Every practice owner has experienced it. The schedule looks full. The team is working hard. Patients are coming through the door. Yet somehow, profits haven't increased.

Hiring an associate is one of the biggest decisions a practice owner can make. Most owners assume that if collections are growing, the practice is becoming more profitable. Unfortunately, that's often not true. We've analyzed hundreds of medical and dental practices over the years, and one pattern appears again and again: Revenue increases while owner income stays flat—or even declines. The problem usually isn't the associate. It's the way practice owners measure associat

A strong practice does not run on hope. It runs on repeatable systems. If cancellations happen almost every day, then cancellations should not surprise the office. The office should have a cancellation list, a short-notice protocol, and a clear owner responsible for filling open time. There should also be a backup person in case the first person is out. That is the difference between reacting and managing.

Most practice owners assume payroll problems come from complicated tax laws or payroll software. In reality, many payroll headaches begin with something much simpler: employees who don't take ownership of their time cards.

Many owners spend enormous energy chasing new patients while overlooking hundreds of existing patients who simply stopped coming. Your Patient Recall Report may be one of the most valuable reports in your practice.

Accounts Receivable isn't just a financial report. It's a roadmap to hidden cash. The practices that thrive aren't necessarily the ones producing the most. They're the ones collecting efficiently, protecting cash flow, and turning earned revenue into money in the bank. If your AR report contains large balances over 90 days, don't assume the opportunity is gone. You may be sitting on one of the biggest financial opportunities in your practice. And the first step is knowing exa

For many medical and dental practice owners, bringing on a partner is one of the biggest decisions they'll ever make. A successful partnership can create growth opportunities, improve work-life balance, and provide a clear path toward succession. A bad partnership, however, can create financial strain, operational challenges, and years of frustration.

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.