Build Different: How the Top 2% of Dentists Design Their Future

If you listen to most dentists, you’d think the world was ending. You can’t go online for five minutes without seeing the rants on team turmoil, supply shortages, rising costs, decreasing reimbursements and burnout. It’s not that those issues are not impacting dentistry. They are. But the essential challenge is that most dentists don’t intentionally create the future they ultimately live. Those who learn to focus on creating that future will overcome all the challenges listed above.

Nearly all of us entered dentistry with extraordinary ambition. We wanted to help people and build a great practice. We wanted financial security and a meaningful life. In short, most of us entered dentistry wanting to make a difference while maintaining the freedom to determine how we go about it.

Somewhere between dental school, insurance contracts, team challenges, patient schedules, payroll and production goals, many of us lost sight of the future we originally set out to build. We felt overworked, at times overwhelmed, and often underappreciated. That has sadly led to practice after practice getting managed and living in an all-consuming present rather than building the practice and the future we set out to create.

I’ve had the privilege of working with dentists at every stage of their careers. I’ve worked with bright-eyed students wondering what their ideal path will be as well as thousands of associates navigating the next steps in their build vs. buy vs. stay journey. I’ve worked with solo doctors in single locations all the way to multilocation owners leading hundreds of team members. While everyone’s circumstances vary dramatically, a few observations consistently stand out. Dentists with extraordinary careers are not necessarily smarter. They’re not necessarily better clinicians. And they don’t work dramatically harder. They simply operate differently and, more specifically, they think differently. They understand something many professionals never fully appreciate: The future is not discovered — it is designed.

The most successful dentists intentionally design their lives and their practices. They are the architects of their leadership capabilities and the businesses they want to build. 

The top performers stop reacting to circumstances and start designing outcomes. Here are three principles that consistently separate those who create extraordinary futures from those who hope things improve and often miss.

Ask most dentists what they want and you’ll hear:

• “I’d like to grow production.”
• “I’d like a better team.”
• “I’d like to work less.”
• “I’d like financial freedom.”

I love these goals, but they’re just that: goals. On their own, they cannot create transformation. They tell us where we want to go. Design tells us how and when we get there, and why it matters.

Many dentists spend years pursuing success without defining how success for them will look. As a result, they achieve milestones that rarely bring fulfillment. Here’s what routinely happens:

• Production increases.
• Stress increases.
• Income grows.
• Complexity grows.
• The practice expands.
• Their personal freedom shrinks.

The top 2% approach this differently. Rather than asking, “How do I make more money?” they know why money matters to them and instead ask, “What kind of life am I trying to build?” See the shift? The latter question helps you define a clear destination and that clarity helps guide every future decision. Any choice that drives toward our destination gets a “yes” — and every choice that does not gets a “no thank you,” even when that choice sounds enticing. This transforms our practice into a vehicle for achieving our design, rather than our end game, and certainly not the burden it becomes for so many.

The Future Audit

One of the most powerful exercises any dentist can complete is what I call a “future audit.” Take 30 uninterrupted minutes and answer the following questions:

• Five years from now, what does my practice look like?
• How many days per week am I working?
• What procedures am I performing?
• What procedures am I no longer performing?
• How many treatment rooms are active?
• Who is on my team and what do they stand for?
• What technologies helped make this happen?
• Who is my ideal patient?
• What does my income allow me to do outside the office?
• What kind of leader have I become?
• And most importantly, what makes me feel genuinely successful?

These answers will help you define what really matters to you. The burnout I mentioned earlier happens for all those negative reasons I listed. It also happens when we chase someone else’s success rather than the one we truly want.

Many dentists spend years building a practice without first defining their destination. You must understand that because life, success and happiness work on two trajectories: A green line trajectory that accelerates our success or a red line that moves us farther away from success. 

When we bring clarity, we avoid expensive wandering and our decisions become directional. Our future trajectory follows the green line. The top 2% don’t simply set goals; they reverse engineer desired outcomes and systematically build toward them.

Most dental practices have a hidden tax called “repetition” on an endless loop, week after week and year after year: 

• The same scheduling issue
• The same communication breakdown
• The same patient confusion
• The same collection challenge
• The same team frustration

The average practice attempts to solve these problems over and over. The top 2% solve them once. This is one of the most profound shifts in business thinking. 

Average performers attack symptoms. Exceptional performers build systems. Consider the following example:

A patient calls with questions about treatment financing. The front desk answers differently, depending on who picks up the phone. Some patients schedule. Some don’t. Some move forward. Some disappear. Most practices see this as a people problem and see treatment acceptance rates ranging from 22–34%. The top 2% recognize it as a systems problem and elevate their treatment acceptance to 60%, 70%, 80% or higher. The solution is not simply coaching your team harder. It’s creating repeatable best practices that produce consistent success regardless of who is involved. In this way, you overcome rescheduling patients or the lost “yes” when your hygienist is out sick, on vacation or moves on. Your associates can now see patients you routinely saw without missing a beat. Freedom comes from predictability and predictability comes from systems.

The Friction Inventory

Every practice has friction. The question is whether you’re measuring it and eliminating it. Complete this exercise with your team: 

Step 1. List every recurring frustration that happens weekly. Examples include:

• Patients not understanding treatment recommendations
• Last-minute cancellations
• Insurance confusion
• Scheduling bottlenecks
• Broken communication between clinical and administrative teams
• Collection challenges
• Supply ordering issues
• Morning huddle inconsistency
• Underperforming team
• Team infighting

Now ask a simple question: “Why does this continue happening?” If the problem has occurred multiple times, there’s a strong chance that the issue isn’t effort, but rather process.

Step 2. Select one problem and document exactly how that process should work.

• Who owns it?
• Who can help?
• What is the expected outcome?
• By when?
• How is success measured?
• How can you help?

Then train it. Measure it. Refine it. Remeasure it. Improve it. Remeasure it … and repeat.

The mistake many leaders make is attempting to solve 20 problems simultaneously, which is overwhelming for everyone. Top performers build leverage one process at a time. Systems compound. Stress shrinks. Consistency improves. Confidence rises. Patient experience improves and you gain freedom.

The strongest practices are not built on systems alone. Equipment matters. Technology matters. Facilities matter. But people matter more. Practices are built on aligned people operating inside efficient systems. Underdeveloped people who lack character will break your system.

One of the most common frustrations I hear from dentists is, “No one cares as much as I do.” The statement is understandable, but points to something happening on a deeper leadership level. In the great words of Yogi Berra, “If you don’t know where you’re going, you’ll end up someplace else.” A team cannot consistently execute if they don’t clearly understand our expectations. The top 2% recognize that leadership is not about finding perfect people. It’s about you, and hiring for attitude and continuing to develop aptitude. This means:

• Our teams need to know what winning looks like in our practice.
• We need to have true accountability for our team, including ourselves.
• We need to develop and coach consistently.
• We need to uphold standards and stop hoping, praying and ignoring what we want.
• We need alignment around a singular, shared mission.

Culture is not something that appears accidentally. It is intentionally created. Every conversation either strengthens culture or weakens it, and every expectation either becomes clearer or more confusing. Similarly, leadership decisions either develop people or diminish them.

The Leadership Multiplier

Take a moment and answer four questions:

• Who is one person on my team with greater potential than they are currently demonstrating?
• What conversation have I been avoiding?
• What responsibility am I still holding that someone else should own?
• What expectation have I failed to clarify?

Those four questions often reveal the greatest growth opportunity inside a practice.

For example, your office manager is capable of leading weekly accountability meetings but has never been empowered to do so. A treatment coordinator needs coaching rather than criticism. Maybe a hygienist could become a mentor for newer team members. Perhaps it’s an uncomfortable conversation you’ve been postponing for months.

Growth frequently exists on the other side of our own self-assessment and conversations you are reluctant to have. Our team calls it skill, will and circumstances. Here’s how it works:

Circumstances

Optimizing circumstances means we’ve created an environment that allows our team to win. For example, you’d like every new patient and every hygiene recare patient to have a healthy scan. You see two new patients per day and have three hygienists daily but just one scanner. Is your team not peak-

performing because they are not scanning, or is having only one scanner negatively impacting your circumstances?

Skill

In the above scenario, let’s assume you have enough scanners, yet only one of your team members has received proper training. Is your team saying no because they want to be difficult or could they be afraid of looking bad in front of patients?

Will

Assume you have the scanners you need and have invested time in developing your team to scan with confidence. Now, is it fair to ask for healthy scans on all new and hygiene recare patients? Of course.

The best leaders understand that developing people means developing more leaders. Consider the following:

• When the number of team leaders grows, our practice grows.
• When teams grow, patient experience improves.
• When accountability grows, execution improves.
• When culture improves, everything becomes easier.

The future of a practice is determined by the people responsible for carrying it forward. The top 2% never forget that.

There are real reasons some dentists create remarkable practices while others spend decades feeling stuck. It isn’t just talent, luck or timing. It’s because of thoughtful consideration and intentional design.

Today’s top 2% of dentists create clarity around where they’re going, build systems that create autonomy and develop people who can help carry the vision forward. None of these principles are complicated, but they do require great intentionality. The future you want tomorrow is created by the decisions you make today, and it begins with the decision to stop reacting and start designing.

As dentistry continues to evolve, those who are the architects of their people, systems and direction will continue separating themselves from the crowd, not simply through production and profitability, but through impact, fulfillment and freedom.