoria Peterson: Good point. Good point. Okay, so I know my data. I know why I’ve plateaued. I get that I need to really shore up my diagnostics. So we’re all looking at it the same way. I know I need to restructure my relationship with the. In network participation. So I can actually bill [00:23:00] for the comprehensive care and I know that, you know, we need to market towards like create a budget and market towards that type of patient.

[00:23:09] Victoria Peterson: Now I’ve got another problem. So before I had challenges of scarcity, like, oh my God, I’ve got too many patients, I don’t know where to put ’em. Now I’m creating challenges of abundance, like. Now I’ve got all of these patients and I need bigger treatment blocks. They’re not like my standard one hour find me a crown anymore.

[00:23:32] Victoria Peterson: It’s like a quadrant or a half mouth. And so something happens. So now my $2 million schedule, that’s packed because of time and I’m booked out three weeks, five weeks, 10 weeks in advance. What do you do to evaluate that system? What do you do to evaluate the scheduling system or how do you even set goals for what we should be doing?

[00:23:57] Kari Miller: Yeah, there’s really three metrics that we’re [00:24:00] looking at. Which one, production per hour by provider. So you’re really establishing, Hey, what are we averaging so we can start to create a structured schedule around that. Production per chair gets lost often, so it’s a, an important piece of the, the. The, you know, um, pie when you start to go, alright, if you have six operatories, where should you be at within each of those?

[00:24:24] Kari Miller: And really you’re scheduling, um, template and the integrity of it. Are we scheduling over new patient blocks? Are we scheduling over our, you know, scaling and root planning or periodontal blocks within that? Because if there’s not intentional. Service mix control, it starts to, your schedule starts to run you, so you need to really structure that or else it’s gonna feel chaotic, you know, even when it’s feel, you know, full.

[00:24:52] Victoria Peterson: Yeah. I love that. Couple benchmarks here. Um, if you’re not familiar with production per chair, [00:25:00] like an industry standard would be $25,000 per chair. So as you’re saying, a six operatory, if I, if I did 25,000 times six, I’m gonna have a $1.5 million practice. I know that you coach offices all the time that are six operatories that are doing two and a half million.

[00:25:20] Victoria Peterson: Uh, in that same space. So with that, the per chair value goes up to 41,000. And I was having this conversation with Kyle Francis a few months ago, and he is like, that’s a unicorn. That doesn’t happen. And so I went back in our database and I was like, yeah, more than 50% of our clients have achieved that $40,000 per chair.

[00:25:45] Victoria Peterson: Ratio, and that includes hygiene chair, right? So it’s not discriminated restorative or hygiene. That doesn’t mean the hygienists are producing $60,000 a month, but it means that the overall productivity of the practice, [00:26:00] it reaches that level. So the schedule is so integral and it needs to be engineered with this.

[00:26:10] Victoria Peterson: With your philosophy of care in mind. Otherwise, it’s just treated like a calendar. And if you treat your schedule like a calendar, you are ne instead of an operating system, you’re never gonna grow your practice. You know, we’re gonna keep reappointed the same people who come in and hygiene and they’re healthy and have no, and all the bad patients get on our schedule and all the good ones are waiting.

[00:26:32] Victoria Peterson: That’s what I found. 

[00:26:34] Kari Miller: Yeah, they need that. You know, I, I always talk about architecture, you know, the, they need that foundational support to be able to do that, and what we tend to focus on gets done. And so when you’re really evaluating what services would fit into that, you start to realize my, you know.

[00:26:54] Kari Miller: Solo individual crowns. I’m not. It’s just making me busy. It’s not making me [00:27:00] really efficient and productive, you know, and you know, you’re not, you know, feeling that profitability. So it’s, this shows you when it’s like you just are feeling exhaust at the end of, end of the day, but you’re not like, you’re like, I only produce this much.

[00:27:15] Kari Miller: It’s because we didn’t engineer the schedule to what you really are looking for out of it. 

[00:27:20] Victoria Peterson: Love it. I’m gonna declare a Carrie Miller challenge. So if we’re listening to this podcast, it’s the Kerry Miller Challenge. I want you to look at the next 10 people who sit in your chair that you’re doing a single tooth restorative procedure on, and ask yourself, is there other disease within this quadrant or within this arch?

[00:27:43] Victoria Peterson: You know, uh, in this quadrant or half mouth and just see, you know, was it truly a single tooth or were there other opportunities that we didn’t talk about? It’s not good or bad. Our standard of care allows for all of this. It’s just simply a observing [00:28:00] where we leak energy, where patient care could be elevated and understanding what’s restricting us, what’s holding us back.

[00:28:10] Victoria Peterson: All right, Carrie, last question. We’ve, we’ve done a lot of data. We’ve done a data deep dive. I wanna talk about the emotions. What do you see as the impact on doctors emotionally when they’re running at this pace and profits are shrinking? What do you see? 

[00:28:28] Kari Miller: They feel trapped. The, it’s hard to see the light at the end of this.

[00:28:32] Kari Miller: Tunnel. You know, they, they feel like they’ve put blood, sweat, and tears into something and they’ve built it to where that production dollar amount is so high. Yet when they see those adjustments, they just are like deflated. And so it really, if. Effects, like, Hey, how am I gonna continue to do this? They get burnout much more quickly.

[00:28:53] Kari Miller: So you know, that’s when you start to go, all right, what does that look like? So they start to consider, [00:29:00] I need another associate. I need to be, you know, looking at maybe being more intentional with the PPOs or expanding my. Space, yet the profits, profits aren’t there to support it, and that’s where they feel stuck.

[00:29:14] Kari Miller: They feel trapped. What they really need is to refine what they’re really looking for, and I wanna make sure there are very. You know, productive PPO practices, it’s a different way. So this is all something that you can be evaluating and, and shifting to, but really when you really are looking at what is the type of practice I want to run and to come into every day, this is where you just have to really look and, and structurally go through it and say, alright, what do I want?

[00:29:46] Kari Miller: And how do we get there? And we build a roadmap together on how we can make that happen. 

[00:29:51] Victoria Peterson: I love that. So you say doctors feel stuck, they feel trapped. 

[00:29:56] Kari Miller: Oh. 

[00:29:56] Victoria Peterson: When you first meet them, are those the words they’re [00:30:00] using or is it something deeper? 

[00:30:02] Kari Miller: Oh, I mean it’s, most doctors get into dentistry to support their community.

[00:30:10] Kari Miller: And to take care of people. And so when this starts to happen, they start to feel really deflated and you know, emotionally they’re just like, I just want to come in and take great care of my patients. Yet these, all these other outside forces are really trapping them into this cycle where they just don’t see a way out.

[00:30:31] Kari Miller: And that’s exactly where I feel a lot of times. This is that. Bend that you know, little thing that you can just go. Hope is still there. You can take control of it. You just need to take the right steps. You know, it’s, you know, where there’s a void, negativity fills it. I always say, let’s make sure there’s no void.

[00:30:53] Kari Miller: You know, we’re, we’re gonna walk through that step by step. So they really get, they’re emotionally tied to it, you know, they’re, they’re feeling [00:31:00] this, you know, scarcity part of like, I don’t know how I’m going to get out of it. Like there’s no way out this hopelessness feeling. And you know, at my core I’m just like, there’s better ways of doing this.

[00:31:12] Kari Miller: You know, you don’t have to be restricted in this way. You can still take amazing care of your patients and get financially compensated for the work and the investment in your CE that you do. There’s a way, yeah. 

[00:31:27] Victoria Peterson: Yeah. This is why your clients love you so much. It’s like you, you re-sparked their dream and then you give them the tools to actually have the team help ’em carry it out.

[00:31:38] Kari Miller: Yeah, I mean, it’s, it’s a passion. It’s like, gosh, you know, we’re here to take great care of our patients and clients and, you know, I just don’t want anyone to dictate what we’re able to do. 

[00:31:51] Victoria Peterson: I love it. Carrie, thank you so much for being here with me today, having this conversation about becoming unrestricted.

[00:31:58] Victoria Peterson: Uh, know that that $2 million [00:32:00] ceiling, it’s real, but it’s not permanent. And here’s the takeaways that I got from you. When we standardize our clinical schedules, when we intentionally reactivate, um, patients that align to that, when productive systems are put in place, then we can. Move out of this viability race to revenue volume stage, we can get in more of a predictable building value per patient stage.

[00:32:27] Victoria Peterson: And, and that’s not a hope or a wish. Um, it’s, it’s the reality of what you do every day. So, hey, if this episode felt a little uncomfortably accurate, that is a really good thing. So if you resonated with this just. Be aware that first, this is an architectural shift, and as a leader you’ve likely done so many things right?

[00:32:50] Victoria Peterson: You’ve created so much success and you deserve to know that, and it’s time to just get a better system. Carrie, thank you so much for joining me here today. [00:33:00] 

[00:33:00] Kari Miller: Aw, thank you for having me.