Every office manager eventually discovers there are two kinds of employees: recipe followers and recipe makers. Both can be valuable, and both can have a place in a medical or dental practice. But if you do not understand the difference, you may manage them the wrong way and spend years frustrated with people who are not actually bad employees. They are simply different kinds of employees.

In a medical or dental practice, the owner is often the most valuable person in the building. For many practices, the owner is also the primary producer. They diagnose, treat patients, perform procedures, build trust, and generate the revenue that keeps the practice alive. That is why micromanagement is so expensive.

For dermatology practices, that might mean: Adding cosmetic services like injectables or laser treatments to increase APC Improving scheduling and patient flow to increase daily visits Expanding provider availability if waitlists are growing The key is identifying which opportunity creates the biggest impact with the least operational strain.

When reviewing resumes, here are the top green flags and red flags to watch for in each area.

At Doctors CFO, one of the many operational metrics Carl analyzes inside a practice is employee turnover. Because turnover numbers alone don’t always tell the full story. Some practices may simply experience a difficult hiring environment or temporary staffing challenges.

Every strong decision starts with accurate numbers. Without clean books, financial reporting is unreliable—and strategic planning becomes guesswork.

Most practices don’t fail because they aren’t working hard enough. They struggle because they’re operating without clear visibility into what actually drives performance.

No one is intentionally under-treating. But without systems and awareness, practices leave thousands of dollars per week on the table—while also underserving patients.

Payroll problems don’t stay in payroll. They show up in your taxes. At Lakeview, the issue wasn’t just padded PTO. Taxes weren’t being paid on time. Filings weren’t being reviewed. Numbers weren’t being reconciled. Once payroll data is wrong, everything downstream is wrong: Your financials Your profit Your tax liability

Being a great clinician and being a great business owner are two completely different skill sets. Dr. Mitchell mastered one. The other nearly destroyed his practice. If you: Discount constantly Over-explain everything Undermine your team’s financial systems You don’t have a revenue problem. You have a boundary problem. And boundaries don’t come from trying harder. They come from systems that make the right behavior automatic.

A plan to work fewer days, earn more money, and build one strong, scalable practice — on her terms. That’s not failure. That’s leadership. Don’t let a “great deal” become an anchor. Know your numbers. Know your bandwidth. And know when to walk away.

Your front desk is the front door of your practice. If no one is checking whether that door is open, you could be losing: new patients, referral relationships, hundreds of thousands of dollars in revenue without realizing it

You don’t need 47 sub-accounts for supplies. You need clean, consistent, reliable data. Excess complexity leads to inconsistent coding, noisy reports, and financial statements you stop trusting. Once that happens, your accounting becomes a compliance exercise instead of a decision-making tool.

You may be one of the best clinicians in your city. But if your financials are unclear, inconsistent, or undocumented, buyers don’t see a business. They see a high-paying job that disappears when you leave. And you can’t sell a job.

The practice had an office manager who had been with them for years. She was a good worker. Reliable. Familiar with the systems and trusted by the team. Like many long-tenured employees, she wasn’t perfect. She could have used a small attitude tune-up, but overall, she did the job and kept the office moving. There were no major red flags.

The office thought they had struck gold. Billing had been a persistent pain point, so when a coder applied claiming nearly twenty years of experience, strong confidence, and fluency in all the right terminology, it felt like the solution they had been waiting for. The interview went smoothly. The résumé looked solid. The explanations sounded convincing.

For practices, this can be an unexpected hiring pipeline. For students like her, it’s a head start on adulthood. Real responsibility. Real skills. Real confidence earned early. That doesn’t mean every homeschool student is a fit. Just like any hiring pool, you still need structure, training, and clear expectations. But it does mean many practices may be overlooking capable candidates simply because they don’t match the traditional profile.

Years ago, while managing a team of about 15 people in Phoenix, one of my employees, Carol, said something that stuck with me. She told me my office was messy. Not in a rude way. Not critically. Just honestly. She said it didn’t match how professional I was—or how professional I should be—and that it felt beneath me. She wasn’t attacking my work. She was pointing out a disconnect between how I showed up as a leader and the environment I allowed around me. She was right.

Bringing on a partner can be one of the most powerful growth moves a business makes. It can also be one of the fastest ways to damage trust if it is done on top of a messy financial structure. In this case, the business is preparing for a potential partner buy-in during a period of rapid growth. Revenue is strong. Demand exceeds capacity. Expansion has raised the fixed-cost baseline. On paper, the opportunity looks attractive.

But refinancing is neither good nor bad, it’s a tool. Used thoughtfully, it can stabilize a growing business under pressure. Used carelessly, it can quietly magnify risk and delay problems until they’re harder and more expensive to fix.