A Good Transition Issue: My Practice Is Growing Too Much!

You’ve worked hard to build a thriving practice. Your practice is busy. The phones are constantly ringing. The patients are streaming in, and your schedule is booked numerous weeks in advance. Why should you be concerned? One word: Saturation. Simply stated, you may have more patients than you can efficiently handle. If you ignore the signs of saturation your practice eventually reach a less profitable state, where you lose patients who don’t want to wait for an appointment or find your chair-side manner a little rushed.

You’re at a crossroads: When continued growth becomes an issue, your practice, patients, and staff suffer, and so do you. What to do? Below are the telltale symptoms and some remedies that work.


First, you need to know that you have reached the level of saturation. While alarming, recognizing the signs of saturation can be liberating, in that it compels you to make key decisions about the future of your practice. So how do you know if you’ve reached the level of saturation and need to take action or if you’ve merely hit a busy period, which is temporary, or not busy enough? Consider it a warning bell if you see your situation below on a consistent basis.

  • Your schedule is booked six to eight weeks in advance.
  • 90 percent of your schedule is consistently booked 45 to 60 days in advance.
  • Hygienists are booked three to six months in advance, 90 percent of the time (If so, active patients are not being seen at regular intervals. You also are in danger of hygiene slippage.).
  • New patient hygiene is difficult to schedule.
  • There is an increase in the number of patient emergencies.
  • Patients are falling out of their normal re-care cycle and are overdue for hygiene.
  • It is difficult scheduling multiple appointments for complex services.

These situations happen on a temporary basis once in a while, but if this is the norm over extended periods of time, your practice is saturated, and you need to address the situation. It is not likely to change until your patients start to leave on their own and you have a smaller and less profitable practice. Potentially, this could also negatively impact your reputation.


A general practice usually reaches saturation when approaching 2,000 active patients. At this point, you have two choices: add an associate or subtract patients. For some dentists, reducing the size of the practice through attrition may be the right answer. For others, the better decision is to expand.

Before prescribing a cure, you must first identify a treatment objective. Your vision for your practice must become what drives your decisions. “You have to realize what you want,” says Ben Peck, D.D.S., founding partner of Atco Family Dentistry, a thriving general practice in Atco, NJ. Defining your vision is essential to solving the problem.

If the decision is to reduce your practice size, here are some ways that will drive natural attrition:

  • Restrict services
  • Raise fees
  • Become exclusively fee-for-service
  • Refer out complex cases
  • Turn away new patients

Alternatively, you can continue to grow the practice and add an associate and staff to handle the growing number of patients.

For Dr. Peck, a former solo practitioner, saturation meant 3,000 active patients, a hygiene schedule booked months in advance, and forgoing his quality of life to meet patient needs. “I knew I could not keep that pace forever,” he says. While Dr. Peck wanted more free time, he was conflicted about relinquishing control to an associate. Knowing that he did not want some of the other choices (e.g., raising fees or reducing serves) helped Dr. Peck overcome his apprehension about hiring an Associate, and the inevitable expansion, which had to be addressed. “I realized that there were going to be trade-offs, but the plusses outweighed the minuses for me almost immediately,” he says. Defining your vision for your practice will enable you to effectively sort through options and focus on what will work best for you, your personality and your ideal situation.

For others, the decision to expand is the only one that makes sense. Kent Guebert, D.D.S., of Bourbonnais, Ill., had given great thought to the pros and cons of practice expansion. At age 47, he had been a solo practitioner for 20 years. His practice had ballooned to 2,700 patients. After attending a seminar on practice transitions, which included discussions of adding associates, Dr. Guebert was intrigued. “Up until that point, I was telling myself I didn’t need an associate, and then it all kind of clicked for me,” Dr. Guebert says. Within weeks of the conference, Dr. Guebert had contacted me for advice and to confirm his suspicions that his practice was indeed saturated. At that time, he was seeing 30 to 40 new patients each month and was booked a month in advance. Hygiene appointments also were booked at least two months in advance, and it was impossible to accommodate routine appointments with an increasing number of emergencies.

Dr. Guebert’s experience was a classic example of a saturated practice, but his situation was unique. Unlike most saturated practices, his physical space was more than adequate to accommodate an associate. With only five of the six operatories in his office being used, Dr. Guebert’s main challenge was to find the right associate. He succeeded by hiring a talented Associate who was looking for the right practice to join and eventually buy into. Since Dr. Guebert was a forward-thinker who considered an associate an important asset to his patients and a sound retirement strategy, it was an excellent fit. Scheduling difficulties evaporated, office hours remained unchanged, and an additional hygienist, dental assistant, and front desk support staff rounded out the solution.

For a practice like Dr. Guebert’s, which had the space but not the manpower to effectively serve patients, the addition of an associate and hygiene and support staff is often the most painless remedy. But most saturated practices often are understaffed and under-equipped to satisfy the burgeoning demand for care. If physical space expansion is not possible or feasible when a new associate is brought in, creative scheduling between the owner and associate, as well as expanded office hours can be temporary fixes. In time, however, the need for additional treatment rooms must be addressed. A cost-benefit analysis can alleviate doubt, provide reassurance, and suggest a timeline for easing the transition into capital expansion. Some doctors decide to “bite the bullet” and commit to their vision right away. “Once I decided what direction the practice was moving in, I took the steps to make it happen, all at the same time, “says Dr. Peck, who in a whirlwind hired his first associate (now partner), Dr. Paul Lawyer. They then computerized the practice and expanded its physical space with two new operatories and a separate wing for administrative needs. He also added personnel. Today, Atco Family Practice has grown from 3 to 12 full-time staff members, with one part-time dentist for overflow. Best of all, says Dr. Peck, “I have gained the ability to go away once in a while, and even take a day off every week. I could have never done that before.”


When your practice reaches the point of saturation, it is time to take action. Working at that level long term is not good for your patients, staff, or you. To address the issue, you must first identify your vision and treatment objective that will drive how you address the issue. Once you have identified your vision, you can determine if the best resolution is to reduce the size of the practice using one of several methods, or to grow your practice further by bringing on an associate, and possibly other additional staff.

Thomas Snyder, DMD, MBA