The Hidden Profit Lever in Dental Practices (E.164)

“When trust breaks down, so does the system.” – Joanne Miles

Brief Overview of the Episode

In this conversation, Victoria Peterson sits down with Joanne Miles to uncover one of the most overlooked drivers of profit in a dental practice: the doctor and office manager relationship. Together, they break down why profitability is not just about top line production. It is also about operational trust, role clarity, leadership cadence, and having the right person helping carry the business side of the practice. They show how small misalignments in this partnership can quietly drain profit, culture, and scale. 

What This Episode Reveals

• Profit does not only come from producing more. It also comes from stronger operational alignment.
• A healthy doctor and office manager partnership creates focus, structure, and scalability.
• When authority is unclear, trust is weak, or communication breaks down, the business leaks money.
• The office manager is not there to manage chaos. They are there to create structure so the doctor can lead with focus.
• Practices become more durable when the clinical engine and operational engine move in sync. 

What You’ll Learn

• Why the doctor and office manager partnership is one of the most under-leveraged drivers of profit
• What makes an office manager truly qualified beyond longevity or familiarity
• How trust in this relationship is both emotional and operational
• Why weekly leadership cadence and structured check-ins matter
• Where breakdowns show up first when alignment is weak
• How authority must be clearly defined so the office manager can lead without being undermined
• Why visibility into overhead and business fundamentals helps an office manager protect profit
• How this partnership affects culture, accountability, and long-term practice value
• Why better structure, not more effort, is often the real next move for growth 

If This Sounds Familiar

• You feel like all the responsibility still lands on you
• You want to delegate, but you do not trust what will happen when you do
• Your office manager handles tasks, but not true leadership
• Team issues keep coming back because authority is unclear
• You are producing, but profit still feels tighter than it should
• The front and back feel busy, but not aligned
• You are growing, but the business still depends too much on you
• You know something is off, but you have not been able to name the real leak yet 

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: An owner’s mindset isn’t about control. That’s old school. Today’s owner’s mindset is about becoming a steward, and stewardship requires partnership. Hi, I’m Victoria Peterson, your host for uh, investment grade practice podcast. And here’s what I know for sure. Every dental practice runs on two engines, clinical productivity.

[00:00:30] Victoria Peterson: Operational execution, those engines. Running independently. Friction increases right front and the back when they run smoothly and in sync your growth as a business owner compounds. I am here today with Joanne Miles. She’s a senior investment grade practice business advisor. We love having her on our team here at.

[00:00:54] Victoria Peterson: Uh, productive Dentist Academy. She’s also a diplomat in the American Academy of Dental Office [00:01:00] Managers, and she grew up in this industry as a young child dental assistant. So, uh, I don’t think there’s a thing you’ve done except pick up a handpiece and I’m pr I’m pretty sure you pick that up out of the mouth as the law would allow to adjust.

[00:01:15] Victoria Peterson: And temporaries. Joe, you’re a welcome knowledge. Thank you for being here today.

[00:01:21] Joanne Miles: Thank you for having me. This is a wonderful topic. I can’t wait to dig in.

[00:01:25] Victoria Peterson: Well, you brought this topic up and I love it because it was hidden from me as well. And so this episode is called The Hidden Profit Lever, and you’re gonna bring a new perspective to it that that lever is the doctor, office manager partnership and how that drives profitability.

[00:01:45] Victoria Peterson: Mm-hmm. Tell me, tell me how you got interested or what, what brought that top of mind for you?

[00:01:51] Joanne Miles: Well, as you said, I kind of grew up in dentistry, so I’ve, um, been around a long time and what I’ve, what I’ve learned along the [00:02:00] way, um, through trial and error, you know, a bit of baptism by fire is, um, that the relationship for a truly successful office, there’s an arc of its growth and the relationship between a doctor and their office manager.

[00:02:17] Joanne Miles: We can define what I mean by office manager, um, is probably one of the most pivotal pieces that we, we, we call them levers within the business. Mm-hmm. That have to be there. And it’s, it’s really, um, trust. We talk about trust, but trust is an emotional, it’s operational. Yes. So when trust breaks down, so does the system.

[00:02:43] Joanne Miles: And one of my favorite quotes from James Clear’s book of Atomic Habits is we don’t rise to the level our goals, we fall to the level of our system. So it all is predicated on this level of trust, but that trust between a OM and a doctor is really based [00:03:00] on operational excellence and that partnership.

[00:03:03] Victoria Peterson: I love that.

[00:03:04] Victoria Peterson: And, you know, um, most dentists focus on production when they wanna increase profitability. Mm-hmm. If they didn’t, we wouldn’t have a company named Productive Dentist Academy. So, uh, but production only takes you so far, and that’s where I think bringing in support. To surround the owner in this partnership with their manager.

[00:03:27] Victoria Peterson: So docs, if you’ve ever felt like you’re carrying all the responsibility in your practice alone, this is the podcast for you. And if you want to delegate, but you don’t know how to delegate with authority, or you’re seeing patterns that your team are doing things without permission and you don’t know how to address it, or if you just feel like you’re still holding.

[00:03:50] Victoria Peterson: Everything. This is gonna be the conversation for you. All right, well, let’s first of all, um, define [00:04:00] why the doctor, office manager partnership is one of the most under-leveraged drivers of profits.

[00:04:08] Joanne Miles: Yeah. So, uh, for doctors, a lot of the time they, they really do feel like they need to be in control. And yes, your name is on the door, and ultimately you are, you are ultimately responsible.

[00:04:23] Joanne Miles: But ownership isn’t, isn’t only just about control, it’s about the stewardship, which you were, how you kind of opened us up here. And that stewardship requires a partnership. And you know their chairside Often in the times their, their eyes are in the mouth. They’re the, they’re, they’re the clinical. Driver of the, of the practice, so they can’t have their eyes on the ball.

[00:04:48] Joanne Miles: Every ball going on around there. I often say that, um, a lot of management is just managing the spinning plates and not, you know, knowing when to run over and [00:05:00] kind of hit the spin again, so it does a drop. And if the dentist was trying to go at it alone, the entire. Life of the practice, um, then you’re just gonna have chaos.

[00:05:12] Joanne Miles: You’re not, you’re gonna have plates that are going to drop. So the, that’s where the trust comes in. Trust, but verify We always say here.

[00:05:20] Victoria Peterson: Yeah.

[00:05:21] Joanne Miles: And that is part of the overall mechanism of the success we always say, or actually you always say that the more successful you are, the more support is required.

[00:05:33] Joanne Miles: And that is where your OM comes in.

[00:05:36] Victoria Peterson: I love that and I love that you’re reiterating this word, stewardship. It’s one that I don’t think we use enough in dentistry, but I do think it’s one that as the old, I say you do, industrial kind of leadership starts fading. Uh, because people today, your team. Demanding.

[00:05:57] Victoria Peterson: See me as a person, give [00:06:00] me challenging work and give me the resources to do that work. Mm-hmm. And I think stewardship is the perfect word for that because it’s disciplined, it’s ethical, it, it means I’m looking for resources. Right. And you really are entrusting your reputation to your team, so it makes sense to invest in your team so that they can, and I know.

[00:06:26] Victoria Peterson: My experience was that’s one of the hardest things in the world for doctors to do. Why do doctors hesitate to spend money training their team? Well, first of all, let’s talk about how do, how do 99% of all office managers become office managers?

[00:06:42] Joanne Miles: Oh, look, I, look, I’m gonna, I’ll throw myself on that too as, um, so my definition, and it’s the hard truth, is a qualified office manager is not.

[00:06:54] Joanne Miles: The person that’s been in the office the longest. So now it can mean [00:07:00] that sometimes if there’s been investment in that, in their professional development on both sides, oh, you know, I believe that office managers have an obligation to invest in themselves as well. Um, but I also believe that the doctors should be investing in their development.

[00:07:18] Joanne Miles: And really investing in their own. It’s really a partnership. You’re investing in both of your developments. You should be growing at the same time around how do we become leaders, co-leaders of our practice?

[00:07:32] Victoria Peterson: Oh, I could see, I can see a conundrum right there. If you’re a doctor owner and you were never taught business and you don’t know what you need to learn, it would be really hard to understand how to.

[00:07:44] Victoria Peterson: Create a training map for your office manager? I was, I was a, a hygienist and I was nominated to be an office manager because our office manager quit two weeks before our doctor had a baby. And I knew the software, [00:08:00] I knew the patients and I knew QuickBooks so I can make sure that payroll was gonna run.

[00:08:05] Victoria Peterson: I knew how to schedule patients. I knew all the patients because I had been in the practice a long time and. We knew we couldn’t find an office manager and train them in two weeks, but we had an associate doctor who could take on my hygiene patients. And so like once or twice a day I’d pop back and do a cleaning.

[00:08:23] Victoria Peterson: That six week maternity leave turned into two years of being the office manager. And, and I’m glad I did that because it, it helped me see, uh, what I knew and what I didn’t know coming from a clinical background. So I like your, your definition. You can. You know, horizontally shift or you can promote into, you can do those things, but you must be cross-trained.

[00:08:46] Victoria Peterson: You must be trained for the job. And there’s also a difference between being a highly skilled administrator, like, I’m a scheduler, I’m a treatment coordinator. I run ar. I can do those as an [00:09:00] individual contributor. There’s a difference between that and becoming a manager. So what’s that nuance?

[00:09:09] Joanne Miles: Absolutely.

[00:09:10] Joanne Miles: Well, we, you would talk about, uh, baptism by fire. So I became an office manager. Um, I was sort of christened that title one day when I came into the office and um, found out that the doctors had let the previous office manager go ’cause she had embezzled over a hundred thousand dollars. And all of a sudden they look to me because, same thing as you, Victoria, I knew the system.

[00:09:34] Joanne Miles: I was cross trained ’cause I was chairside and doing admin work. I had their trust. So I became an office manager in my early twenties. And, um, you know, I, everyone has a, an idea of what leadership is and, and, um, I can, I will say that it was a process for me and my [00:10:00]growth. Um, I was a very effective, but I was a steamroller.

[00:10:04] Joanne Miles: And, um, maybe not exact. I probably wouldn’t have wanna work for me. Um, but I, I was effective, but there was a lot of flat bodies behind me and that took a lot of lessons and a lot of learning and trusting, finding those mentors, finding those people that kind of went before you that see something great, you know, can see the diamond in a rough and be willing to work with you.

[00:10:26] Joanne Miles: Um, but then you have to be, have a willingness to be, to be. Told some truths and learning how to grow there. Um, you know, one of the things that I think a distinction that’s super important for doctors to help them to understand why this is such an important topic is that, you know, there are two engines basically that are running in a dental practice.

[00:10:51] Joanne Miles: You’ve got a clinical excellence side, which is really the dentist and the, and the hygienist too. But then you have the [00:11:00]operational execution side of it.

[00:11:02] Victoria Peterson: Yeah.

[00:11:02] Joanne Miles: That is not always the dentist. Right. And so those two,

[00:11:08] Victoria Peterson: it’s not the dentist?

[00:11:09] Joanne Miles: No, not really. Those two have to be in synchronicity with each other.

[00:11:13] Joanne Miles: They have to have, uh, uh, a nice rhythm and then the practice becomes scalable at that point. If you do not have that synchronized. Clinical excellence engine and the operational execution engine going beautifully, then you can’t scale your practice. You can’t, you know, I, I wouldn’t recommend it. Let’s just say

[00:11:39] Victoria Peterson: by scale we mean one doctor to two, doctor two hygienists to three hygienists, or we’re not even, you know, you.

[00:11:49] Victoria Peterson: Yeah, I was gonna say before we even, like we have, we have got so many beautiful entrepreneurs who don’t have location one on lockdown and then there, and like we [00:12:00] saw one guy buy two practices in six months during the pandemic because everybody was just buying practices. The third one, never got any love.

[00:12:09] Victoria Peterson: And the second one was on life support. So before you scale, you’ve gotta get this, I’m, I picked up my pen because I’m already taking notes and you’re giving me some clues here that I wanna really pull out. So, you know, why is it under leverage? Number one? Uh, you may not know what you’re looking for in this person.

[00:12:26] Victoria Peterson: So without a clear role descriptor, without a clear idea of what you expect beyond the scheduling and, you know, making sure that. Team is full and you’re interviewing and doing some vague office managery stuff. Mm-hmm. You know, you gotta be really clear. And then the number one thing I heard was that makes the candidate even a candidate for this role is that they have to pass a background check.

[00:12:55] Victoria Peterson: I don’t think doctors do this, but they need to pass a background, [00:13:00] check their credit score. Are they worthy because they’re handling your money? Mm-hmm. So, uh, here’s a, here’s a quake in your boots question. Doctors. Think about the person that’s in charge now. Would you trust them with your retirement, with your ability to retire?

[00:13:19] Victoria Peterson: Will they handle money in a way that ensures that your business is profitable and you can reach what you deserve? For investing, you took the risk in being here as a business owner, you deserve. Profits, you deserve a reward. And all of this is being entrusted into your team’s hands. And so I, I love high, high trust.

[00:13:45] Victoria Peterson: It is the most high trust relationship in the office. So you gotta know that they’re financially secure, they’re gonna take care of your finances in a great way. But then the other side of the coin was high emotional. Intelligence [00:14:00] because they’re going to, to support the culture that you wanna build. So you, yeah, you can build it like a steep steam roller or you know, you could, I don’t know.

[00:14:12] Victoria Peterson: I’m trying to think of a steamy. Analogy here. That doesn’t sound like a hot tub, but it could be something pleasant, you know? It could be something really good. A nice sauna. A nice sauna. There you go. Yeah, it’s like a spa day for everybody. So it feels, it feels warm, it feels comfortable, it feels engaging, you know, those kinds of things.

[00:14:34] Victoria Peterson: So where do you see, let’s say I’ve got. One of these, I’ve got a beautiful office manager. I’m learning, she’s learning, they’re learning, he’s learning. Um, where do you see those, the common breakdowns in that relationship?

[00:14:49] Joanne Miles: I would say one of the, one of the bigger breakdowns is this lack of clarity, not only between, um, okay, what are, what are our rules of engagement, if you [00:15:00] will?

[00:15:00] Joanne Miles: How are we gonna stay in alignment as a leadership team? So there’s that piece of it. So there’s absolute clarity about our cadence of when we’re gonna meet as a leadership team, what are we going to cover during that time, that it can’t be a shoot from the hit. There needs to be a true agenda. And, um, and then there has to be action items that are, that are taken out of that.

[00:15:27] Joanne Miles: And then the next time you’re meeting again, you’re checking in. Okay. Did we. Adhere to our commitments of our action items. What fell through? What do we still need help with? So there should be a clear, this is where the trust but verify part of the relationship comes in because you, the docker can’t keep their eye on it all the time, the business side of it.

[00:15:49] Joanne Miles: And that’s where you’re trusting the OM to. But then you’re now gonna verify that. What was said was said, these are our goals. Where are we at? What’s the gap? What are [00:16:00] your things that you’re having issues with? Um, the other piece of that then is then the, the unified message and implementation and having each other’s backs with the team.

[00:16:15] Joanne Miles: You know, the OM is not there to manage chaos. They’re there to create the structure so the doctor can lead with focus. See, so there’s a, there’s a dependency that is so vital here. Um, and, um, often oms do feel like they’re on that hamster wheel playing whack-a-mole all day long. It’s a, it’s, let me tell you this, that job is not for the faint apart.

[00:16:42] Joanne Miles: It’s, it is a, sometimes can be seen as a thankless. It’s really, you have to have a servant’s heart to be in that role. You really do. And there’s a lot, you’re, I always say the om is on the island because who do you, you know, [00:17:00] sometimes, you know, you wanna vent to somebody, you’re not gonna vent to the team.

[00:17:03] Joanne Miles: You’re not gonna vent to your doctor. ’cause maybe the thing you need to vent about is maybe the doctor sometimes. ’cause let’s face it, they’re not perfect. And, and then the team, uh, yeah, none of us are, the team’s not perfect. So you’re sort of in this island. Um, ’cause you can’t get too familiar with the team.

[00:17:20] Joanne Miles: That can break down. Um, so,

[00:17:24] Victoria Peterson: you know, I think that’s why I love the masterminds that you lead for our clients, the emerging leaders is such a safe space. Mm-hmm. Uh, tell us some of the topics that you cover in emerging leaders.

[00:17:37] Joanne Miles: Yeah. So, um, just, well, January, we, we talked about how to start with momentum for the year.

[00:17:44] Joanne Miles: We talk about goal setting, how to enroll the team and get them engaged in, into the goals, how to run, uh, structured team meetings where you’re actually getting these check-ins and you’re getting buy-in with the team. So we talked about a lot of the communication techniques [00:18:00] around that. This last, um, this month we just had our emerging leaders and we talked about managing on your feet.

[00:18:06] Joanne Miles: So that presence over paperwork. How do you get, how do you manage your day? Have dedicated time to be able to do your oming, right, your om stuff. But then also you’re on the floor, you’re walking the floor, you’re, you’re listening to the patient’s experience. You’re, you’re checking in and you’re, you’re actually auditing in a way what that new patient experience is from the check-in to checkout.

[00:18:34] Joanne Miles: And then you’re finding those coaching opportunities where the, where we can improve in those areas. As well as just being there for your team have and then helping out. I often say that the, you know, if, if it you have to go plunge a toilet with a plunger, then you, you roll up your sleeves and you do it, your team will do so much for you.

[00:18:55] Joanne Miles: If they see, you’ll do so much for them.

[00:18:57] Victoria Peterson: Yeah. You know, it sounds like, [00:19:00] um, stewardship on the OMS part. Why we both are growing in our stewardship and our servant leadership here and, and I love how you pointed out being. Physically present with the team, so we’re not talking doctors. If you’ve not hired an office manager or you’re, you’re contemplating like really elevating somebody to this position, you said something really great, uh, they’re not there to manage chaos.

[00:19:27] Victoria Peterson: They’re scared so that the doctor can lead with focus. So step one is, hey doc work. Work with someone who can help you get really clear about your focus. And I know for myself as a business owner, I own five practices. I couldn’t tell my team. Everything. I couldn’t show them the finances. I couldn’t show ’em how I was robbing Peter to pay Paul and all of these things.

[00:19:54] Victoria Peterson: I mean, I could, but it would not have served any purpose. I couldn’t have done much about it. But if you’re [00:20:00] carrying that silent stress, if you’re. Hiding major pieces of information, it’s gonna be really hard for anyone to come and partner with you at that level and take things off your plate. Mm-hmm. So be clear about what gives me energy, what drains my energy.

[00:20:19] Victoria Peterson: Uh, I’m a visionary, but I do need someone who can handle the details. It’s really getting clear about those details and setting priority. Um, and then. I love that you’re modeling that for the om as well. She can’t say everything to the team, can’t always give you the why behind things, but you can’t come in there with a my way or the highway.

[00:20:42] Victoria Peterson: So stepping into their world to learn the world and staying current is, is huge. Um. Oh, I feel like there’s this piece of delegation without authority. How do you really [00:21:00] design like a, um, decision making tree or authority tree? You know, a document that says you’ve got authority to make these kinds of decisions and give me a recap.

[00:21:13] Victoria Peterson: These decisions we have to talk about and these decisions are only mine, the owners.

[00:21:19] Joanne Miles: Right. You know, um, I’ve worked with, um, I would say on the entire pendulum swing, I’ve been on all, I’ve had that kind of a, of a relationship with the entire pendulum swing. And there’s a couple areas for me as a, an office manager that I have a deal breaker.

[00:21:43] Joanne Miles: Believe it or not, I’ve had doctors argue with me on this, and that is number one. Yes, I have visibility to QuickBooks, um, you know, our bookkeeping, and I was making sure that we, we had a lot of, um, we did a lot of EFT [00:22:00] payments from insurance rather than a paper check. So I had to kind of know, okay, what were the EFT deposits and from what company so I can make sure that my.

[00:22:09] Joanne Miles: A council coordinator was, knew what EOBs to pull and make sure we posted them. Um, so I had, I had a lot and I paid the bills, you know, so I would, you know, go ahead and I see like our Patterson bill needed to be paid. I would be reconciling those statements, making sure that all the, we actually got everything that we’re getting charged for,

[00:22:31] Victoria Peterson: however.

[00:22:33] Joanne Miles: Where I drew the lying was I would never, ever, ever, I did not want signature authority on a check. And I actually had, um, the, I don’t know if you remember this, Victoria, you, you’ve been around long enough too, where the, it used to, you used to have the doctor’s signature on a stamp and they would stamp the check.

[00:22:52] Joanne Miles: Do you remember those days? Yeah. Um, so I just said absolutely not. And I had, [00:23:00] I did have a part, uh, a partnership, um, practice where they’re like, well, you could just sign them. I’m like, no. You need to sign every single check. You need to see the invoice that’s attached to the check that I actually printed out for you so you can see where your money is going, and that’s kind of where that trust but verify comes in.

[00:23:21] Joanne Miles: I would say for an OM just to protect yourself and be beyond reproach, you should never have that level of access. However, there should be some visibility to the overall. Overhead and expenses of the practice. ’cause then how am I gonna know as a manager how where I can help pull those levers to keep the overhead down unless I know how much we’re spending and what that’s going to.

[00:23:47] Joanne Miles: So that’s where that this balance comes in and it takes time. Like you have to create those parameters around that.

[00:23:57] Victoria Peterson: Yeah. Well, and I tell you what you’re describing are just [00:24:00] business best practices and ask if you’re listening to this right now and maybe you are smaller and you’ve got one person and she’s your sister, or she’s somebody that you really depended on for a long time.

[00:24:13] Victoria Peterson: I think, uh, to your point earlier, longevity and being familiar with someone, they become like family to you. That is a wonderful thing. Also is the hallmark for, uh. Statistically the person that will embezzle with you. And so it’s not that they start out that way, but a life event could happen. You know, their health, the spouse’s health, some financial crisis, and then slowly leaks start coming in.

[00:24:46] Victoria Peterson: So you never have the person who’s depositing the money, reconciling the QuickBooks and then paying the bills.

[00:24:55] Joanne Miles: Uh,

[00:24:55] Victoria Peterson: and going to the bank, I, it’s just break that system [00:25:00] apart. If you make deposits, you do not write checks if you, mm-hmm. If you make deposits or you write checks, you don’t reconcile the books.

[00:25:10] Victoria Peterson: If you do write the checks and reconcile the books, you hate CPA who ties everything back to

[00:25:17] Joanne Miles: Absolutely.

[00:25:18] Victoria Peterson: With your practice management system, with your ar. Like every month. So this is, this is kind of beyond the scope of this podcast ’cause we’re just talking about relationship.

[00:25:30] Joanne Miles: Yeah.

[00:25:30] Victoria Peterson: But this is how quickly I was gonna ask you the question financially, how does this impact if you’re not in alignment, but embezzlement is probably one of the, uh, you.

[00:25:42] Victoria Peterson: It’s going to happen to everybody. It is, it is just a matter of to what degree and how quickly do you catch it?

[00:25:49] Joanne Miles: It’s unfortunate. Um, it really is unfortunate, um, that it, it is prevalent in our, in our industry. Um, I’ve [00:26:00] personally have discovered, I would say through, um, my roles throughout dentistry, probably seven embezzlements.

[00:26:12] Joanne Miles: Um, and it, it, it’s a head scratcher every single time about how creative

[00:26:17] Victoria Peterson: mm-hmm.

[00:26:18] Joanne Miles: People get. Like, it’s a lot of energy. Um, and it is, it’s always, I gotta tell you, I haven’t, I haven’t had a circumstance where the doctor, number one wasn’t blindsided, felt blindsided. We’ll say the, the, the, the, the signs were there.

[00:26:36] Joanne Miles: They just didn’t want to see them because they just couldn’t believe that this person would do that to them. Um, but in

[00:26:44] Victoria Peterson: my, we, we caught our, as the office manager was trying to buy $800 worth of concert tickets to the Dave Matthews Band.

[00:26:53] Joanne Miles: Oh. I just went on Facebook the other day and it was like almo, it was $900,000 over a [00:27:00] course of like 10 years.

[00:27:03] Joanne Miles: And it, it, you know, so yeah, there’s, and that one was really, that one was just, we were the, they weren’t watching at all.

[00:27:13] Victoria Peterson: So now that we’ve scared doctors from ever having, no, um, let’s start about where, where do you see the breakdown first? So if you haven’t truly. Sat down and created a job description.

[00:27:27] Victoria Peterson: Have clear expectations if you, the doctor, haven’t done the work to understand what you want, what your goals are, how you measure it. Weekly cadence of checking in. What, what are the smaller areas that you would see an overwhelmed, um, om what, what would be some of the things that you might see first?

[00:27:49] Joanne Miles: In, in regards to just this, we’re going back to the relationship,

[00:27:52] Victoria Peterson: right?

[00:27:53] Victoria Peterson: Yeah. I think if there’s a misalignment there, uh, we, we see where it shows up financially, but where allowance would show [00:28:00] up even early.

[00:28:01] Joanne Miles: I would say a lot of it also is if you are gonna put the authority, give the om an authority to, let’s just say manage and correct the team, right? We’ve, we’ve created our parameters we’re you have an employee manual.

[00:28:17] Joanne Miles: Yo Om is gonna be in charge of managing that. And then let’s say there’s a dental assistant that is continually late, right? They’re constantly showing up late. This happens to be just the doctor’s favorite chairside assistant because they just are so good chairside, but they just can’t show up on time.

[00:28:36] Joanne Miles: And then you have, as the manager, this conversation with them, you come with a plan, you explain, you know how this isn’t gonna work for the team, and then they go crying to the doctor. And then the doctor says it’s okay and undermines the OMI would say that’s one big breakdown. So that’s where alignment of authority does need to come in place.

[00:28:56] Joanne Miles: You’ve gotta have their back if they’re actually executing on what you [00:29:00] agreed upon. Um, the, the other area I think co also coming back to is this, these structured check-in meetings. There has to be this structured check-in meetings and as your practice grows and becomes. More complex. I would also recommend, if possible, that they’re there with maybe the CPA meeting too, where you’re checking in together.

[00:29:25] Joanne Miles: And of course this isn’t gonna be like, you don’t need to divulge what your draws are and, but you know, we all know you’re gonna get paid as a provider in the practice. So that really shouldn’t be a secret. That shouldn’t be something you feel like you have to hide. You know, what you do on the backend is a for profitabilities or.

[00:29:43] Joanne Miles: Your tax structure. Yeah. They don’t need to necessarily know that, but just the day-to-day here are where your overheads are, here are, here’s where the spending is, here’s where the things I’m concerned. Sometimes the om can fill in the gap that the doneness can’t.

[00:29:59] Victoria Peterson: Yeah.

[00:29:59] Joanne Miles: [00:30:00] Right. So, um, so I think that having that visibility to the profit and loss statement from a overhead management stewardship, we’re gonna go back to that stewardship word.

[00:30:12] Joanne Miles: Is very important because again, they know they can, they can help control the costs and the spendings or the cadence of when, when we order dental supplies, um, sometimes that alone gets out of hand. So

[00:30:30] Victoria Peterson: I like what you’re describing here, going back to your, there’s clinical operations and there’s clinical functionality, and then there’s operational functionality.

[00:30:40] Victoria Peterson: But even in the p and l review, it could be like that the doctor, his, his leadership and guidance is what generates, uh, productivity and revenues. Right? Right. So my. My philosophy of care, our standard of care setting clinical benchmarks, uh, and then, uh, making sure that the [00:31:00] scheduling templates are in place for productivity.

[00:31:03] Victoria Peterson: That’s doctor leadership. Mm-hmm. And om takes the profitability our. Supplies are within budgets. Our labs are within budgets. I’m monitoring the write-offs. If they escalate above a certain point, I raise a red flag. Um, our resubmission, our days to collections, all of that falls into this operational management.

[00:31:27] Victoria Peterson: So for me, I’m just sitting here as an owner and going, oh, that, that would give me relief to know that my job is to set the clinical standard and the top line. KPIs and then I’ve got a partner that’s been fully vetted, that’s been fully trained, that has been educated to help me with the bottom line issues of AR management write-offs.

[00:31:52] Victoria Peterson: And that is not an easy skill to learn. So if you, if you just took your [00:32:00] dental assistant and made her a front desk person who’s now called the office manager. She won’t know how to do that on day one. Mm-hmm. But we can, I like the, the piece of bringing them into the CPA conversations. And if you’re passing along this podcast to your om, here’s, here’s one thing that I did with team for is start reading financial journals.

[00:32:28] Victoria Peterson: Go online, read the Wall Street Journal, circle the words you don’t know. Get Forbes Magazine, investor magazines, like just learn the financial vocabulary of business. Take a, take a Coursera or Udemi course on finance for non-finance majors. Just being in the vocabulary of business and the vocabulary of profits will make you incredibly valuable to your owner.

[00:32:56] Joanne Miles: Yeah. And you know, w when we talk about this [00:33:00] partnership, it it, I mean, this is the same thing where you’re gonna do a health grade and I would, that would be kind of a fun little piece of homework for anyone who’s listening to this. Um, podcast is to sort of do a reality check on what is the health grade between the doctor om partnership, because that is ultimately is what directly impacts the profitability.

[00:33:26] Joanne Miles: Any misalignment is going to leak. Money and alignment is gonna compound it, and we all love about compounding. So it, it, it, and every relationship, I mean, yes, we could give you a framework of what that om doctor relationship look should look like. What are your weekly cadence check-ins? There’s, there is some scaffolding, but every relationship is going to have its nuances and be a little bit different.

[00:33:57] Joanne Miles: Mm-hmm.

[00:33:58] Victoria Peterson: Um,

[00:33:58] Joanne Miles: depending on [00:34:00] the complexity of the practice and the goals, the, you know, the long-term goals of the practice. I think that OMS should also understand, um, that every practice is going to have a transition at some point, and that the OMS have a vital piece, that that relationship can really impact the value of the practice long-term and how that transition happens.

[00:34:27] Joanne Miles: It shouldn’t be something that doctors should keep, should really keep in some vault because the OM can really help with that overall. That, you know, and, um, it’s another podcast for another day. And you’ve said you’ve done this a million times already, is um, in fact, I was just listening to one of yours, the other, um, today, this morning, and you talked about, unfortunately, some doctors decide, oh, I wanna sell some in a year from now, but they’re not near ready because they hadn’t put the time in.

[00:34:58] Joanne Miles: It’s a longer runway [00:35:00] and the om can be a, an intricate part of that in helping you get there.

[00:35:05] Victoria Peterson: I love that. Well, we are going to have that health check for the owner om, uh, relationship in the show notes. Uh, I love that you’re offering that, Joanne. Um, that’s, that’s amazing. And all month, I, I guess something clicked in 2026, and we’ve said this before, but.

[00:35:27] Victoria Peterson: It’s coming through so strong now that as an owner you are not broken. Um, the, the system around you is broken. And so if you’re under a million dollars and you’re going to cross that million dollar threshold, what work to get you to that point likely won’t work. As your next strategy. So there’s, there’s different strategies for each stage of growth.

[00:35:54] Victoria Peterson: So there’s the race to revenue, then there’s the, the predictable place [00:36:00] of, of optimizing your systems. But sometimes we get caught in our comfort zone there. Mm-hmm. When you get to the, uh, Carrie Miller and I, uh, she was on my podcast recently and we talked about the $2 million crunch. So when you get to 2 million, if you built that through, um, high involvement in network PPOs, you match your capacity.

[00:36:24] Victoria Peterson: And that’s another opportunity to, um. Redesign your business. So docs, if you’re really stressed out, if there’s more month than there is money. If, if chaos seems to be around you, you can’t scale on that. But what you can do is get clarity about where the chaos is coming from and fix one thing at a time.

[00:36:49] Victoria Peterson: Just fix that ne next thing. And here’s the thing, you may have three or four different. Strategies for your company. [00:37:00]Think about that. You know, why wouldn’t you? You don’t act the same at 17 as you did at seven or 27 or 37 or 47. So as you grow and your lifestyle changes, and your capabilities change, your team’s capabilities change, of course you’re gonna have another system.

[00:37:19] Victoria Peterson: And bringing in a trusted manager that is at the level. That you are at and growing into is a vital piece of that equation.

[00:37:30] Joanne Miles: Mm-hmm. I think the curiosity is so vital. Um, because, and you have to be adaptable and you have to be willing to change. I mean, I started, I started in dentistry when it was pegboard.

[00:37:43] Joanne Miles: For the accounting, right. And, and a paper schedule. Um, so if I, you know, and here I am today, you know, adopting all the technology, all the new systems. Like, so if you’re not willing to change your mind [00:38:00] and your mindset on things, um, yeah, that would be another, I would say, important trait to be looking for.

[00:38:09] Victoria Peterson: Want me to say that? For some of our younger listeners, like younger, I mean anybody under 50. I can’t even explain what a pegboard is. Yeah, it would, it would take too long. It would take too long. Hey, Joe, as we wrap up, tell me what a great partnership looks like, feels like, sounds like, what do we, what are we creating here?

[00:38:32] Joanne Miles: Well, if I can give you, if I can first sum it up in one liner. Um, I would have to say that if the doctor and om are not visibly united, uh, the team will divide them privately. So that is, that is very, very important. Like that’s, uh, if I can give a huge umbrella, that would be one of the biggest pieces of it.

[00:38:58] Joanne Miles: It, so doctors, if you [00:39:00] have, if you have crossed the bridge and now say you have a office manager. You are asking them to be the extension of your voice and your authority, then you have to be completely united, visibly united. Um, and, and trust me, that, that the team will test it just like children test mom and dad.

[00:39:25] Joanne Miles: Right? Um, so. What it looks like is, is that there’s this strong united front. There’s a, uh, um, the messaging is, is the same. It’s, um, they are visibly, um, showing the cadence of their check-ins, and then they’re showing the fruits of those check-ins with the team. And I would say the other piece of this is, um.

[00:39:51] Joanne Miles: The, sometimes the, uh, not sometimes the om often is the counterbalance in the, uh, with the doctor. Doctors have gone, and [00:40:00] you’ll hear me say this all the time, dentists have gone into, gone to school, have gone into extreme amount of debt to learn to find everything broken at a magnification and then fix it.

[00:40:13] Joanne Miles: They’re fixers.

[00:40:14] Victoria Peterson: Right,

[00:40:14] Joanne Miles: right. So, but that doesn’t align with team. You know, and, and helping foster this really positive culture sometimes, because that’s just the way they’re wired. The om is the counterbalance to that. They’re the ones bringing up and elevating what to celebrate. They’re that, that balance to find things broken, fix it.

[00:40:35] Joanne Miles: So if you, you know, you have to make sure that there’s somebody on the other side reminding the doctor, like, Hey, so and so did an amazing job today. Just take a moment and thank them for something specific today. There’s this, um, there’s a, that is culture. We always call it the cultural North Star culture is everything as part of this too.

[00:40:58] Joanne Miles: So, um, if [00:41:00] there, if, if there’s not a lockstep in there,

[00:41:03] Victoria Peterson: yeah. Well, I think what you’re saying is there’s a balance between data and emotion. Yes. Yeah. Our KPIs and what we want from the business, if not balanced with emotion and it, and you’re right, it’s difficult to have your focus in the size of tennis ball with precision all day long.

[00:41:22] Victoria Peterson: You have no idea what’s

[00:41:24] Joanne Miles: coming

[00:41:24] Victoria Peterson: around you. So having somebody that’s your eyes, your ears, and helping you display your heart, I love that.

[00:41:31] Joanne Miles: Yeah.

[00:41:32] Victoria Peterson: Great. So, um. Let’s start wrapping this up. If this episode has stirred something in you, please don’t ignore it. Um, misalignments between the doctor and the office manager, we’ve identified here, uh, doing this work of building investment grade practices.

[00:41:48] Victoria Peterson: It’s one of the most expensive, silent profit leaks of an independent practice. And so here’s your next step. I want you to download the, the owner [00:42:00] om partnership scorecard. Both of you take it separately, compare your answers, and if your scores align, you’re building something scalable. If they don’t, you just found your next leadership move.

[00:42:13] Victoria Peterson: So this scorecard that Joanne’s put together is gonna help you identify where you can build and strengthen your relationship. So the link is gonna be, um. In the show notes, time in in the show notes here. So I put the link in there and if you’re a private practice owner with one to three locations and you’re serious about building something profitable, investible, and less dependent on you, which is what we’ve been talking about here today, then book a 30 minute clarity call for with me.

[00:42:41] Victoria Peterson: I book five a week, so grab one of my slots. You don’t. Need more effort. I think that’s my big walkaway here today is owners, you don’t have to put more effort. What we need is to get more structural alignment, so until next time, lead with stewardship, [00:43:00] build with intention, and create something durable.

[00:43:02] Victoria Peterson: Joanne, it was so delightful having you here.

[00:43:05] Joanne Miles: It was fun. Till next time.

[00:43:08] Victoria Peterson: Till next time.