GrowOrtho Archives - HIP Creative

Episode: What Is My Practice Worth When Selling To An OSO Or DSO In 2026? Show: GrowOrtho Podcast,

Summary: Selling an orthodontic or dental practice to a DSO or OSO usually takes about six months from signing with an M&A advisor to closing, according to Brian Christensen, CFA, Chief Development Officer at 7 Pillars, and 60 to 90 days of that is due diligence after the letter of intent. Buyers price the practice on adjusted EBITDA, which is revenue minus true go-forward operating expenses minus market-rate doctor pay, and multiples start to climb at roughly $1 million of EBITDA. Christensen estimates a one-doctor practice with $2 million of EBITDA an hour outside Atlanta would trade at about 7.5x to 8.5x, while very high EBITDA concentrated in one provider creates key-person risk that lowers the multiple. Earnouts only count if the targets are achievable, and buyers weigh the last three to six months of performance heavily. In 2026 the DSO market is shifting toward large groups buying smaller groups, sponsor-led platform mergers, and IPOs as alternatives to the traditional private equity recapitalization.

Topics covered: practice sale timeline, M&A advisor engagement letters and success fees, adjusted EBITDA and add-backs, buyer selection and letters of intent, due diligence, exit multiples, earnouts, key-person risk, DSO consolidation, private equity recapitalizations, dental IPOs, the orthodontic M&A market.

Key entities: 7 Pillars, Brian Christensen, Brett Pierce, Christy Ratcliff, Luke Infinger, HIP Creative, GrowOrtho Podcast, US Oral Surgery Management (USOSM), MB2 Dental, Heartland Dental, Foundation Dental Partners, Smile Doctors, myOrthos, Paradigm Oral Health, BlackRock Long Term Private Capital, Warburg Pincus, Thurston Group, SGA Dental Partners, Gen4 Dental Partners, Modis Dental Partners, Tyree & D’Angelo Partners, Park Dental Partners, Blackstone, KKR, Invisalign.

Luke Infinger CEO and co-founder, HIP Creative | Host, GrowOrtho Podcast

Luke Infinger leads HIP Creative, a growth partner for orthodontic, dental, oral surgery, and multi-specialty practices, and hosts the GrowOrtho Podcast, where he interviews the advisors, operators, and doctors behind growing orthodontic practices.

Profile: [AUTHOR PROFILE URL]

Brian Christensen, CFA Chief Development Officer, 7 Pillars

Brian Christensen oversees client development at 7 Pillars, an M&A advisory firm that represents healthcare business owners. He previously worked in M&A at US Oral Surgery Management and as Vice President of Business Development at BOND Orthodontic Partners, and he holds an MBA from Southern Methodist University.

Profile: https://www.7pillarsadvisory.com/our-practice/meet-our-doctors/brian-christensen/

Selling to a DSO or OSO takes about six months once the process starts, according to Brian Christensen, CFA, Chief Development Officer at 7 Pillars, and many practice owners start the conversation later than they should. Christensen has worked both sides of these deals. He did M&A for US Oral Surgery Management, helped a West Coast orthodontic support organization grow from 3 locations to 50 in about two years, and now represents sellers at 7 Pillars, a healthcare M&A advisory firm that completes 20 to 25 DSO and private equity transactions a year.

In this GrowOrtho Podcast episode, Luke Infinger, CEO and co-founder of HIP Creative, asks Christensen to walk through a sale from the first signature to closing. They cover how buyers calculate adjusted EBITDA, which add-backs raise it, what multiples a single-doctor practice can expect, why an earnout can make an $8 million offer look like $10 million, and how the DSO market is moving toward platform mergers and public offerings.

Christensen’s main advice for sellers is to know your numbers the way a buyer will calculate them, and to keep growing after you sign with an advisor, because the last three to six months of performance can move your multiple.

Brian Christensen of 7 Pillars tells practice owners he would rather they start the conversation slightly too early than too late. Waiting too long narrows the pool of dental support organizations (DSOs) and orthodontic support organizations (OSOs) willing to bid, and it lowers the price.

He also separates timing from motive. Christensen’s rule is to never sell out of fear and never sell because a friend did. Start with what you are trying to solve for. When owners say the answer is money, the follow-up is what the money is for, and Christensen points out that if money alone were the goal, more orthodontists would be working Fridays and Saturdays.

An early conversation does not commit anyone to a sale. 7 Pillars regularly talks with owners who only want to understand current deal structures and what buyers are paying for, and some owners go to market just to test their value. Christensen’s view is that when several buyers independently give the same feedback, such as growing new patients, hiring more treatment coordinators (TCs), expanding the footprint, or closing underperforming locations, the feedback is probably right and worth acting on.

According to Brian Christensen of 7 Pillars, a practice sale usually takes about six months from signing the engagement letter to closing when the seller, advisor, and buyer all move quickly. The fastest deal he cited closed in five and a half months. Roughly 60 to 90 days of that window is due diligence after the letter of intent (LOI) is signed.

Delays come from ordinary life as often as from deal problems. One 7 Pillars client left for a month-long trip to Japan, and the process paused while he was gone. Christensen describes a push and pull: buyers have momentum and their own pipelines, and a seller who stalls risks losing that momentum.

Longer timelines happen. Christensen described a non-dental operating business that engaged 7 Pillars in December 2024, went to market in spring 2025, accepted an LOI in July 2025, and was still expected to close at the end of 2026, close to two years in total. He also described a general dentist (GP) who signed with 7 Pillars in 2024, found a dental support organization (DSO) he liked, and then spent another year fixing staff turnover and growing cash flow and EBITDA before closing with MB2 Dental. Waiting the extra year let him close with the group he had wanted from the start.

An engagement letter is the contract a practice owner signs with an M&A advisor before any analysis begins. Brian Christensen of 7 Pillars describes it as a long document that sets out the advisor’s responsibilities, the seller’s responsibilities, and the economic arrangement.

At 7 Pillars, the economics are usually a success fee, meaning a percentage of the transaction paid only if the deal closes. The firm typically charges no retainer or upfront fee. Christensen’s reasoning is that when the seller gets paid, the advisor gets paid, and if the process ends without a deal, both sides lose only time.

A tail is the clause that protects the advisor if the seller walks away. Under 7 Pillars’ usual terms, Christensen said, a seller who terminates the engagement or decides not to transact cannot pursue a deal with any buyer 7 Pillars talked to on the seller’s behalf for about one year. He noted that other advisors use breakup fees or longer tails, so sellers should compare those terms before signing.

EBITDA (earnings before interest, taxes, depreciation, and amortization) is the cash-flow number that dental support organizations (DSOs) and orthodontic support organizations (OSOs) use to price a practice. Brian Christensen’s working formula for a practice sale is revenue, minus the true go-forward operating expenses of the business, minus market-rate compensation for the doctor.

The go-forward adjustment is where add-backs come in. Add-backs are expenses on the current books that a buyer will not carry after closing, so they get added back to profit. Christensen splits them into two groups.

Personal add-backs include pay for a spouse or children who do not actually work in the practice, a boat, a country club membership, sports tickets (he has seen 49ers tickets on the books), a personal car, home renovations, and the share of online orders that went to the house instead of the office.

One-time add-backs include a $30,000 carpet replacement, two software tools that do the same job, a stretch of paying two marketing vendors during a switch, an employee who left and will not be replaced, and a large one-time technology purchase.

Adding both groups back produces what Christensen calls normalized adjusted EBITDA. The last step is subtracting doctor pay. Many owners quote an EBITDA figure that includes nothing for their own clinical work. In Christensen’s example, a doctor who reports $2 million of EBITDA with no salary built in is really describing what that doctor takes home before taxes, and a buyer has to pay someone to treat patients the next morning. Most groups pay doctors a percentage of collections or production. A few orthodontic groups use a day rate or flat salary, though Christensen said most are moving to a percentage of collections, and groups buying general dentistry, pediatric dentistry, endodontic, periodontic, and oral and maxillofacial surgery (OMS) practices pay a percentage of collections.

7 Pillars runs its own EBITDA calculation before going to market, separate from the buyer’s underwriting. Without that number, Christensen said, he could not tell whether a $10 million offer was excellent or poor. Luke Infinger added that this is how an advisor can spot a seller who is happy with an offer but leaving $3 million to $4 million on the table.

Buyers want to know what they are purchasing today and what they can do with it after closing. During the analysis phase, 7 Pillars collects practice financials, payroll data, and operational data, including how many operatories the practice has and whether the chairs or the building have room to grow.

Brian Christensen’s current example is a general dentistry practice with 10 operatories and room to add 5 more. That expansion capacity changes how a dental support organization (DSO) models the deal. Buyers test for four kinds of constraints: space, doctors, geography, and payers. A buyer that cannot take a practice from its current value to something higher has no reason to buy it.

Christensen said that when 7 Pillars takes an orthodontic practice to around 10 DSOs and orthodontic support organizations (OSOs), many buyers call back asking for the story: why the doctor is really selling and what the growth path looks like. That information does not appear in the financials, so the advisor has to gather it and present it alongside the numbers.

After the seller reviews the adjusted EBITDA figure and decides to proceed, 7 Pillars matches the seller with buyers based on what the seller wants from a partner, which is rarely only price. Brian Christensen listed common preferences: a growth partner, a joint venture (JV) model in which the buyer takes a majority stake but not 100%, an early-stage dental support organization (DSO) with equity upside, or a late-stage group that is steady and stable.

He estimates there are around 300 DSOs in the U.S., and 7 Pillars feels very confident in about 30 of them. Not all 30 buy every specialty in every state; some only want orthodontists, and a GP in Florida or an oral surgeon in Washington will have a shorter list. 7 Pillars introduces each client to a handful of groups and always includes one wild card, because a weak pitch makes the strong ones easier to recognize.

The sequence Christensen described:

Personal fit carries weight because many selling doctors sign 5-year employment agreements. Christensen advises getting someone from the buyer’s side to the in-person dinner who is not on the M&A team, such as the CEO, CFO, COO, chief clinical officer, or a doctor who has already partnered with the group, since the M&A contact moves on to the next deal after closing.

Due diligence is the 60 to 90 day verification period between signing the letter of intent (LOI) and closing. Brian Christensen of 7 Pillars calls it the hardest stretch for doctors, because they are still running a practice, seeing patients, and managing family life while answering questions such as why an employee was terminated three years ago.

He described three main diligence streams.

Quality of earnings (QoE): The buyer hires a third-party accounting firm to verify the numbers. Most buyers hope it confirms the figures, but sellers should expect pushback and requests for explanation.

Legal: The deal involves hundreds of pages of documents. Christensen recommends an attorney who specializes in dental or healthcare M&A and understands corporate practice of dentistry rules, because a generalist has to learn those on the seller’s time and slows the deal. 7 Pillars introduces clients to preferred attorneys at the LOI stage.

Operational: The buyer prepares to integrate the practice, covering HR, technology, compliance, and systems such as the practice management software (PMS). For the buyer, closing day is when the integration work begins.

Yes, according to Brian Christensen of 7 Pillars, because recent trends carry heavy weight in valuation. Buyers start with trailing 12-month (TTM) EBITDA, but they increasingly look at the last 3 and 6 months as a better predictor of the next 3 to 6. Christensen tells clients to push harder once they engage, because many sellers do the opposite and ease off.

The effect runs both ways. When Luke Infinger asked whether strong in-process growth could move a deal from a 5x multiple to 6x or 8x, Christensen agreed. An unexplained dip has the opposite effect: the seller loses negotiating power, and some buyers drop out entirely.

Christensen attached two cautions. Buyers will judge whether growth is sustainable or a short spike. And extra hours that cannot continue after closing, such as suddenly working Saturdays and Sundays, set an expectation the doctor will be held to. He said a practice is usually worth the most when it sits in the middle of a growth trajectory, rather than at the start of one or at the peak.

Earnouts, also called growth bonuses, are payments a buyer promises after closing if the practice hits future targets. Brian Christensen of 7 Pillars supports them when they fit the deal and says they often do not.

His test is whether the target is achievable, and usually only the selling doctor knows. In his example, a buyer values a practice at $8 million today and offers another $2 million in a year if the practice reaches certain numbers. The buyer presents that as a $10 million offer. If the $2 million target is out of reach, the seller received an $8 million offer, which Christensen said may still be a good deal.

He said some dental support organizations (DSOs) stack aggressive incentives on top of the closing price so a seller can announce a 15x headline multiple when the cash at close reflects 8x. When comparing offers, weigh what is paid at closing and discount any contingent amount the practice is unlikely to earn.

Brian Christensen of 7 Pillars said multiples start to rise at roughly $1 million of EBITDA. There is also a ceiling, and it depends on how many providers produce that EBITDA.

A single doctor in a hard-to-recruit market producing $5 million of EBITDA has an excellent business for that owner, but buyers see key-person risk (often called key man risk): the profit depends on one person who may slow down after receiving a check. Those deals tend to get a low multiple and heavy structure. 7 Pillars has advised owners in that position to hire an associate or bring in a partner, accepting lower profit in exchange for a higher multiple. Christensen’s general rule is to build a practice that would keep running if the owner left for a month.

He gave two reference points. A one-doctor practice about an hour outside Atlanta with $2 million of EBITDA would likely trade at about 7.5x to 8.5x EBITDA, which is already close to the point where key-person risk becomes a concern. A Southeast client with $3 million of EBITDA and one doctor worried buyers; with an associate in place at the same EBITDA, Christensen said that practice would draw strong interest and about 8x would be fair.

If the associate is central to the practice, the associate may need a share of the deal. Christensen said that can take the form of a transaction bonus, equity in the acquiring dental support organization (DSO) or orthodontic support organization (OSO), a joint venture stake or share of future practice profits, or a cash signing bonus, depending on what the associate, buyer, and owner negotiate.

Beyond key-person risk, Brian Christensen named two blockers he sees repeatedly across the 20 to 25 dental support organization (DSO) and private equity deals 7 Pillars completes each year.

The first is bringing in a financial advisor or CPA too late. An M&A advisor does not know the seller’s savings, investments, spending habits, or family obligations, and those details decide which deal structure fits. A doctor with children headed to expensive universities, a doctor who needs the ongoing cash flow of a joint venture (JV) model, and a doctor already holding a large position in a single stock who wants a steady buyer each need a different deal. 7 Pillars prefers to work alongside the client’s financial advisor for that reason.

The second is too many opinions. Christensen told a story about a client who insisted the team consult a friend in private equity; the friend turned out to sell representations and warranties insurance to private equity-backed companies. His recommended core team is the seller’s spouse, a trusted practice manager, an M&A advisor, a CPA or financial advisor with tax expertise, and eventually a transaction attorney. Anyone outside that group, he said, adds noise.

Brian Christensen of 7 Pillars described the current phase of dental consolidation as consolidators buying consolidators. Four or five years ago, when debt was cheap, the roughly 300 dental support organizations (DSOs) in the U.S. were buying individual practices. Now large DSOs are buying smaller and emerging DSOs with 20 to 40 practices that fill a geographic gap or strategic need, and 7 Pillars has represented several of those sellers.

Recent deals fit that pattern. Heartland Dental closed its acquisition of Foundation Dental Partners, a 33-practice group in Georgia, Tennessee, South Carolina, and Kentucky, on October 2, 2026, according to Heartland’s announcement. Smile Doctors acquired myOrthos, an orthodontic support organization with more than 70 locations in 13 states, in March 2025, according to Smile Doctors’ press release.

Christensen also explained why private equity is looking for new exit routes. A recapitalization, or recap, is when the private equity firm that owns a DSO sells its stake to another investor. The usual path runs from a lower middle market firm (he put that segment at businesses with $5 million to $30 million of EBITDA) to a mid-market firm to one of the largest firms, such as BlackRock, Blackstone, or KKR. Recaps have slowed since 2021 and 2022 because the cost of capital has risen and these deals depend on debt.

He pointed to two alternatives taking shape.

Ownership buybacks: In July 2026, Paradigm Oral Health announced a surgeon-led buyback of BlackRock Long Term Private Capital’s stake, backed by an investor group led by Warburg Pincus with Goldman Sachs Alternatives and Sixth Street, according to the company’s announcement. Christensen estimated Paradigm’s value at $3 billion to $4 billion and expects it to become a test case for other forms of liquidity, such as annual distributions.

Mergers aimed at an IPO: In June 2026, Thurston Group combined SGA Dental Partners, Gen4 Dental Partners, and Modis Dental Partners under the SGA Dental Partners name, creating a platform with more than 250 locations and more than 500 dentists across 26 states, according to Becker’s Dental Review. Christensen said Tyree & D’Angelo Partners has also merged three of its general dentistry groups. His read is that sponsors are building enough scale to go public instead of passing a company through a third or fourth private equity owner. Park Dental Partners, a Minnesota-based group, priced its Nasdaq IPO at $13 per share in December 2025 under the ticker PARK, and Christensen said the shares were trading around $20 at the time of recording.

Luke Infinger and Brian Christensen both described the orthodontic market as uneven. Infinger said figures he has seen online show orthodontics growing about 3.5%, but he considers the market flat or slightly down once rising costs are counted: higher team pay, more expensive supplies, and higher build-out and lease costs for new satellite offices.

Infinger sees fewer orthodontic transactions and more joint venture (JV) structures from reputable orthodontic support organizations (OSOs). He prefers JVs because the doctor keeps a meaningful stake, sometimes 40% of the practice. In 2021 and 2022, he said, he often talked to founding doctors who had sold outright, dropped to one clinical day a week, and watched growth stall. Christensen agreed that JVs align incentives. He described 2021 and part of 2022 as banner years when many OSO acquisitions happened, and said the market now looks like a normal steady state.

Results vary sharply by location and patient mix. Infinger said two practices with the same offer and the same marketing can diverge, with one growing fast and the other flat or down 1% to 2%. Some HIP Creative clients see 500% to 600% returns on combined agency fees and ad spend and are still flat; Infinger’s point was that without that marketing, those practices might be down 10%.

Christensen added that practices with more adult patients feel a slowdown first, because adults postpone Invisalign while parents keep prioritizing treatment for their kids. Infinger noted that general dentists offering clear aligners, sometimes at half the cost, are now orthodontists’ biggest competitor in that category.

Looking ahead, Christensen doubts pure-play OSOs will exist in five years. He expects more multi-specialty groups combining pediatric dentistry and orthodontics, sometimes with oral surgery, either through new platforms or through orthodontic groups acquiring pediatric practices.

About six months from signing with an M&A advisor to closing when everyone moves quickly, according to Brian Christensen of 7 Pillars. The fastest deal he cited took five and a half months. Roughly 60 to 90 days of the process is due diligence after the letter of intent.

It depends on the firm. 7 Pillars usually charges no retainer and is paid a success fee, a percentage of the transaction, only if the deal closes. Its engagement letters typically include a one-year tail that prevents the seller from dealing with buyers the firm contacted on their behalf for a year after terminating.

Add-backs are expenses on the current books that a buyer will not continue after closing. They include personal costs run through the practice, such as a salary for a spouse who does not work there, a boat, or a car, and one-time costs, such as a $30,000 carpet replacement or overlapping software. Adding them back raises adjusted EBITDA.

It can. Brian Christensen said multiples start to rise around $1 million of EBITDA, but a single provider producing very high EBITDA creates key-person risk, which leads buyers to offer lower multiples with more structure. Adding an associate can raise the multiple even if profit dips.

Christensen’s view is that a practice is usually worth the most in the middle of a growth trajectory. Buyers weigh the last 3 to 6 months heavily, so strong, sustainable recent growth can support a higher exit multiple, while an unexplained dip can cost the seller negotiating power.

Christensen doubts it. He expects orthodontic support organizations (OSOs) to move into multi-specialty groups, especially combinations of pediatric dentistry and orthodontics, sometimes with oral surgery.

DSO (dental support organization): A company that provides business and administrative support to affiliated dental practices, often backed by private equity.

OSO (orthodontic support organization): A DSO focused on orthodontic practices.

EBITDA: Earnings before interest, taxes, depreciation, and amortization; the cash-flow measure buyers use to value a practice.

Adjusted EBITDA: EBITDA after add-backs for personal and one-time expenses and after subtracting market-rate doctor compensation.

Add-back: An expense on the current books that a buyer will not carry forward, added back to profit when calculating adjusted EBITDA.

Trailing 12 months (TTM): Financial performance over the most recent 12 months.

Multiple: The number by which a buyer multiplies EBITDA to set the purchase price (for example, 8x).

Success fee: An advisor fee paid as a percentage of the transaction, only if the deal closes.

Tail: An engagement-letter clause that bars the seller from transacting with buyers the advisor contacted for a set period after terminating the engagement.

Letter of intent (LOI): A preliminary agreement on deal terms that starts formal due diligence.

Quality of earnings (QoE): A third-party accounting review, commissioned by the buyer, that verifies the seller’s financial figures.

Earnout or growth bonus: A payment promised after closing if the practice reaches future performance targets.

Joint venture (JV) model: A structure in which the buyer acquires a majority of the practice and the doctor keeps a minority ownership stake.

Recapitalization (recap): A transaction in which the private equity owner of a DSO sells its stake to another investor.

Key-person risk: The risk that a practice’s profit depends on a single individual, often called key man risk in dental M&A.

Corporate practice of dentistry: State rules that limit non-dentist ownership or control of dental practices.

PMS (practice management software): The scheduling, billing, and records system a practice runs on.

Luke Infinger: All right, we are here with Brian from 7 Pillars. Super excited to have you on the show today.

Brian Christensen: Thanks for having me. Happy to be here.

Luke Infinger: Absolutely. Tell us a little bit about you. What’s your background? How did you get into this space?

Brian Christensen: Sometimes I ask myself that every day. I left business school at SMU and joined a small investment bank, which is just a fancy place that sells businesses, more or less. We started doing some consulting for private equity firms that were starting to get into the DSO space, so we did some consulting for MB2 and some other multi-site healthcare groups: veterinary, dermatology, et cetera. As I was considering my next step, I thought, man, that would be interesting. I saw how fast-paced it was. MB2 was doing 60, 70 acquisitions per year.

So a job opening came open at US Oral Surgery Management, which was the first OMS-only group in the United States. I joined at a perfect time. It was right after COVID, and everyone was scared. They didn’t want to go through something like that alone. I joined an amazing team there with great leadership. Rick Hall, who was the CEO, is now chairman of the board. He gave me a chance, and I lucked into an amazing spot. I helped do M&A there for around 15 months and went through one of these things called a recap event, which are tough to come by these days. I helped with some of that recap process, and for a young guy it was an incredible experience to see a $700 million-plus valuation company and get to play a role in that transaction.

Luke Infinger: How old were you then?

Brian Christensen: I was 28. So having a seat at the table there was super cool and great for experience. The transaction went through, and it was very successful for all the shareholders, including the partner doctors. I had an opportunity to stay on and take on an elevated role. At the time, I was young and naive, and I thought, well, this is easy. Anyone can build a business, scale it, deal with doctors every day, get them all rowing in the same direction.

So I joined a startup. It was an OSO, an ortho-only group on the West Coast, and I was going to lead their M&A engine at 29 years old. They had 3 practices, and they said, hey, we want you to go scale it. I thought it was a good idea at the time, and it was an incredible experience. I helped scale it from 3 locations to 50 in around 2 years.

Luke Infinger: That’s a lot.

Brian Christensen: It’s a lot. It was a lot of travel to California and Utah and Washington and Oregon. At the same time, on the personal side, my dad is a small business owner with a small accounting firm in Waco, Texas. He was going through a transition as well. He was getting a lot of inbound emails, a lot of inbound calls, and he was getting offers. I felt a shift happen where I wanted to help guys like my dad, because I knew that if my dad’s transition went poorly, it would not bode well for my parents long-term.

My dad has one chance to do this, but I’m an M&A guy doing 15, 20 transactions per year. One goes bad, you go on to the next. My dad only has one chance. So I started seeing things from that perspective, because ultimately, as a buyer, Luke, my job, and it’s just business, is to buy the best businesses for as cheap as possible. There’s nothing wrong with that. It’s the same as buying a home. You want to buy the best home for as cheap as possible. But as a seller, you want to maximize that value. So I felt like I should go represent sellers.

The hard part is that, and you know this space well, there are a lot of bad actors in dental on both sides, very pro-DSO or OSO and very anti-DSO or OSO. I wanted to join a firm I was proud to say I worked for, with good people who represented clients the right way. I had done a few transactions with 7 Pillars, and I always felt that as a buyer I got a fair shake, and that they put the client’s needs above all else. I’ve been at 7 Pillars for 2 and a half years now, and it’s been awesome.

Luke Infinger: What year did you come on board with 7 Pillars?

Brian Christensen: 2024.

Luke Infinger: When you started with 7 Pillars, who were you working with?

Brian Christensen: A lot of Brett Pierce, who’s our founding partner, and Christy Ratcliff, who’s a managing partner.

Luke Infinger: And what’s your role at 7 Pillars now?

Brian Christensen: Chief Development Officer.

Luke Infinger: So are you the face and leading the day-to-day at 7 Pillars, or what does the team look like?

Brian Christensen: If this is the face of 7 Pillars, we’re all in trouble. My role is to oversee client development: bringing in new business, and once business is in the door, making sure it’s taken care of properly. My role is to grow the client base.

Luke Infinger: Some people listening and watching may be asking, okay, what is 7 Pillars exactly? How would you define it?

Brian Christensen: 7 Pillars is an M&A advisor that specifically represents healthcare business owners. Historically, Luke, we represented dentists only, so dentists and dental specialists. Recently we’ve taken our knowledge, a lot of what I built in my prior life in investment banking, and said, well, if I can help an orthodontist or a dentist or a pediatric dentist, why can’t I help a plastic surgeon or an optometrist?

Luke Infinger: Makes sense.

Brian Christensen: Or even further, because we know dental pretty well, why couldn’t we represent a business that caters to those clients, like an orthodontic marketing business or a dental IT business? Because of our knowledge of dental, we feel pretty comfortable representing those types of businesses as well.

Luke Infinger: Interesting. Give us an idea of the size of 7 Pillars, the team makeup, and how many deals you’re looking at a year.

Brian Christensen: The team is around 12 to 15 people. There’s what we’d call the deal-facing team, which is 3 or 4 of us, and that’s the quarterback of the transaction. Then we have a back office team that does all the financials and all the underwriting. Then we have some leadership and some administrative and support functions. So it’s around 15 people. On the number of transactions, Luke, we’ll probably do 20 to 25 per year on what you’d call the DSO private equity side of things.

Luke Infinger: Got it. So when somebody is thinking about transitioning, or wondering what they’re going to do, maybe they figure they’ve got another 5 years, I’d think you start talking to people too late in a lot of cases, right? From what I’ve seen, if you’re thinking about it at all, go ahead and have a conversation, because it could take a lot longer than you think to sell your business. This isn’t 2021 or 2022. The market’s a little different. So ideally, when do you want to talk to someone?

Brian Christensen: There’s a lot to unpack there. One, I would never pursue a transaction out of fear, and I’d never pursue a transaction or partnership because your buddy did it. I’d do it because you’re trying to solve for something, and an eventual transition is okay to solve for. But everyone has their why, so first you need to understand what your why is. Now, Luke, we’ve talked about this, and everyone says, well, it’s money. Yes and no.

Luke Infinger: For what?

Brian Christensen: Right, for what? And if money were that important, you’d probably be working Fridays and Saturdays too, and there probably aren’t many orthodontists working those days.

Luke Infinger: That’s true. Although Saturday’s a great day to be open.

Brian Christensen: It is a great day.

Luke Infinger: Get an associate to work it. We’ll come back to that.

Brian Christensen: But I agree completely, Luke. Sometimes people wait too long. It’s okay to have a discussion with us and get educated on what’s going on in the market: what deal structures are out there, what buyers are looking for. We always have those conversations. Or you might even go to market to test what your business is worth or see if you like anyone. The best advice I always give is I’d much rather you do it slightly too early than too late. Too many times people wait too long, and it affects their options from a buyer cohort, and it also affects their value.

Luke Infinger: Because you don’t have to sell.

Brian Christensen: You don’t have to sell.

Luke Infinger: Like you said, you could go to market and see, and maybe potential buyers tell you what to fix inside your business to be worth even more.

Brian Christensen: Look, if you go to market and you start getting feedback from several groups and they’re all saying the same thing, it’s probably true. And that’s okay. Maybe it’s, hey, you need to grow new patients. Maybe it’s, hey, you need to hire more TCs. You need to expand your footprint. You need to shut down a few locations because you have too many. All of that is fantastic feedback, and if everyone’s saying it, it’s probably true and you should listen.

Luke Infinger: What’s the longest you’ve worked with a business before it actually transacted?

Brian Christensen: I’ll give you the truthful answer.

Luke Infinger: Don’t lie to me.

Brian Christensen: Never lie. We had a client engage us in December of 2024. It’s not a dental practice; it’s an operating business. It went to market that spring, spring of ’25, and got under letter of intent, or accepted a formal offer, in July of 2025. It’s still under LOI as of today, and it’s going to close, fingers crossed, at the end of the year. So that’s been a 2-year process. That’s not normal, but things happen. Things come up through the process. Life happens. Things pop up in diligence where you have to go tweak something or there has to be a fix.

We also just had a GP that was interesting. He signed up with us in 2024, went to market, and liked one specific group. They liked him, but he had some things to sort out in his practice. He had a lot of turnover. He also had a lot of growth embedded in his business, and he felt his value should be higher. Luke, you probably talk to guys like this all the time. It’s like, okay, if you really think you have growth, go do it. Well, he went and did it, and he closed with MB2 earlier this month, which is fantastic. He waited a little longer, got his personal cash flow up a little, got his EBITDA up a little, waited one more year to get personally ready, and then partnered with a group he always wanted to partner with. That’s a win. We helped him through that process: here’s the feedback we’re getting, here are some tweaks you can make that will probably impact value.

Luke Infinger: I thought you were going to say longer. Really, 2 years? It can go by so fast, especially if there’s a clear path to what you need to fix in the business and a light at the end of the tunnel. Hey, if we do these things, you can get another point, or whatever that is.

Brian Christensen: I agree completely. They have to be coachable and willing to take the advice. A lot of times people say, well, I could grow so much, I could do this. And look, I used to be on the buy side, and you know what I’d say? Well, why haven’t you done it?

Luke Infinger: It goes back to your why. If you’re not doing it from a place of fear, logically you’d want to fix those things so you can get the most juice from the squeeze.

Luke Infinger: We’ve thrown out buzzwords like EBITDA and diligence, and you brought up letter of intent. Explain what those mean, and let’s walk through the timeline of a transaction.

Brian Christensen: Say you engage us today. We’re going to start requesting a lot of information, because we’re trying to determine your profitability, which is EBITDA.

Luke Infinger: What do you call that stage when you start collecting info?

Brian Christensen: We call it analysis. We collect that information and try to understand the puts and takes of your business.

Luke Infinger: If I’m a dental office, have I signed anything while you’re collecting this info?

Brian Christensen: You’ve signed an engagement letter.

Luke Infinger: What does an engagement letter look like? Different groups can do them differently. What’s a tail? What fee is standard in the industry?

Brian Christensen: They sign an engagement letter with us, and that’s a long Word document, thank you to the attorneys, that outlines our responsibilities as an advisor, their responsibilities as a seller or client, and our economic arrangement. Usually, Luke, we don’t charge a retainer or an upfront cost. We believe strongly that if you go through the process and end up partnering with someone, you get paid, we get paid. If you don’t get paid, we don’t get anything. I feel like that’s fair. If you go through the whole process and don’t do anything, then it’s lost time, but it’s lost time for us and for you. So the engagement letter outlines the economic arrangement. Usually it’s a success fee.

Luke Infinger: Success fee. Okay.

Brian Christensen: It’s a percentage of the transaction. A tail, essentially, Luke, works like this: you engage us, and we’re your exclusive M&A advisor.

Luke Infinger: You’re going to do all the work, the accounting, the analysis.

Brian Christensen: We’re going to do all the work, all the diligence. We’re going to talk to all the buyers and negotiate on your behalf.

Luke Infinger: Market them.

Brian Christensen: No doubt. If you decide not to pursue a transaction, or you terminate the engagement, we have, I think it’s usually a year. Anyone we’ve talked to on your behalf, you can’t pursue a partnership or relationship with them for a year. It’s mostly there to protect us, and it’s very standard. Some people have breakup fees, some people have longer tails. We just say, don’t go do anything for a year.

Luke Infinger: That’s very simple.

Brian Christensen: Very simple. So they sign an engagement letter.

Luke Infinger: Then you do analysis.

Brian Christensen: Then we do the analysis. We’re collecting a lot of information: practice financials, payroll data, operational data. We’re trying to understand your business. How many operatories or chairs do you have? Is there room for growth in those operatories, or can you expand? All of that helps us position the business to maximize value.

Luke Infinger: Because like anything, you want to put together a story that’s factual. But stories sell. So what’s the story of the business?

Brian Christensen: Right now we have a 10-operatory GP who has the ability to expand another 5 operatories. That helps paint a picture, because buyers, Luke, want to understand what they’re buying historically, but also what they can go do with it. Do I have space constraints? Doctor constraints? Geographical constraints? Payer constraints? They’re trying to understand their upside and their opportunity, because if they can’t buy a business at X and take it to Y and make it better, they’re dead in the water. So it’s not just about EBITDA, and we’ll get to that. It’s also, what can we go do with it?

We do all this analysis to understand the story of the business so we can position it properly. Luke, when we represent an orthodontist and take it to 10 DSOs, OSOs, whatever you want to call them, I can’t tell you how many calls we get saying, this is all great, but what’s the story? Why is this doctor really pursuing it? What can I go do with the business? None of that is on paper. We gather that information, put it together, and determine what we deem profitability, or EBITDA, to be. That’s the cash flow of the business on a go-forward basis.

Luke Infinger: Let’s talk about that, because I don’t think a lot of people understand what adjusted EBITDA is. Doctors tell me, hey, it’s going to take me another 5 or 10 years because I need to get to X EBITDA. And I say, well, what’s your adjusted EBITDA? And they don’t know what that is.

Brian Christensen: There’s a lot to unpack with adjusted EBITDA. Let’s start with revenue. Everyone, for the most part, agrees on what revenue is. Then we need to understand the true go-forward operating expenses of the business. If you sold or partnered with a DSO, they’re probably not paying your spouse unless your spouse actually works in the business, and probably not paying your kids unless they work in the business.

Luke Infinger: Not paying for your boat.

Brian Christensen: Not paying for your boat or your country club membership or tickets to the 49ers. I’ve had that happen.

Luke Infinger: Owner draws.

Brian Christensen: Owner draws. It doesn’t include your car. It doesn’t include home renovations. It doesn’t include all the Amazon orders that are probably 50% for the office and 50% for your house.

Luke Infinger: Date night.

Brian Christensen: Date night. All those things.

Luke Infinger: And that can be massive. Once you do all those, what are called add-backs, it could be substantial.

Brian Christensen: You add that back because a buyer isn’t going to let it continue going forward. The other thing, Luke, is one-time costs. Did you just replace the carpet for $30,000? You’re probably not going to do that every year.

Luke Infinger: Do you have 2 softwares that do the same thing?

Brian Christensen: Right. Do you have 2 marketing vendors where you’re offloading one and onboarding another, and there’s crossover? Did you fire an employee who isn’t going to be replaced? All of those should be added back because they’re not normal. If you just bought a big piece of technology, or you had other one-time expenses, those need to be added back. All of those add-backs, both personal and one-time, get you to what I call normalized adjusted EBITDA.

But there’s one more thing. Hey, Dr. Smith, you’re not going to work for free. A lot of people say, well, my EBITDA is $2 million. Okay, have you baked a salary in there? Well, no. So that $2 million, Dr. Smith, is what you’re really taking home before taxes. Someone is going to have to pay you to come to work tomorrow.

Luke Infinger: So then you have to look at the industry average salary.

Brian Christensen: Yes. Most groups pay a percentage of collections or production. A few orthodontic groups pay a day rate or a flat salary, but most are moving toward a percentage of collections. And if you’re not an orthodontist, whether you’re a GP, pedo, endo, perio, or OMS, they all pay a percentage of collections. It’s an eat-what-you-kill revenue share model. After that is subtracted, you have EBITDA. So it’s your revenue, less your true go-forward operating expenses, less your doctor compensation. That equals EBITDA, the cash flow of the business that they’re buying. Make sense?

Luke Infinger: Makes sense.

Brian Christensen: We do our own EBITDA calculation, because if a doctor gets a $10 million offer, I don’t otherwise know if that’s really good or really bad. The DSOs or OSOs are always going to do their own diligence and their own underwriting as well. But we do it too, because if you get a $10 million offer, I don’t know if that’s the best offer in the world or a terrible one.

Luke Infinger: Right. The doctor could be happy, and you could say, hey, you’re leaving $3 or $4 million on the table. That’s where you act like a fiduciary: we’re going to get the most you can get. I can’t imagine doing a deal like this alone. Do dentists try to do this on their own?

Brian Christensen: They do.

Luke Infinger: We’ll come back to that. Let’s keep going with the timeline.

Brian Christensen: Once we calculate that EBITDA, we show it to our clients. Was this about what you expected? Some say, yeah, it’s about what I expected; I have a really good accountant who’s helped me through this. Other times they have no idea. They think their EBITDA is way up here, and it’s actually way down here. So it’s a good pulse check. Are you good? Do you want to continue? Sometimes people say, man, that’s not what I expected. I’m not sure I’m going to get what I thought. Okay, let’s talk about that. What can we do to grow? Are there low-hanging fruit items we can take care of? But let’s assume they want to move forward. Then we introduce them to prospective partners or buyers.

Luke Infinger: How do you do that?

Brian Christensen: It starts with understanding what the client needs and wants out of a partner. Everyone goes to financial, but it’s always more than that. I want a growth partner. I want a joint venture model, where someone buys…

Luke Infinger: Very popular right now.

Brian Christensen: …where someone buys a majority percentage of your business, but not all of it. I want an early-stage company because I want some upside in their equity. I want a late-stage company that’s very steady and stable. Okay, now that we know that, we try to match you with a handful of groups that fit. We don’t run processes where we introduce our clients to 30 possible buyers.

Luke Infinger: Because that’s overwhelming.

Brian Christensen: It’s overwhelming.

Luke Infinger: It’s a lot of meetings, and some of these people want to meet in person.

Brian Christensen: If you talk to 10 DSOs or 10 OSOs, they’re all going to tell you they do things differently, that they have real clinical autonomy, and that they look at a lot of deals and only choose the best of the best. It sounds very compelling, but if you hear 7 of those in a row, it’s like, what was the difference? Your eyes start glazing over. So we introduce them to a handful of groups we think could be a good fit. Fun fact: we always introduce a wild card, just to see how they react. Sometimes it makes the other groups look better. You don’t know how good all the groups are until you talk to a bad one.

Luke Infinger: You have to know what’s out there. If you’re hearing the same pitch and maybe you’re not really happy, and then you talk to the wild card and their offer is significantly lower, you go, oh, that first one was actually a really good offer and meeting.

Brian Christensen: Yeah. There are 300 DSOs out there, and they’re not all created equal.

Luke Infinger: 300?

Brian Christensen: Too many. We should start a DSO. What’s one more? But of those 300, there are probably only 30 we feel very confident about. And if you’re a GP in Florida, not all 30 buy GPs in Florida. If you’re an oral surgeon in Washington, not all 30 buy oral surgeons.

Luke Infinger: The laws are different in each state.

Brian Christensen: That, and some groups don’t want an oral surgeon. They only want orthodontists. So we introduce them to a handful of groups. These are virtual, get-to-know-you meetings. I call it a virtual let’s-have-a-coffee. It’s 45 minutes; you tell your story, they tell theirs, and we’ll have a handful of those. Then we call for initial offers. These aren’t best and final, but they’re a good step in the right direction. It’s like an initial offer on a home. Is your initial offer the best you can do? Probably not. You just hope it gets you to the dance.

So we’ll say, hey, Dr. Smith, we talked to 8 groups, and 5 of them offered you an initial term sheet. Before I show you any offers, who did you like? Once you start seeing money, you start changing the way you think about groups. So, who did you like?

Luke Infinger: The worst meeting becomes the best. Well, actually, Ronnie was pretty cool.

Brian Christensen: Right. Well, actually, I hated everything Ronnie said, but I guess they’re okay. So we want to understand who you liked, because that matters.

Luke Infinger: You’re going to be working with those people to some degree, depending on the size and scale.

Brian Christensen: And 5 years is a long time to be miserable. A lot of these doctors sign up for a 5-year employment agreement. You’re going to forget about the big check at the end. So who do you like? That’s important.

Then we narrow the group from 5 to probably 2 or 3, and we have in-person meetings with them in your hometown. They’ll come see the practice after hours, and then we’ll go to dinner. It’ll be a nice steak dinner. They’re going to tell you how great you are and how great their business is. But ultimately it’s about the people. Can I see myself working with these people? You always want to get someone there from their side who isn’t an M&A person, because the M&A person is going to move on and keep working on deals. You want someone you’ll be working with day to day: the CEO, CFO, COO, chief clinical officer, or another doctor who has partnered with them. After those dinners, you call for final offers.

Luke Infinger: Best and final.

Brian Christensen: Best and final. That’s where we really start negotiating, probably with the group the client actually prefers. If the client says, I really want Group A, then we do everything we can to maximize value and structure with Group A. Assuming we get an offer the client wants to move forward with, they sign a letter of intent. The way I describe it: you’re not getting married, but you’re getting engaged and planning the wedding.

Luke Infinger: And that’s what triggers diligence.

Brian Christensen: That’s what triggers diligence. It’s been a lot of work to get to this point, and doctors reach this high, and then it’s, oh man, I have 60 to 90 more days of…

Luke Infinger: Really kind of hell.

Brian Christensen: It is hell, because they’re a business owner, they’re seeing patients, they’re a mother or a father, a husband or a wife, and oh, by the way, they’re selling their business. It’s a lot for 60 to 90 days. We do our best to take that off them, but there are some things we can’t do.

Luke Infinger: Right. You’re not going to know what happened 5 years ago.

Brian Christensen: Why did you terminate this employee 3 years ago, and all those things. There are 3 or 4 major diligence streams between signing an LOI and closing on the partnership. One is a quality of earnings. This is a third-party accounting firm the buyer brings in to justify the numbers and make sure everything checks the box.

Luke Infinger: So they’re going to poke holes and push back, and you’re going to have to say, here’s what that was.

Brian Christensen: You got it. That’s one stream. For the most part, people look for it to be confirmatory rather than an exercise in poking holes in the numbers. Two is legal. There are hundreds of pages of legal documents, and you want an attorney who knows dental M&A or healthcare M&A to look at this transaction. You don’t want to use your brother-in-law, the part-time dog walker.

Luke Infinger: That slows down the deal massively.

Brian Christensen: It slows down the deal. They have to learn dentistry, M&A, healthcare, corporate practice of medicine, or corporate practice of dentistry on your time.

Luke Infinger: Do you have attorneys you work with?

Brian Christensen: We do.

Luke Infinger: So you probably make those introductions early.

Brian Christensen: We do that at the LOI stage. We have preferred attorneys we work really well with. We know they serve clients well, and the pricing is very affordable. So you have quality of earnings, you have legal, and then you have what I call operational diligence, where the buyer or DSO prepares for your business to integrate into theirs. That’s HR, technology, compliance.

Luke Infinger: What PMS system are you on?

Brian Christensen: It’s all the operational pieces, so that when the close happens and everyone’s celebrating, it’s actually time for them to go to work integrating your business into theirs.

Brian Christensen: Everything I just explained, from start to finish, if we’re running hard, is probably 6 months. We’ve done one in 5 and a half months; we were all running very hard, and it was a great outcome for the client. But usually it’s 6 months. And life happens: kids’ soccer games, kids’ football.

Luke Infinger: Vacation.

Brian Christensen: You go on vacation. We had one client go to Japan for a month, and we didn’t do anything. Life happens, stuff with the business happens. So it’s a push-pull, because when you have momentum with buyers, you want to capitalize on it, because they have to move on.

Luke Infinger: What happens when someone is in process and they hit a stride, and now the business is growing way faster? Does that matter?

Brian Christensen: It does. You have to understand whether it’s momentary or whether it will continue for the foreseeable future. Largely speaking, trends matter. When we talked about EBITDA, Luke, people look at your last 12 months of profitability, and they call that…

Luke Infinger: Trailing…

Brian Christensen: Trailing 12 months.

Luke Infinger: There are all these buzzwords you have to learn.

Brian Christensen: All these finance guys, and I’m including myself, create buzzwords and acronyms that make us sound cooler than we really are. So that’s trailing 12-month EBITDA. But recently, Luke, yes, that matters, but what did you do in the last 3 months? The last 6 months? Because that’s a better predictor of what’s going to happen in the next 3 to 6 months. So we always tell clients, whenever you engage with us, pedal to the metal, because trends matter.

Luke Infinger: Work Saturdays.

Brian Christensen: Work Saturdays, work Sundays. Well, actually not, because they’re going to expect you to keep that up going forward. But trends matter. A lot of times, Luke, people engage us and then take their foot off the gas. No, you need to put the pedal to the metal there.

Luke Infinger: That’s when they need to come work with HIP.

Brian Christensen: Well, they need to come work with HIP way before that.

Luke Infinger: Grow the EBITDA first.

Brian Christensen: That’s right. But it depends on whether the growth is sustainable or a moment in time, a pop. The trend over the last 3 to 6 months will help drive the exit multiple, if I’m being honest. So I think that calls for a higher exit multiple.

Luke Infinger: So if you’re having rapid growth in process, and let’s break down the multiple in a second, you could maybe argue, hey, we can get you a 6x or 8x instead of a 5.

Brian Christensen: Correct.

Luke Infinger: And alternatively, if you don’t go pedal to the metal and there’s a dip, you won’t have that leverage in the negotiation.

Brian Christensen: You lose leverage. And sometimes, if there’s a dip that can’t be explained, buyers lose interest altogether.

Luke Infinger: They may back out.

Brian Christensen: The growth thing is interesting, Luke, because some people say, well, I’m growing so much right now, why would I do it? I totally understand. But your business is probably worth the most when it’s up and to the right, not when it’s steady.

Luke Infinger: And you really want to be in the middle. Not at the top, because when you’re at the top, where’s the only place you can go?

Brian Christensen: Down. So you want to be in the middle of your growth trajectory, not at the beginning and not at the end. Those trends help drive the exit multiple the buyer puts on your business.

Brian Christensen: There are also mechanics we can put into the deal itself that reward future growth. Those are called growth bonuses or earnouts. I’m a big proponent of them if they make sense for the deal. A lot of times they don’t.

Luke Infinger: So ideally, what should that look like if it’s going to make sense?

Brian Christensen: It needs to be achievable. Here’s what buyers will do, and I’ll use simple math. Buyers say the business is worth $8 million today, and we’ll give you another $2 million a year from now if you grow to X, Y, and Z. The way they position it, they’ve given you a $10 million offer. You can go tell your friends, I got a $10 million offer, and my buddies only got $7, $8, or $9 million. I got the greatest offer ever.

Luke Infinger: But the buddies actually got their money.

Brian Christensen: They actually got their money. The challenge is that if that $2 million set aside for a future incentive isn’t achievable, you didn’t get a $10 million offer. You got $8 million, which is probably still a great deal. Usually only you know whether it’s achievable. Can I really do that? If it’s not achievable, why are you counting it? That’s where a lot of DSOs start adding these crazy growth bonuses or incentives.

Luke Infinger: Make it look sexy.

Brian Christensen: Make it look sexy and awesome, so you can tell your friends on Facebook you got the greatest offer ever: 15x. Yeah, but you got 8x at close. The rest is who knows, and not achievable.

Luke Infinger: Let’s talk about EBITDA and multiples. What’s the threshold to start getting a much higher multiple? You can give ranges.

Brian Christensen: There’s a threshold, and there’s a ceiling.

Luke Infinger: So you can be too big?

Brian Christensen: Depending on the number of providers. I’d say multiples start moving a little at about $1 million of earnings, or $1 million of EBITDA. But there’s a world where you have too much EBITDA if you’re not scaled the right way. If you’re a single provider in a tough-to-recruit market and you have $5 million of EBITDA, that’s a fantastic business. But if I’m the buyer, I’m so scared of that.

Luke Infinger: Because I buy you…

Brian Christensen: …and what the hell am I going to do with it? You’ve squeezed everything out of it. That’s fantastic for you personally.

Luke Infinger: And on the other side, are you going to continue to work the same way?

Brian Christensen: Right. Everyone takes that risk once you get a check. In fact, because we’ve seen businesses in that situation, we’ve told people, your business will be worth more if you hire more people. Hire an associate or bring on another partner. Yes, it may affect your profitability, but your multiple will be a lot higher. There’s a threshold at the bottom, which is about $1 million of EBITDA, and there’s also one at the top. If it’s an unhealthy amount of EBITDA for the number of providers, there’s a lot of key man risk. Buyers say, yes, we’ll do a deal, but at a very low multiple and very structured. We’ve dealt with that. We always recommend building your business so that if you leave for a month, it keeps going. A lot of times people build a business so dependent on them that they can’t scale it past a certain threshold.

Luke Infinger: So you’ll get dinged for that.

Brian Christensen: You’ll get dinged for that, for sure.

Luke Infinger: What are you seeing right now? Back when things were hot, it seemed like everybody was going to sell their practice. We should also talk about DSOs versus OSOs, dental versus ortho, and the market there. But on average, say I bring you a practice with $2 million in EBITDA. What’s the multiple?

Brian Christensen: Where is it located? Give me a little more.

Luke Infinger: Say it’s in the Southeast, about an hour outside Atlanta. One-doctor practice, but maybe open to bringing on an associate. $2 million in EBITDA. What’s my multiple?

Brian Christensen: You’re probably at 7.5 to 8.5 there. You’re getting close to that threshold where there’s a lot of key man risk. We had a client in the Southeast with $3 million of EBITDA and one doctor, and it just scared people.

Luke Infinger: So say they had an associate at $3 million. What would that unlock?

Brian Christensen: You’re probably getting an A+ there. Now, if the associate is really important, you probably need to give them a cut of the deal.

Luke Infinger: How do you do that? Is it a bonus on the transaction?

Brian Christensen: It could be a bonus on the transaction. It depends on what the associate wants, what the buyer thinks they should get, and what you think they should get. It’s a conversation.

Luke Infinger: Because they could get equity in the new company.

Brian Christensen: They could get equity in the DSO or OSO. They could get a joint venture or future profits from the practice going forward. They could get a signing bonus, which is cash. But that’s a fantastic business, and it would draw a ton of interest. I think 8x is probably fair.

Luke Infinger: You’re doing 20-plus transactions a year. What are the top 3 blockers for a deal that you see over and over, maybe even something you tell people on an intro call that they need to fix? You talked about key man risk, so maybe that’s one.

Brian Christensen: Not including a financial advisor or your CPA sooner.

Luke Infinger: So the financials are a wreck.

Brian Christensen: The financials are a wreck, in a sense. What I mean is, as an M&A advisor, I don’t know what you, the client, need out of a transaction. Do you need a bigger salary? More cash? Are you in a very expensive part of life where you need a joint venture model for cash flow purposes? I don’t know any of that. I don’t know how much you’ve saved or how much you’ve invested. So we actually prefer to work with financial advisors. We think that’s the best service to the client in getting a transaction done that meets their financial needs. I don’t have 20 years of history to know that their kid wants to go to Harvard and it costs XYZ, or their kid wants to go to Stanford, or that they have a bit of a spending problem so they need a joint venture model, or that they hold a ton of Nvidia stock so they don’t need more high-risk stock and need a steady group. All those things matter for happiness later on.

Luke Infinger: So you need the full financial picture.

Brian Christensen: I need the full financial picture. I think that’s the best service to the client.

This is going to sound a little tongue-in-cheek, but fewer opinions. I just said I want the opinion of a financial advisor, but what you don’t need is opinions from your dog walker or your buddy. Luke, one time we had a client who said, one of my best friends is in private equity and I want you to talk to him. Okay, that’s interesting. The guy sold reps and warranties insurance.

Luke Infinger: Oh boy.

Brian Christensen: To private equity-backed companies.

Luke Infinger: So a complete waste of time.

Brian Christensen: A complete waste of time. Fewer opinions is actually better. One thing I’d really focus on is who your team is. Probably your spouse, and maybe your practice manager if they’re trusted. You need an M&A advisor. I’d love for you to hire us, but hire someone. It’s worth it.

Luke Infinger: CPA.

Brian Christensen: A CPA or financial advisor, and a tax expert. Then eventually, if you pursue a transaction, an attorney. That should be your core team. Anything outside of that starts to get really noisy. The biggest thing is probably too many opinions.

Luke Infinger: What are you seeing strictly in dentistry right now? The DSO market. Are more deals being done this year than last year?

Brian Christensen: What we’re seeing is pretty fascinating. We talked about 300 DSOs out there. Four or five years ago, when debt was cheap, all of them were buying this practice and that practice. Now we’re starting to see aggregation of those DSOs. Large DSOs are buying smaller DSOs, or what we call emerging DSOs. So Heartland or MB2 or Smile Doctors or Paradigm Oral Surgery is buying a group of 20, 30, 40 practices that meets a geographical need or a strategic fit. We’re just now starting to see that. We’ve actually represented a few of those, and it’s been awesome for us to play a role there.

Luke Infinger: So consolidation within dental.

Brian Christensen: Consolidation of consolidators, and it’s happening right now. I think I just saw Heartland bought a 33-location group last week. Smile Doctors bought myOrthos. Those things are going to keep happening, and I think that’s great for the industry. Fewer options is okay here.

Luke Infinger: Best wins.

Brian Christensen: Best wins.

Brian Christensen: The other thing we’re seeing relates to recaps, which we mentioned earlier. What is a recap? A private equity investor owns a DSO, like MB2, and eventually that investor needs to sell its interest to another investor in hopes of achieving a return. I wish I had a whiteboard to draw it all out.

Luke Infinger: At the top you always hear about the big ones. BlackRock. Blackstone. What’s the other?

Brian Christensen: KKR.

Luke Infinger: KKR. Is State Street one? Am I hallucinating?

Brian Christensen: I think you’re hallucinating.

Luke Infinger: I might be, at this point in the podcast. But you always hear KKR and BlackRock at the top. And maybe the next step after that is who’s going to go public?

Brian Christensen: That’s what’s interesting. These businesses started with very small investors called lower middle market private equity firms, which invest in businesses with between $5 million and $30 million of EBITDA. They scale them, grow them, add a lot of infrastructure, and then sell them to a mid-market private equity firm. That mid-market firm does some things to it, and then sells it to one of the big boys: BlackRock, Blackstone, KKR. At the same time, recaps haven’t been happening as frequently as they were in ’21 and ’22. Why? The cost of capital has gone up, and all these firms use financial engineering, or a heavy debt load, to finance acquisitions, both at the practice level and for DSOs.

We used to think of getting liquidity from a DSO as, well, I need a recap. But private equity guys are the smartest guys in the room, and they’ll tell you that, by the way. What we’re starting to see is private equity saying, we have to create other avenues of liquidity besides the traditional recap process. What does that mean? We’re seeing a few things. One, Paradigm Oral Surgery just bought out BlackRock.

Luke Infinger: I saw that.

Brian Christensen: BlackRock had a healthcare fund, and they were getting out of the healthcare space altogether. That was a strategic decision on their part. So Paradigm said, okay, we could sell to another private equity group, or what if we bought it? Well, they bought it. What does that mean? Paradigm is now a $3 or $4 billion company, so kudos to their leadership for building an amazing company. Now they have the power to create whatever form of liquidity they want, whether that’s annual liquidity or a dividend every year. They’re going to be a test case for that.

On the other side, we just saw some groups merge, or large groups acquire smaller groups. Why? The Thurston Group, one of the best private equity sponsors in the country, was the initial backer of US Endo, Smile Doctors, and US Oral Surgery, so they’re pretty good at investing in dental. They had 3 GP groups, SGA, Modis, and Gen4, each focused on different things and different geographies, and they just merged all 3. Tyree & D’Angelo Partners, another private equity sponsor, had 3 GP groups in different geographies and just merged all 3. What are they doing? They’re trying to get enough scale to pursue a public offering. That’s the next wave, Luke. Rather than going from private equity sponsor 1, then 2, then 3, maybe a 4th, just go public. But you have to achieve scale to do that, so they’re putting these together first.

Luke Infinger: Because then people have to buy your stock.

Brian Christensen: You got it. Has it happened before? Yes. Park Dental Partners, a microcap DSO up in the Midwest, went public a year and a half ago. The ticker is PARK if you want to look it up. It opened at $13 per share, and it’s now trading at $20 per share. So there’s a test case. If a microcap can do it with, I don’t know, $5, $7, $10 million of EBITDA, why can’t the group Thurston just put together do it with $50, $75, or $100 million of EBITDA? That’s much better scaled than Park. So again, we’re seeing all these different ways groups are trying to create liquidity that doesn’t rely on the traditional recap process.

Luke Infinger: So we hit dental. Let’s niche down and talk about ortho. What are you seeing specifically in orthodontics?

Brian Christensen: Ortho’s weird.

Luke Infinger: That’s one way to say it.

Brian Christensen: That’s one way to say it. I love orthodontists. It’s been, honestly, a little bumpy.

Luke Infinger: I’ll tell you what I’ve seen. If you Google it right now, I think it says something like orthodontics is up 3.5%. I call it flat, or maybe even slightly down, and here’s why. The cost of everything else has gone up. You’re paying team members more. You’re paying more for supplies. If you’re opening a satellite, the build-out and the lease are all going to cost more. I think that outweighs the 3.5 or 3.6% of growth.

So what I’m seeing is a lot fewer transactions. But also, and check me on this, the reputable OSOs have gotten smarter, and they’re doing JVs, which I actually prefer, because the doctor still has skin in the game. What I saw in ’21 and ’22, and it’s justifiable, is the founding doctor would get a deal, and then I’d be talking to them and they’d say, yeah, I’m only working 1 day a week now. Okay, what’s the practice doing? Oh, we’re not really growing like we were. With these JVs, they’re continuing to have bumper years and figuring out how to grow, because maybe they still own 40% of the business.

Brian Christensen: Incentives are definitely aligned there. I’d say it’s honestly just been weird, and it’s hard to figure out what normal is. I think now we’re at a normal steady state. We had 2020. The first half of 2020 was pretty rough, and the second half was actually pretty good. ’21 was a banner year, and part of ’22 was a banner year. Then everyone just kept thinking they’d ride the wave, and a lot of the acquisitions in the OSO or ortho space happened in ’21 and ’22.

Luke Infinger: Everybody. It’s interesting. People always text me, hey Luke, what are you seeing in the market? And I say the same thing every time in a different way: there’s no way to predict what’s going to happen. Practice A looks just like practice B, but maybe they’re in a different part of town or a different region, and one is blowing and going while the other is down 1 or 2%, or flat. Same offer, same marketing.

And this is fascinating: we see practices with a 500% ROI. What does that mean? Their investment with HIP plus ad spend is returning 500, 600%, but they’re still flat. Here’s the thing. Remove that, and what would it be like? Do you want to be flat, or do you want to be down 10%? So it’s very interesting, based on what area of the country…

Brian Christensen: Area of the country, and what your patient demographic is. If you have a lot more adults… I’m a simple guy. The way I think about it is, when things get tight, mom can get Invisalign next year, but you’ll do anything for your kids.

Luke Infinger: Or she’ll get it at her dentist for half the cost. Dentists are now the biggest competitor to ortho on clear aligners.

Brian Christensen: 100%. And the other thing, Luke, is I don’t know if we’ll have any pure-play OSOs 5 years from now. I think we’ll move into multi-specialty groups. We’re already seeing a lot of that with pedo-ortho, or pedo-ortho-OMS. I think we’ll see more pedo-ortho in the next 5 years, or groups consolidating and starting to acquire pedo. I don’t know if we’ll have any pure-play ortho in 5 years.

Luke Infinger: That’s fascinating. We covered a lot of ground. If someone listening or watching realizes they need to talk to somebody, who should they reach out to? How do they get ahold of you?

Brian Christensen: We’d love to have a conversation, tell you what we’re seeing, and understand your goals. You can reach us at 7pillarsadvisory.com, and we’ll get you connected to the right people.

Luke Infinger: Amazing. And to plug the event we’re planning next year: when and where is it? We don’t have a sign-up page yet, but let’s tell people about it.

Brian Christensen: For now, they need to reach out to either 7 Pillars or you at HIP. Essentially, we’re going to have a small-group setting about practice growth, practice transitions, and what to do with the wealth afterward. It’s tailored to people who want to scale and grow for a purpose and want to know what to do with it all afterward. It’s going to be a very small group, not a massive lecture hall. It’s going to be 15 to 20 doctors.

Luke Infinger: Very strategic.

Brian Christensen: Very strategic and very high-end. We’re going to have some big names there, including Mr. Ben Fishbein, and you, of course. It’s going to be awesome. I’m really looking forward to sitting next to people who are all working toward the same thing.

Luke Infinger: Awesome. And that’s going to be…

Brian Christensen: September 27th.

Luke Infinger: All right. Thanks for coming on the GrowOrtho Podcast. Looking forward to having you on again.

Buyers price your practice on the trend in your last three to six months. If you want new-patient growth working for you before you talk to an advisor, book a growth call with HIP Creative: https://hip.agency/landing/discovery/

The post What Is My Practice Worth When Selling To An OSO Or DSO In 2026? appeared first on HIP Creative.

Commercial real estate for dentists and orthodontists is one of the largest costs a practice carries, second only to payroll, and it is the one most owners handle with no expert help. On this GrowOrtho episode, host Luke Infinger sits down with Colin Carr, founder and CEO of CARR, a firm that represents healthcare providers on the tenant and buyer side of real estate deals in all 50 states and currently works with more than 6,000 clients.

Carr’s core argument is blunt. When a doctor shows up to a lease renewal or a purchase without representation, the landlord already knows it, and the doctor loses. Not a rounding error. On a normal 10-year lease, Carr puts the average loss around $300,000.

This post lays out where that money goes, why representation changes the math, and exactly when in the process a practice owner should pick up the phone.

CARR is a commercial real estate firm that represents only healthcare providers, and only on the tenant or buyer side of a deal. Colin Carr, the founder and CEO, does not take listings and does not work for landlords or property owners. His clients are dentists, orthodontists, physicians, veterinarians, and other providers. The firm is licensed in all 50 states and, as of this recording, represents more than 6,000 clients.

The reason for that double niche traces back to Carr’s earlier career. He spent close to a decade in commercial real estate, much of it on the landlord side, at one point holding around 1.5 million square feet of listings in the Denver suburbs. In retail, industrial, and office deals, he says, both sides almost always had representation. In medical deals, roughly 9 out of 10 doctors had none, and the rare doctor who did was often working with a residential agent or a friend of the family who had never done a commercial deal.

Carr founded the firm at the start of 2009 around a single mission he describes as helping people who help people, and leveling the playing field for providers who have never been taught how these negotiations actually work.

More than 90% of doctors handle their commercial real estate deals with no representation, according to Carr, and that number comes from both sides of his career. As a landlord’s agent, he watched it play out deal after deal. As a tenant and buyer’s agent now, he sees the same pattern in the leases his new clients bring him: no broker on the last two, three, or four deals, or a broker who did not know how to push.

The turning point for Carr came from a handful of deals in a short window where he did exactly what his landlord clients instructed. The terms he was told to propose were, in his words, egregious, and the doctors signed them anyway. Doing quick math after the fact, he realized one doctor had lost around $400,000 and another around $600,000 compared to what a competent tenant’s agent could have secured through lower lease rates, larger buildout allowances, free rent, and lower annual increases. He decided he could have more impact on the other side of the table, went healthcare-only and tenant-and-buyer-only, and never looked back.

The lease renewal is the transaction where practice owners lose the most money, and it is not close. Carr calls it the number one transaction for losing money in all of commercial real estate, across retail, office, and industrial, not just healthcare. Roughly 90% of doctors lease their space, so this is the deal most practice owners will face repeatedly over a career.

On an average renewal, Carr says the typical dentist or physician in a couple-thousand-square-foot space leaves a couple hundred thousand dollars on the table. On a standard 10-year lease for a 3,000-square-foot tenant, he puts the figure closer to $300,000. The reason the number is so high is that a lease cannot be altered once it is signed, and a renewal only comes around every five, seven, or ten years. As Carr frames it, you get one crack at it, and a shanked drive cannot be replayed with a second ball.

For the roughly 1 in 10 doctors who buy their real estate, ownership usually becomes the more valuable asset. Carr says that for practice owners who buy, the real estate is worth more than the practice itself about 90% of the time, and not by a small margin. His estimate is that buying commercial real estate for the practice increases an owner’s net worth by $1.5 million to $2 million over 20 years.

His larger point applies whether you lease or buy. A renewal, a startup lease, and a purchase all put a large amount of money on the line that can be won or lost, so the transaction deserves to be treated with the respect that size warrants rather than handled off the side of a desk.

One case Carr shared makes the stakes concrete. He met with a dentist who was one of about five providers on the second floor of a medical building. The dentist had never had representation and had always done his own leases. Looking at the lease, Carr found no free rent and no buildout allowance, even though the space had not been touched in about 20 years, and the rate was above market.

When Carr asked why, the dentist explained that the four other providers on the floor all shared their terms with each other, so he assumed his deal was as good as anyone could get. Carr pointed out the flaw: every doctor he was comparing against was also unrepresented, so they were all measuring “fair” against each other while trusting whatever the landlord told them. Carr had just signed a brand-new dentist on the first floor of the same building at roughly $8 to $9 per square foot less, with six months to build out, five months of free rent after opening, and a large renovation allowance.

Using that fresh comparable, Carr renegotiated the second-floor dentist’s renewal. He cut the lease rate by about 30%, secured renovation money and free rent, and swung the deal in the dentist’s favor by a couple hundred thousand dollars. He compares the old approach to a patient asking another patient for a diagnosis instead of seeing the doctor. It sounds absurd, and people are doing it on multimillion-dollar contracts.

Sophisticated landlords expect every serious tenant to have representation, so a doctor who shows up alone signals inexperience before the negotiation even starts. Carr’s point is that no major tenant negotiates without a broker. Chipotle, Starbucks, and Chase Bank all have internal real estate teams plus outside brokers. So do office tenants like Lockheed Martin and Charles Schwab. When an institutional landlord sees a provider who will do only two, three, or four real estate transactions in an entire career and has no broker, the landlord assumes that person cannot level the playing field.

From there, Carr says, landlords lean on predictable tactics. They know most doctors avoid confrontation, while landlords deal in it daily. They run out the clock. They say things like “our lender won’t allow that.” If the doctor concedes even part of it, the landlord has the upper hand. This is why an unrepresented doctor rarely gets even a fraction of the terms a represented one would.

Carr’s answer is that AI and a general attorney can inform you, but they cannot represent you, and trying to DIY the negotiation usually backfires. He grants that tools like ChatGPT or Gemini are useful for learning what to expect. The problem is that neither is an expert healthcare real estate attorney, and landlords can tell instantly when lease comments came from someone doing family law in Iowa rather than a commercial specialist. Asking for terms that are not market makes the landlord take the tenant less seriously and can cost movement on the points that were actually winnable.

There are two ideas here worth holding onto. First, “it never hurts to ask” is false in a negotiation; asking for absurd terms damages the relationship and shrinks what the other side is willing to give. Second, the broker commission is already set aside in every commercial deal. Carr compares it to dental insurance: you pay the premium whether or not you use the benefit, and if you never see the dentist, the insurer keeps the money rather than refunding you. Skip representation and you do not save the commission, you just forfeit the benefit, lose 30 to 50 hours of your time, and end up with a result you cannot undo for another five to ten years.

The single biggest lever a practice owner controls is timing, because a landlord who knows you are out of time knows you cannot walk. Carr breaks the timeline down by scenario.

For a startup, begin right away. The process runs a minimum of 9 to 12 months and often longer, so start the conversation even before you finish residency and you can build the ideal timeline.

For an acquisition, start before you have even identified the practice, so the lease can be reviewed quickly when you find one. Carr warns against trusting the practice broker’s read on the lease, since that broker has a fiduciary duty to the seller, not to you. A comment that the previous doctor “wouldn’t have signed it if it wasn’t fair” means nothing, because that doctor was likely unrepresented too.

For scaling to multiple locations, start as soon as you think you want to scale.

For a ground-up build where you buy land and construct your own building, the conversation has to begin about two years out. Carr estimates a solid 18 to 24 months for that process, unlike a residential build in a master-planned community.

For a lease renewal, a relocation, or buying an existing building, start ideally 18 months out, with 12 months as the absolute minimum. Here is why the runway matters. If your lease is up in three months and you only then approach the landlord, they know you cannot relocate in time, so they run out the clock and give you nothing reasonable until you are forced into their deal. Carr compares it to a football team running out the clock with a lead. Start 12 to 18 months out with a broker who has already gone to market, gathered best-and-final terms from multiple landlords and sellers, and knows exactly what a market deal looks like, and the posture flips. You are no longer at the landlord’s mercy; you are telling them the terms it will take to keep you.

He adds a point Luke Infinger reinforced: even if representation saved you nothing, the time is worth it. The hours a busy owner would burn negotiating could be spent seeing 25, 50, or 100-plus patients.

If your practice is facing a lease renewal, a relocation, a purchase, or a startup buildout, the time to get represented is before you are out of runway. Watch or listen to the full GrowOrtho episode with Colin Carr, and if you want to know how your current lease compares to the market, CARR offers a free lease or purchase evaluation and can match you with a healthcare-specialized agent at carr.us.

When should a dental practice contact a commercial real estate broker? Right away for a startup (a 9 to 12 month process minimum) or an acquisition. For a lease renewal, relocation, or purchase of an existing building, start 18 months out, with 12 months as the minimum. For a ground-up build, start about two years out.

How much do doctors typically lose on a lease renewal? Carr says the average practice leaves a couple hundred thousand dollars on the table at a typical renewal, and closer to $300,000 on a standard 10-year lease for a 3,000-square-foot space. Lease renewals are the number one transaction for losing money in all of commercial real estate.

Is it better to lease or buy commercial real estate for a practice? About 1 in 10 doctors buys, and Carr says the real estate ends up worth more than the practice about 90% of the time, adding an estimated $1.5 million to $2 million in net worth over 20 years. Both leasing and buying put large money on the line, so both deserve real representation.

Can I just use ChatGPT or my attorney to review a commercial lease? They can help you understand the process, but they cannot represent you in the negotiation. A general attorney is not a healthcare real estate specialist, and landlords can spot non-market requests immediately, which weakens your position on the points you could have won.

Does hiring a tenant broker cost the practice extra? No. Carr says the commission is already built into commercial real estate transactions. If you do not use representation, you do not get that money back, you simply lose the benefit it was meant to pay for.

Tenant (or buyer) representation: A broker who works exclusively for the tenant or buyer in a deal, not the landlord or seller.

Buildout / tenant improvement (TI) allowance: Money a landlord contributes toward constructing or renovating the tenant’s space.

Free rent (rent abatement): A period, often during buildout or shortly after opening, when the tenant pays no rent.

Base year: The reference year used to calculate certain operating-expense pass-throughs in a lease; resetting it on a renewal can lower a tenant’s costs.

Lease renewal: Extending an existing lease with the current landlord, and the transaction where Carr says practices most often overpay.

Notice to vacate: Formal notice that a tenant intends to leave, which can shift negotiating power in a renewal.

Fiduciary duty: A legal obligation to act in one party’s best interest. A practice broker owes this to the seller, which is why their read on a lease is not neutral.

Title: Why Most Orthodontists Get Their Commercial Leases Wrong

Summary: More than 90% of dentists and orthodontists negotiate their office real estate with no representation, and it costs them. Colin Carr explains that lease renewals are the single transaction where healthcare providers lose the most money, with the average practice leaving a couple hundred thousand dollars on the table, and roughly $300,000 on a standard 10-year lease for a 3,000-square-foot space. He walks through why savvy landlords treat an unrepresented doctor as an easy target, why ChatGPT and a family-law attorney friend cannot substitute for a healthcare-specialized broker, and why the broker commission is already built into every deal whether the tenant uses it or not. The episode closes with clear timing: start a renewal, relocation, or purchase conversation 18 months out, a ground-up build 18 to 24 months out, and a startup 9 to 12 months out.

Topics covered: lease renewals, tenant and buyer representation, buildout allowances, free rent, lease vs. purchase, practice startups and acquisitions, ground-up construction timing, landlord negotiation tactics.

Key entities: CARR (Carr Healthcare Realty), Colin Carr, Luke Infinger, HIP Creative, GrowOrtho, ChatGPT, Gemini.

About the author

By Luke Infinger, CEO and Co-Founder, HIP Creative | Author

Luke Infinger has spent more than 12 years helping dental and orthodontic practices grow through marketing, software, and education. He is the founder of HIP Creative, which works with 580+ dental and specialty practices across the country, and the creator of Practice Beacon, a lead-tracking CRM built specifically for dental and orthodontic teams. His work has included taking practices from regional obscurity to nationally recognized growth benchmarks, among them helping an orthodontist become the fastest-growing in the country by 2018. He is also the author of multiple books on practice growth and a sought-after speaker for dental continuing education events. LinkedIn: https://www.linkedin.com/in/luke-infinger-b36a001b/

[00:00] Introduction

Luke: Colin, thanks so much for coming on the GrowOrtho podcast.

Colin Carr: Thanks for having me, I appreciate it.

Luke: Absolutely. For those watching or listening, tell them a little about you and your company.

Colin Carr: Our company is called CARR, maybe very uninspired because it’s my last name. It was originally Carr Healthcare Realty, and everyone just dropped the Healthcare Realty, so we dropped it as well. We’re a commercial real estate firm that exclusively represents healthcare providers with their real estate, and we only work on the tenant or buyer side of the transaction. No listings, no landlord or owner work, just tenant and buyer work. Our only clients are doctors: physicians, dentists, veterinarians, and so on. Our entire mission is to level the playing field for healthcare providers with their real estate. We’re licensed in all 50 states, we serve thousands of clients per year, and our mission is to help people that help people.

Luke: Love that. It’s funny you named your company that, when that’s what most private practices do, right? Doctor’s name.

Colin Carr: It works.

Luke: We named our company HIP Creative 12 years ago and basically dropped the Creative. Everybody just says HIP. Walk me through the origin story. How’d you get into this?

Colin Carr: I’ll give you the short version. The company was the result of me working on the landlord side of a number of medical transactions where I was the listing agent. The landlord was super savvy, hundreds of millions of dollars of medical assets, so they were the consummate professional when it came to negotiating and running properties. I’d been doing real estate for a long time, mostly landlord work. On a retail deal, both parties had representation. Industrial, both parties had representation. Same for office. Then I started doing medical deals and realized that literally 9 out of 10 doctors had no representation when we transacted.

The 1 out of 10 that did have representation, it was a friend or a family member or a patient who was really a residential real estate broker with no clue about commercial. You could tell within seconds of talking to them. I had a number of deals in a short period where the landlord told me what to propose, the terms were egregious or predatory, and I did what I was told because it’s my legal obligation. The doctor just signed off on these lease renewals or new office deals. I remember looking at what we accomplished for the landlord, how much more the doctors paid, and how little they received. I did some quick napkin math and thought, that doctor just lost $400,000, that doctor just lost $600,000. If I’d been on the other side of the table, I could have gotten them another half million in lower lease rates, higher buildout allowances, free rent, lower annual increases, resetting base years on renewals.

So at the end of 2008, beginning of 2009, I decided to go healthcare only and tenant and buyer rep only. I picked up a couple of healthcare deals on the tenant side and completely flipped the script. Doctors who had been getting destroyed in negotiations, I got brought in and turned the tables by $300,000, $400,000, $500,000 in a short period. After that I said, this is the greatest impact I’ve ever had in real estate. For every landlord listing, there are 10, 15, 20 brokers who’d take it in a second. On the doctor side, for some reason, no one was representing them. So I started the company at the beginning of 2009, and today we’re licensed and operate in all 50 states. As of this recording, we have over 6,000 clients we’re representing right now.

[04:07] The 30-second pitch to a doctor

Luke: If you had only 30 seconds to make your point to a doctor, what would you say?

Colin Carr: About 90% of doctors lease their office space. The number one transaction where doctors lose money is on lease renewals. It’s the number one transaction in all of commercial real estate, not just medical but retail, office, and industrial. People get a lease, it comes up in five, seven, or ten years, and the average doctor will leave a couple hundred thousand dollars on the table during an average renewal. I know that sounds high, but I’ve done thousands of deals personally. The average dentist or physician in a couple-thousand-foot space will leave a couple hundred thousand dollars on the table.

Here’s my second 30-second commercial. For the maybe 1 out of 10 doctors who buys commercial real estate, that real estate will be worth more than the practice 90% of the time, and not by a little. Most doctors who buy increase their net worth by $1.5 million to $2 million over 20 years. So whether you’re renewing a lease, buying real estate, or getting a lease for a startup, there’s a lot of money on the line that can be won or lost. Treat the transaction with the respect it deserves.

[05:21] A deal turned around

Luke: Share a story where things were going the wrong way and you came in, saved the deal, and added value.

Colin Carr: We meet with a dentist who is one of five doctors on the second floor of a medical building. We’re looking at his lease, the master lease plus his last two or three five-year amendments. We ask if he’s ever had representation. He says no, he’s always done his own leases. I said, I’m looking at the lease and I don’t see any free rent on your last renewal. He said he didn’t get any. I asked about buildout or renovation allowance, because his space was tired, and he admitted they hadn’t done any work in about 20 years. No allowance there either.

I asked why. Why no free rent, no tenant improvement allowance, and why was he paying that lease rate, which was not market? He said there were four other doctors on the floor, they all talk, they share terms, and they all have the same deal, so he figured it was the best he could get. I said, so you’re gauging a fair, market deal by what four other unrepresented doctors received, when you’re also not represented, and really you’re just hoping what the landlord told you is true. I told him I’d just signed a brand-new dentist on the first floor whose buildout hadn’t started yet, so he didn’t know about it. That doctor was $8 or $9 a square foot less than what he was paying. We got them six months to build out, five months free upon opening, and a huge renovation allowance.

I said, if you got even a fraction of that, half the TI allowance, half the rent reduction, that’s $400,000 or $500,000 you’ve lost over the last three or four deals. That landlord knows I know the market better than anyone, and that you’re now educated, so you won’t accept that kind of deal moving forward. We went in and cut his lease rate by about 30%, got him money to renovate and a bunch of free rent, and swung it in his favor by a couple hundred thousand dollars. Then I talked to the other four doctors on that floor too. That scenario of a patient just talking to another patient about a medical issue, take my word for it rather than seeing the doctor, when you hear it like that it’s the dumbest approach. That’s exactly what people are doing on multimillion-dollar contracts.

[08:30] How many doctors go unrepresented

Luke: What percentage of doctors do a deal with no representation?

Colin Carr: Well over 90%. We have thousands of clients and have barely scratched the surface. I know that because I was on the landlord side for a long time. I had a million and a half square feet of listings when I stopped doing landlord work, even in one city, in the Denver suburbs. I knew the market really well. For every one doctor who had a broker, nine did not. We’ve proven this out many times. We’ll do a deal for a doctor, look at their lease, and they didn’t have a broker on the last three or four deals, or if they did, the broker often didn’t know what they were doing. They made a call on a property, the broker said “I don’t have anything here but I can help you on your next one,” and that’s a landlord broker trying to be a tenant broker who just wants to get a deal done. They won’t push even a fraction as hard as they could. Even when doctors have representation, it’s very rarely good representation.

[09:34] Business owners and the DIY instinct

Luke: How old are you? You look super young.

Colin Carr: I’m 45.

Luke: I’m 39, and I’d say you look my age. Congrats, that’s a lot of success in a short time. Let’s unpack some of that, because I feel very similar with marketing. Business owners want to DIY it, and hypothetically that’s great, but it can cost a lot of money and time. When you say you can save people hundreds of thousands of dollars, what are some of the things they don’t know to look for?

Colin Carr: Landlords, especially institutional or savvy ones, know that no legitimate tenant or buyer goes without representation. Take the top 200 or 300 retailers. Not one goes to market without a broker. Chipotle, Starbucks, Chase Bank, pick any retailer, they all have an internal real estate team and an external broker. Same with office. Lockheed Martin, Charles Schwab, any tech company, there’s no scenario where they don’t have both. So when a savvy landlord sees a doctor show up who will do two, three, or four transactions in an entire career with no broker, they instantly assume this person has no clue. It doesn’t matter how many times they ask ChatGPT or Gemini a question. There’s no way to level the playing field showing up without a broker. The landlord knows the doctor has no time, no expertise, hasn’t researched competing properties, and won’t go negotiate with three or four landlords simultaneously the way top companies do.

Then there are the little things they pick up on. Most doctors don’t want confrontation. Landlords deal in it. They know if they make it uncomfortable, run out the clock, say “we can’t do this” or “our lender won’t allow it,” and the doctor bites off on even part of that, they’ve got them.

[12:45] Why DIY costs more than it saves

Colin Carr: DIY looks a lot of ways. I can pull my own teeth. I can grab pliers and push a tooth out. You can build your own deck. The irony of commercial real estate is that there’s already a commission set aside in every transaction for the doctor to have a broker. It’s like dental insurance. You pay a premium every month for a benefit you can use during the year. If you don’t go see the dentist, the insurance company doesn’t refund your premiums. They keep it and thank you for not using your benefit. Same thing in commercial real estate. Take the DIY route and you’ll waste 30, 40, 50 hours, get frustrated, and figure out how much you lost a year later when we do a lease analysis and show you what you should have gotten. You lose time, you lose money, and you cannot undo that result. You get one crack at this every five or ten years. You can’t carry two balls to the tee box and, when you shank the first drive into the woods, pull out another and hit again. You mess up, it costs you a couple hundred thousand.

Luke: There’s a parallel with M&A deals, DSOs and OSOs. If you don’t have someone helping you, imagine all the paperwork and legal terms. You can take that to ChatGPT and it can misguide you or give you wrong information. You think it’s brilliant because it’s flagging all this stuff, then your attorney says none of it is accurate. I think it’s not just doctors, it’s small business owners as a whole who want to DIY to save money. Years ago my wife and I were budgeting, listening to Dave Ramsey, and I bought a cheap car. I ended up spending more fixing it than I would have on a newer car with a warranty. When I finally bought a small Lexus with free service and roadside assistance, I saved money. We tell ourselves we can DIY, and doctors are so competent from years of school that it feels like it should transfer, but that’s not the real world.

Colin Carr: I agree. AI or the internet is great for “how do I jump my car battery.” When it comes to an 80-page lease, none of these tools are expert real estate attorneys, and you’ll ask for things you shouldn’t. Landlords know when comments on a lease didn’t come from a real estate attorney, they came from a guy who does family law in Iowa while you’re in LA. People say “it never hurts to ask.” I can think of a hundred questions that will hurt you quite a bit. You’ll look uninformed, damage the relationship, and put yourself in a vulnerable position. If I’m selling my house for a million and you offer $400,000, that doesn’t build respect. Same with attorneys on leases. Ask for ridiculous things and they’ll say no on everything, or give you two token points instead of the ten or twelve points of movement you could have gotten. When you educate a doctor and say you can do this yourself, but if you make a mistake and leave money on the table, would it still be worth it if it were only $50,000, they say of course. The reality is it’s probably $300,000 on a standard 10-year lease for a 3,000-foot tenant. This isn’t overpaying at the grocery store. It’s a lease you can’t alter once it’s signed, and you get one crack every five, seven, or ten years.

[18:49] Why timing matters and when to reach out

Luke: Even if you don’t save money, there’s the time. How much is your time worth? In the hours you’d spend negotiating one deal, you could see 25, 50, 100 patients. A lot of business owners don’t value their time like they should. So when should a doctor contact you? You have startups, people going multi-location. Break that down.

Colin Carr: If you’re starting up, start talking right away, because that process takes a minimum of 9 to 12 months or longer. Start the conversation even if you’re six months from finishing residency, and we can lay out the ideal timeline. For an acquisition, as soon as you have a property or practice you’re interested in, the lease has to get reviewed very quickly, so starting before you find it makes sense. And 99% of people buying a practice will ask the practice broker, who has a fiduciary duty to the seller, whether the lease is good. They’ll hear “this is a fair lease, Dr. So-and-so wouldn’t have signed it otherwise.” That means nothing. That doctor probably had no clue about representation, signed it eight years ago, and left it. It’s the lease they have, so they’ll tell you it’s good. So startup right away, acquisition right away, scaling right away.

If you want to buy a piece of ground and build your own building, that conversation has to happen two years in advance. It’s not like a master-planned residential community with pre-approved floor plans you can build in six months. Your own building is a solid 18 to 24 month process. If you’re in a current lease and want to build, start that conversation two years out. Wait until your lease is up in six months and you’ve run out of time.

If you don’t want to build and you either want to renew, buy an existing building, or relocate, those three, start the process ideally around 18 months out. Twelve months is the absolute minimum. Here’s why. If your lease is up in three months and you start the conversation with your landlord, they know you can’t relocate the practice. They’ll say this person was asleep at the wheel and punish them for waiting too long. It’s like a football team running out the clock with a lead. Don’t give the other team the ball. If a landlord knows a doctor has three months left, they’ll give them nothing reasonable until forced. Start the process 12 months out with an expert broker who contacts the landlord and says, before I called you, I’ve been working with this doctor, we’ve gone to market, we have all the purchase and relocation options, and we have best-and-final terms from multiple landlords or sellers. We know exactly what a market deal looks like. If you’d like to entertain a renewal, here are the terms it would take to keep this doctor. We’re not asking for an offer as if we don’t know the market. We’re telling you what the terms need to be. That posture speaks differently than “you’ve got three months left, send me an offer.” It’s a strategy. I respect you, I’m not going to be a jerk, I’m not trying to bankrupt you, but you’ll have to bring a fair deal, and if it doesn’t work, I’ll move the practice or buy another building and you can re-lease my space.

[23:51] How to reach CARR

Luke: If a private practice owner watching or listening wants to get ahold of you, what’s the best way?

Colin Carr: The best way is our website, CARR.US. You can click to find an agent in your city or market, send a submission, and we’ll match you with the right person. If you want to get educated, we have a ton of resources and content on commercial real estate, not to teach you how to do it yourself, but to tell you what’s going to happen so you have more confidence in the process, similar to how a provider has articles or videos on what to expect with Invisalign or a hip replacement. We also do a lease analysis and a purchase-versus-lease analysis as part of the process once you talk to an agent. It helps direct you on what to expect and the direction you’re probably going.

Luke: Amazing. Thanks for coming on the podcast, I appreciate it.

Colin Carr: Thanks for having me.

The post Why Most Orthodontists Get Their Commercial Leases Wrong appeared first on HIP Creative.

Episode: Dental/Orthodontic Website Visitors Aren’t Booking? You’re Missing This!

Show: GrowOrtho Podcast

Hosts: Luke Infinger (HIP Creative) and James Kuck (HIP Creative)

Published: [7-20-2026] · Last updated: [7-20-2026]

Summary: The best orthodontic or dental website does two jobs at once: it ranks number one for the practice’s top local search terms, and it converts that traffic into booked consults. Luke Infinger and James Kuck lay out six must-haves for 2026: correct on-page SEO basics (page titles, meta descriptions, location-optimized content), homepage trust and credibility signals, current and professional design, mobile-first build, measurable new-patient output, and calls to action wired into a CRM. Their central point is that ranking and traffic are vanity numbers until you can answer one question: how many new patients did this site bring in this month? They argue a dental site producing two or three new patients a month, or an orthodontic site producing one, is not pulling its weight.

Topics covered: dental and orthodontic website SEO, on-page optimization, credibility and trust signals, website design and photography, mobile optimization, new-patient tracking, calls to action, CRM measurement, AI search.

Entities named: HIP Creative, GrowOrtho, Luke Infinger, James Kuck, AI search, CRM, page titles, meta descriptions, Invisalign, TikTok.

About the author

Luke Infinger is the founder of HIP Creative and co-creator of PracticeBeacon, where he has helped 580+ dental and orthodontic practices nationwide grow, and is the bestselling author of The Scalable Practice, Front Desk Secrets, and The Ultimate Treatment Coordinator, Master Your Mindset. Connect with Luke on [https://www.linkedin.com/in/luke-infinger-b36a001b/].

Most orthodontists and dentists know whether their website ranks. Far fewer can tell you what it earns. That gap is the whole problem with how practice owners evaluate the best orthodontic and dental website: they look at rankings and traffic and stop there.

On this episode of the GrowOrtho Podcast, Luke Infinger and James Kuck break down what a practice website actually has to do in 2026. It has to rank number one for the searches that matter, and it has to convert the people who land on it. A site that ranks but doesn’t convert defeats the point. A site that converts but can’t be measured leaves you guessing about your single most important marketing asset.

They walk through six must-haves. The first four are about getting found and earning trust. The last two are about proving the site works.

A practice website that ranks and converts needs all six of these working together. Missing any one of them creates a leak somewhere between the search result and the booked consult.

On-page SEO is the SEO 101 layer, and it is still where James finds the most broken basics during an audit. He means page titles, meta descriptions, optimized content, and images, all set up correctly and targeted to the practice’s location and services.

The example he gives is blunt. He audits sites where the homepage title tag just says “Home.” That single field is one of the strongest on-page ranking signals for local search, and leaving it generic or location-blind throws away ranking before any of the harder work matters. Getting the fundamentals right is the start of ranking number one, not an afterthought once the design looks good.

Across the analytics James reviews, the doctor page is the second most popular page on practice websites. The reason is straightforward: someone about to get a procedure done wants to know who is doing it and whether they are qualified.

Most practices treat this as a quick bio and move on. The hosts argue trust should start on the homepage instead. The moment a visitor lands, credibility builders and trust factors should already be visible, balanced against the SEO so you rank number one and build confidence at the same time.

This matters more in 2026 because of AI search. AI answer engines read a site’s actual language to understand who the practice is and what it does. The more credibility and trust you build into the words on the page, the better positioned the site is to be understood and surfaced by those systems.

Design is the third must-have, and the test Luke uses is whether the owner has put themselves in the patient’s shoes. Owners look at their site as their business. A prospective patient looks at it cold, deciding in seconds whether this practice feels current and credible.

The most common failure is the doctor page with no photo of the doctor. People process information differently, and a visual visitor needs to see a real, current photo to feel comfortable. The other failure is stale imagery: pixelated photos, or pictures that look fifteen years old. Clear, current, professional photography signals that the practice keeps up, and that signal carries into how trustworthy the whole operation feels.

The fourth must-have is mobile optimization, and Luke’s framing is that owners search from a different device than patients do. Practice owners review their site on a computer because they work on one all day. Most patients run their lives from a phone.

So the question is whether the site actually works on a phone. Is it optimized for mobile, and is there an easy way to call or request a consultation without pinching, scrolling, or hunting for a button? If the desktop site looks great but the mobile experience is clumsy, you are losing the majority of your real audience at the exact moment they are ready to act.

This is the fifth must-have and, in Luke’s view, the most important one. In going on thirteen years of asking practice owners how much money their website makes them each year, or how many new patients it brought in this month, he says he has never gotten a straight answer. The responses are some version of “I’m not sure,” “I’d have to find the report,” or “I think someone on the team tracks that.”

His point is that the website is a core business asset, so you should know its output the same way an orthodontist knows what moves teeth. If you review it and the number is zero, or a dentist is getting two or three new patients a month, or an orthodontist is getting one, that is not good enough. A site doing its job should bring in many more new patients than that. Treating the site scientifically, with a real new-patient number attached, is what separates a measurable asset from a hopeful guess.

The sixth must-have is calls to action that feed a CRM you can measure. A call to action that does not route into a trackable system produces vanity metrics, the same trap James compares to TikTok view counts: impressive on the surface, useless for decisions.

He frames the choice directly. You can report that 5,000 people visited the site this month, or you can report that 37 people filled out a consult request, 21 of them turned into starts, and 5 are still deciding. The second report is far more useful because it ties marketing to outcomes. And that data does more than prove the site works. When patients are calling and requesting appointments but not showing up, or showing up but not starting, the numbers let you find exactly where the breakdown is instead of blaming “the marketing.” Without the data, every problem looks like a marketing problem, when the real issue might be the phone call or the consult itself.

What makes the best orthodontic or dental website? A site that does both jobs at once: ranks number one for the practice’s top local search terms and converts that traffic into booked consults. Ranking without conversion wastes the traffic, and conversion you can’t measure leaves you guessing. Luke Infinger and James Kuck name six must-haves: on-page SEO, trust signals, design, mobile optimization, new-patient tracking, and CRM-connected calls to action.

Why is the doctor page so important on a dental website? Because it is consistently the second most-visited page in practice analytics. Patients about to get a procedure want to confirm who is treating them and whether they are qualified. The hosts recommend building trust starting on the homepage rather than leaving credibility to a buried bio, which also helps AI search understand the practice.

How many new patients should my website bring in each month? More than most practices think. The hosts call out a dental site producing two or three new patients a month, or an orthodontic site producing one, as underperforming. The bigger issue is that most owners can’t answer the question at all, which means the site isn’t being measured as the core asset it is.

What is the difference between traffic and conversions for a practice website? Traffic is how many people reach the site. Conversions are how many take a measurable action: calling, filling out a consult form, or chatting with the practice. James contrasts reporting 5,000 visitors against reporting 37 consult requests, 21 starts, and 5 prospects still deciding. The second tells you whether the site is actually producing patients.

Does website design really affect whether patients book? Yes. Design carries trust. A doctor page with no photo, pixelated images, or photography that looks a decade old quietly undercuts credibility. Clear, current, professional imagery signals that the practice is maintained and competent, which influences whether a cold visitor feels comfortable enough to book.

On-page SEO: The optimization done directly on a web page, including the page title, meta description, content, and images, to help it rank in search.

Page title (title tag): The clickable headline a page shows in search results and browser tabs. A strong one targets the practice’s location and service rather than reading “Home.”

Meta description: The short snippet under the title in search results that summarizes the page and influences whether someone clicks.

CRM: Customer relationship management software that captures and tracks leads, so contact form submissions, calls, and chats become measurable consults and starts.

Call to action (CTA): The prompt that tells a visitor what to do next, such as call the office, request a consultation, or start a chat.

AI search: Answer engines such as ChatGPT, Perplexity, Google AI Overviews, and Gemini that read a site’s content to generate direct answers, increasingly a source of how patients find and evaluate practices.

[00:00] The two jobs of the best website

Luke Infinger: We’re going to talk about the best orthodontic and dental websites. What does it take to have the best website? When we say best, it’s ranking number one for the most terms, and it’s converting the traffic coming to it. If you rank and get the click but can’t convert, it defeats the purpose. So it’s those two things: is it ranking number one for the top searches, and is it actually converting traffic?

James Kuck: Great question. The best orthodontic website is not just the one ranking number one. That’s the goal for SEO, but it’s conversions. Without conversions, you’re not going to have any growth.

Luke Infinger: Are they calling? Are they requesting a consultation? Are they using the contact form? Are they chatting with the AI bot? Is it working?

[00:52] Must-have one: on-page SEO done correctly

James Kuck: The first thing that’s mandatory on a site is optimizations. Even when I audit a site, I find things like page titles that aren’t optimized for location.

Luke Infinger: It just says “Home.”

James Kuck: Yeah, it just says “Home.” The first thing is having the SEO 101 right: page titles, meta description, optimized content, images, that basic stuff correct. That’s the start of it.

[01:30] Must-have two: credibility and trust

James Kuck: Number two, and this is more important than ever, is credibility builders and trust. I look at a ton of analytics across all the accounts, and the second most popular page, do you know what it is? It’s the doctor page.

Luke Infinger: That makes sense.

James Kuck: If you’re going to get any procedure done, you want to know who is going to do it and whether they’re qualified. We quickly forget that and abandon the idea, maybe doing a quick bio. Imagine instead that as soon as someone hits your homepage, there are credibility builders and trust factors built in. We don’t want to take away from the SEO, we want to combine the two so we rank number one and instantly build trust. Especially with AI search now, they’re reading the site with specific language. The more credibility we build, the better.

[02:29] Must-have three: design

Luke Infinger: I’ll piggyback off that. Number three is design. You talked about a doctor page. When I go to a doctor page and there’s no photo of the doctor, that’s a problem. I’m highly visual. Some people are auditory, some are kinesthetic. How does it make them feel? A lot of people don’t put themselves in the patient’s shoes when they review their site. How would that person view it? Is there great photography? Sometimes I see pixelated photos, or a photo that looks like it was taken fifteen years ago. Are you keeping up with the site? Are the images clear?

[03:21] Must-have four: mobile optimization

Luke Infinger: A fourth would be: is it optimized for mobile? We search a lot on our computers because we’re at work and live on a machine. Most people don’t. This is what most people have, and they run their life from it. So does your site work well on a phone? Is it optimized? Is there an easy way to call or request a consultation?

[03:50] Must-have five: tracking new patients

Luke Infinger: Number five. I ask this question, and in twelve years of doing this, going on thirteen, I don’t think it’s ever been answered: how much money does your website produce for you every single year? Sometimes I change it to, how much money did your site make this month, or how many new patients did your site bring you this month? No one can ever tell me. It’s “I’m not sure,” “I’d have to find the report,” “we don’t track that,” or “I think someone handles that.” If that’s a core asset of my business, I want to know. Yes, it ranks, yes people come to it, yes people click. Did I get five new patients this month? Did I get ten? Then it becomes scientific. Just like orthodontists and dentists want to know what works, what moves teeth, what data proves it, where the before and afters are. Is it actually working? Are we tracking it? If you review it and it’s zero, or you’re a dentist getting two or three, or an orthodontist getting one, that’s not good enough. It should be bringing you many more new patients if the site is doing its job.

James Kuck: I’m glad you mentioned that. That’s probably the most important one, along with calls to action.

[05:30] Must-have six: calls to action into a CRM

James Kuck: You want calls to action. That can be number six. But it drives into a CRM system you can measure, because there are a lot of vanity metrics out there, just like TikTok. “I got all these views.” The same thing happens with SEO. They want to know, am I ranking? Yes, that’s a good sign for strong SEO. Did I get a lot of traffic? Okay, but what kind of traffic? Would you rather I say we got 5,000 people to the site this month, or that 37 people filled out a consult, 21 of them turned into starts, and 5 want to think about it? Having that data is so much stronger than just saying I got 5,000 people to your website.

Luke Infinger: Exactly. If all those things are working and people are calling and requesting appointments but maybe not coming in, or coming in but not starting, the data lets you look at what’s happening after that. Let’s listen to the first phone call, let’s record some consults. If you’re not tracking any of that, people’s minds go straight to “the marketing’s not working.” You don’t have the data. It’s like the patient who says their Invisalign isn’t working when they’re not wearing the tray. You really have to have the data to know what is or isn’t working. So those are the six must-haves in 2026 for your site to work well if you’re an orthodontist, dentist, or practice owner.

The post Best Orthodontic and Dental Websites: 6 Must-Haves for 2026 appeared first on HIP Creative.

Episode: The 6 Treatment Coordinator Mindset Shifts That Take Close Rates to 75%

Summary: Luke Infinger argues that treatment coordinator performance is a mindset problem before it is a training problem, and he lays out six shifts that change it. Only 20 to 30% of dental and orthodontic offices staff a dedicated treatment coordinator, which means most practices are asking an admin or the doctor to sell, and conversion suffers. The core reframe is that the patient who booked, showed up, and sat down is already pre-sold, so the consult exists to remove fear and friction rather than to convince. Practices that install these shifts can move from the roughly 52% average close rate to 75% or higher, add up to $1,000 in production per new patient start, and double daily consult capacity by cutting the new patient consult from 60 minutes to 30. Luke also covers pay structure, recommending low hourly with heavy commission upside rather than the high-hourly, low-commission model most practices default to.

Topics covered: treatment coordinator role, case acceptance, close rate, consult length and scheduling capacity, sales mindset, patient objections and no-shows, softening language and tone, film review for sales teams, TC compensation and commission structure.

Entities named: HIP Creative, GrowOrtho, Luke Infinger, George Bernard Shaw, Brian Tracy, Buckle, Amazon, Invisalign, HIPAA.

By Luke Infinger CEO & Co-Founder, HIP Creative | Author |

Luke Infinger has spent more than 12 years helping dental and orthodontic practices grow through marketing, software, and education. He is the founder of HIP Creative, which works with 580+ dental and specialty practices across the country, and the creator of Practice Beacon, a lead-tracking CRM built specifically for dental and orthodontic teams. His work has included taking practices from regional obscurity to nationally recognized growth benchmarks, among them helping an orthodontist become the fastest-growing in the country by 2018. He is also the author of multiple books on practice growth and a sought-after speaker for dental continuing education events.

LinkedIn: https://www.linkedin.com/in/luke-infinger-b36a001b/

Most practices try to fix case acceptance with a new script. The treatment coordinator mindset is what actually moves the number, and it moves before anyone opens their mouth in the consult room. What your treatment coordinator believes about the patient walking through the door determines how they open, how hard they push, and whether they ask for the start at all.

Luke Infinger opens this episode with a line from George Bernard Shaw: those who cannot change their minds cannot change anything. It sounds like a poster on a wall until you watch two coordinators with identical training produce a 45% close rate and a 78% close rate. The scripts were the same. The belief about the patient was not.

Six shifts follow. They cover who should hold the role, what to assume about the person in the chair, how to hold your own certainty when leads go quiet, how to lower a guarded patient’s defenses, how to build consult capacity out of thin air, and how to pay a top performer so they never take a call from a competitor.

A treatment coordinator (TC) is a specialized sales role, and only 20 to 30% of dental and orthodontic offices actually staff one. In orthodontics it is more common. In general dentistry, Luke says a dedicated TC is genuinely rare.

The cost of not having one shows up as broken flow state. When the doctor has to sell, the doctor stops doing the only thing the doctor can do, which is diagnose, treat, and move to the next chair. Pull that same doctor into payroll, time-off approvals, and team conflict, and you get a stressed owner with operational chaos underneath them.

The same principle applies to the coordinator. A strong TC who is skilled at sales, extroverted, and genuinely empathetic should be presenting treatment, closing treatment, and moving to the next patient. Break that rhythm by handing them administrative work and their numbers drop, partly because they are not happy doing it.

Luke’s argument on direction of movement is worth sitting with. Take a salesperson and put them at the front desk or in an admin seat and they will probably be fine. Take an admin and put them in a sales seat and conversion tends to fall apart. The skills do not travel both ways.

For a small or startup practice, Luke still treats the TC as a key hire. His build order is one administrative assistant, one clinical assistant, and one treatment coordinator. As the practice grows, that administrative assistant becomes the office manager.

It means the patient already decided something before they arrived, and the consult is not where the decision gets made.

Luke sees practices operating from the opposite belief. They act like the patient is on the fence, like there is a long warming-up process, like the start is genuinely in doubt until the last minute. Then he asks the obvious question: who takes two hours off work, gets the kids ready, and drives to an orthodontic office for the fun of it?

Most patients who need treatment are insecure about their smile. That insecurity is what motivates them to move fast. They want confidence. They picked your practice out of the options available to them, booked the appointment, and showed up. Very few of them want to repeat that process at two more offices next month.

Luke pulls the analogy from his own retail days at Buckle in the mall. Plenty of people walked past. But the ones who came in were touching product, picking up jeans, holding shirts against themselves. He closed at a high rate because he believed those signals meant intent. If he had assumed those people did not want to buy, he would have performed like someone who assumed that.

When a treatment coordinator treats every patient as ready to move forward, the close rate can move from the roughly 52% average to 75% and above. The belief changes the ask, and the ask changes the number.

Luke’s third shift is a three-question check a treatment coordinator (TC) runs on themselves whenever their confidence slips. He calls it truth, fact, and reality.

The truth. What does this person actually want? Straight teeth. Teeth that let them eat normally. Confidence. To stop hiding their smile in photographs. That desire existed before your practice showed up in their feed.

The fact. They clicked on something. They called your practice. They booked an appointment. Nobody forced them to do any of it. That fact does not evaporate because they went quiet afterward.

The reality. Everyone is guarded, and people are busy. A no-show does not mean a bad patient, and it does not automatically warrant a fee or a booking block. In a dental practice, the patient may be carrying real fear about pain. In an orthodontic practice, they may be scared of what it costs. They may have simply forgotten.

The practical payoff is in follow-up. A practice that varies its outreach across call, voicemail, text, and email eventually reconnects the dots for the patient. They recognize the name, remember the person who was kind on the phone, and remember that they do want braces or Invisalign after all. Luke’s point is that the no-show can become your best patient once the guard comes down.

Any time a coordinator catches themselves believing a lead is dead, running truth, fact, and reality restores the accurate picture.

Luke frames the treatment coordinator (TC) as a disarmament agent. The job in the first minutes of contact is to lower the guard, and guard comes down through words, tone, and body language.

Start with the words. Here is a transactional version of a same-day start offer:

“We offer same day starts, so we can start today if you’re interested.”

Here is the softened version Luke prefers:

“We offer same day starts, so you could begin today without another visit, if that might possibly work for you and your schedule.”

The content is identical. The second one gives the patient room to breathe. Softening words and connecting phrases lower guard where a direct push raises it.

Delivery carries more weight than word choice. Luke cites the widely repeated Mehrabian research, which found that in situations of ambiguous emotional messaging, the literal words accounted for around 7% of what got communicated, with tone and body language carrying the rest. The specific percentages get overapplied, but the practical lesson holds. How the coordinator says it is doing most of the work.

Which leads to Luke’s most concrete recommendation in this section: record your treatment coordinators and watch film with them. Every competitive team, collegiate or professional, reviews tape. Salespeople almost never do. If a coordinator pushes back hard on being recorded, you probably have a real problem, because a good salesperson wants refinement.

There is a HIPAA-compliant way to do this in a healthcare setting. Talk to your attorney about the specifics before you start. Once you have the mechanism, sit the front desk and the treatment coordinators down together, listen to phone calls, and watch consults. Listen for tone. Watch for body language.

By cutting the new patient consult from 60 minutes to 30.

The one-hour new patient consultation is standard in orthodontics. HIP Creative runs a 30-minute consult process instead, tested with a stopwatch alongside practice teams. The math is simple. A practice doing three new patient consults a day can do six.

Two things make the hour work against you. First, patients do not want to be in your office longer than necessary. Second, an hour-long block gives the team permission to slow down and expand into areas where extra time adds nothing. The most common expansion is the doctor over-explaining.

Luke’s rule: details are the enemy of execution. When a patient receives a large volume of information, they typically do not move forward. This is not an argument for withholding or for failing to educate. It is an argument for understanding what information does to a nervous person.

He tells it through his own bilateral hernia procedure. He chose an expert in Ohio with thousands of cases behind him, the kind of surgeon patients fly in from other countries to see. Every communication from that surgeon was designed to put Luke at ease. Your case is easy. It will go quickly. I could do this with my eyes closed. The surgeon never went into detail, because he knows that detail frightens people about a procedure that frightens people.

Easier, faster, better. Brian Tracy calls it the “-er factor.” Amazon is the clearest example. Faster shipping with Prime, equal or better quality, reviews front and center. Luke buys the 4.9-star product over the 4.5-star product for exactly that reason. In a practice, the equivalents are better outcomes, faster appointments, easier processes, and lower down payments.

Low hourly, high commission. Luke’s position is that most practices have it backward.

Across the hundreds of doctors he speaks with each year, the pattern is consistent: a high hourly rate paired with a small commission. He points to a director of sales at an eight-figure practice who confirmed their treatment coordinators (TCs) are commission-based, and that is not a coincidence.

The structure Luke recommends is an hourly rate at or near minimum wage, with substantial upside tied to goals, new patient starts, and revenue added to the practice. A treatment coordinator who is genuinely good at closing will earn more under that structure than under the safe salary, and a coordinator who is not good at closing will self-select out.

The retention logic sits underneath the compensation logic. If you install these six shifts and build a top closer, the last thing you want is for that person to leave. Upside that grows as the practice grows gives them a real financial reason to stay.

HIP Creative has a full incentive framework covering the entire team, not only the TC role.

The numbers Luke attaches to these six shifts:

Those three compound. Twice the consults at a substantially higher close rate, each start worth more, is not an incremental improvement to a practice. It is a different practice.

Change your thoughts, change your practice.

What is a treatment coordinator in an orthodontic practice?

What percentage of practices have a dedicated treatment coordinator?

What is a good case acceptance rate for an orthodontic practice?

Should a treatment coordinator be paid hourly or on commission?

Should you charge a fee for a no-show consult?

How long should a new patient consultation take?

Treatment coordinator (TC): The team member responsible for presenting treatment options, handling financial conversations, and closing the case with the patient.

Case acceptance rate (close rate): The percentage of new patient consults that result in a treatment start.

Same-day start: Beginning treatment during the initial consultation visit rather than scheduling a separate appointment.

Flow state: Working in a focused, uninterrupted rhythm on a single type of task. Luke uses it to describe why doctors and treatment coordinators should not be pulled into administrative work.

Disarmament: Lowering a patient’s natural defensiveness through softening language, tone, and body language before asking for a commitment.

[00:00] Opening: mindset as the limiting factor

Luke Infinger: Today we’re going to talk about mindset. How do you foster the right mindset in your team to get the best performance possible? Specifically with your TC, your treatment coordinator. There are six specific steps I’m going to share with you, and when installed in the practice and in the mindset of your treatment coordinator, you will have the ability to be in the top 1% of practices in the country. So let’s jump into it.

I love this quote by George Bernard Shaw. It says, those who cannot change their minds cannot change anything. What we see in psychology with people is that the one thing you have control over is your mind. Most people have a poor mindset, and that is their limiting factor.

When you think you can and you believe in the possibility, you have a much greater chance of actually accomplishing your goal, mission, vision, whatever it is. I was just listening to Brian Tracy today, and he was talking to a group of people, and none of them were where they wanted to be with their income goals. He told a story about people coming to our country and within five or ten years they could be millionaires, or in some cases documented billionaires. How is it that immigrants can come in and do that, but your average American citizen typically doesn’t? It all goes back to mindset. I get that some of that self-help stuff can be cheesy, but I do think there is truth to belief, to having a resilient mindset, to being optimistic versus negative, poor, or doubtful.

[02:00] Shift one: the TC is a specialized role

So here are the shifts. Number one, the TC is a specialized role. In many practices we see a generalist in the sales role, and specifically with sales, putting a generalist in the role is the worst possible thing you could do. I would argue you could take a salesperson and put them at the front desk, maybe put them in an admin role, and they could do okay. But when you take an admin role and put them in a sales role, it is typically very poor performance, specifically with conversion rate.

[02:50] Shift two: the patient is pre-sold

Number two, the patient is pre-sold. It’s strange. I go into a lot of practices every single year, and they don’t really have the mindset and the belief that the patients coming in just want to start. There’s this whole process to getting them warmed up to the idea, and they’re on pins and needles, and are they going to start or not start? I don’t think many people go to a dental practice or orthodontic practice just for the hell of it. Maybe I’ll take time off work and get the kids ready and take an hour or two out of our day without thinking or wanting treatment to happen, right?

So when people come in, let’s just say in an orthodontic practice, believe that they’re already there to get started. That’s the assumption. If they’re coming into a dental practice, they want to have treatment, whether they need hygiene or something else. I went to the dentist recently and had some cosmetic things done.

People are there, especially with a brick and mortar business. When people are coming in, they want to buy stuff. I used to work at Buckle in the mall. Yeah, there are people who just walk through, but by and large people are looking and touching product, touching the jeans, touching a shirt, wanting to try something on. If I believed that they didn’t really want to buy whatever they were trying on, I probably wouldn’t have been a top closer at Buckle. But I was, because I was very optimistic and believed, hey, they’re coming in, they’re touching product, they’re looking at things. If I ask them or introduce certain things, they want to try it on. If I go get something like the product they liked, they’ll try that on. And I just keep stacking my potential of closing more business.

[04:55] Shifts three through six, introduced

Number three, certainty from truth, fact, and reality. I’ll explain that later. Number four, you are a guard disarmament agent. People are guarded. If you had someone opt in from the website or a Facebook ad and you call them and they pick up, what do they sound like? They probably don’t know who you are. They don’t have your number saved in their phone. Guarded. How do you lower that guard?

Number five, build capacity for more consultations. I hear this all the time. We’re having to book out two weeks, four weeks. How do you actually create more capacity in your schedule? It can be very easy.

And finally, number six, how do you reward the right behavior? The last thing you want is to install these things, have a top closer, a top treatment coordinator, and then have them leave. So how do you keep them? How do you give them upside as they grow? As you grow, they have a large benefit to staying with you in the practice.

[05:51] Specialized role, in detail

Getting into the specifics. A specialized role. Only 20 to 30% of offices have a dedicated treatment coordinator. This is across dental and orthodontic practices. Certainly in orthodontics it’s more commonplace. In a dental practice it’s actually very rare, from what we see, to have a treatment coordinator.

The issue with having an admin or a front desk person or a doctor selling treatment is that you start taking people out of flow state. With the doctor, you want them focused on treatment, on the patient, then getting them out of that room and into the next bay, next chair, to keep doing what only they can do. When they have to sell, it takes them out of flow state. Now they’re having to do multiple things, and then there’s operational chaos if they’re doing more than that. Maybe they’re running payroll, approving time off, dealing with team issues. That’s when a doctor typically is very unhappy, very stressed out.

The same applies to your TC. You want them just closing, presenting treatment, closing treatment, and then moving to the next patient. There’s an optimized way to do this. When that is done, and when that treatment coordinator, who’s very skilled at sales, an extrovert, has empathy, is good with people, is just focused on presenting treatment and closing treatment, that’s when they’re going to be most valuable for the practice.

Now, you break that flow state and make them go do an administrative task, and their results can go down drastically, because ultimately they’re not happy doing those other things.

You may not be able to do this if you’re a small practice or starting out. But I would also argue that in a small practice, a TC is a key hire. You could have an administrative assistant, a clinical assistant, and then a TC. That is kind of the priority. Then maybe as you grow, that administrative assistant becomes office manager.

[08:22] The patient is pre-sold, in detail

Number two, the patient is pre-sold. Most people who need treatment are insecure about their smile. They’re motivated to act fast because of that insecurity. They want confidence. And they chose your practice to come into. Do most people want to get a second or third opinion? Do most people want to take more time off? Probably not. So if you have the right offer and they feel comfortable and they feel like you get them and you make the process easy, they’re going to move forward that day.

When you treat every patient as if they are ready to move forward, your conversion rate can go from the average 52% to 75% or even higher.

[09:34] Truth, fact, and reality

Number three, build certainty from three questions. The truth. What is the truth? This person wants straight teeth. Or this person wants teeth so they can eat food. Or this person wants confidence. This person wants to stop hiding their smile in photos. That’s the truth.

The fact is they clicked on something, they called your practice, they booked an appointment. It doesn’t matter whether you can get a hold of them, whether they no-showed. That is the fact. They did that. No one forced them to do that.

And the reality is everyone’s guarded. So when you call, you text, and you don’t get a hold of them, it doesn’t mean they’re a bad lead. When they no-show, it doesn’t mean you should charge them necessarily, or that you should block them from booking another consult. The reality is people are busy. They may have forgotten, or they may have gotten scared. There’s fear. If you’re a dental practice, there can be a lot of pain associated with going to the dentist. If you’re an orthodontic practice, maybe they’re concerned about their finances. That is the reality. We’re all guarded.

So how do you have empathy for that person? Put yourself in their shoes and understand there’s just a process to lowering the guard. Once you do, maybe that no-show comes in and becomes your best patient. Maybe that person who wasn’t responding to your phone calls, when you have a process to try different messaging and methods, meaning call, voicemail, send a text, send an email, and you connect communication, they go, oh yeah, that is that person. They sounded really nice on the phone. I really do want to get braces or Invisalign. Maybe I should call them back.

So anytime you catch yourself having the wrong mindset around getting people into the practice or converting cases, go through the truth, fact, and reality with yourself.

[11:07] Shift four: you are the disarmament agent

Mindset shift number four. You are the disarmament agent. So how do you disarm? You can disarm with words. You can disarm with body language. There’s this whole thing to communication.

So this is pretty pushy: we offer same day starts, so we can start today if you’re interested. Some people may not respond to that well. So how do you soften it? Something like this: we offer same day starts, so you could begin today without another visit, if that might possibly work for you in your schedule. It’s a little softer, a little less transactional. So softening words and connecting phrases can help lower guard.

Now, it’s all about how you deliver it. Tone is a huge thing. I think it’s estimated that only 8% of communication is verbal. So tone and body language are the things that really put your words to work.

I like to record treatment coordinators and have them watch film, just like an NFL team or basketball team. Really, any team that competes competitively, whether collegiate or pro, is going to watch film. Oftentimes salespeople don’t. And if there’s strong pushback from salespeople about watching film, you most likely have a big problem, because any good salesperson is going to want refinement.

There is a HIPAA-compliant way to do this. You have to do it right. If you’re doing it in a healthcare practice, you can look into that, you can talk to your attorney. But I would strongly suggest doing this, so you can have the sales team, front desk, and treatment coordinators watch film together, listen to phone calls together, and listen for tone and watch for body language. It will be huge with your team in the practice.

[13:42] Shift five: creating capacity

All right, mindset shift number five. How do you create more capacity? We find, and I’ll use an orthodontic practice here, it’s very commonplace for a new patient consultation to last about an hour. We have a 30-minute consult process. If you click below this video and drop us a line, we will send it to you. But there is a specific format to follow, and we have even worked with practices who get a stopwatch out and test this with our team to optimize the schedule.

The reality is people don’t want to spend more time in your practice than they have to. Also, when you have an hour-long consult, it allows the team to move a little slower and to spend more time in areas where it’s actually unnecessary, meaning we find the doctor gives way too much explanation. Details are the enemy of execution. So when you give a lot of information to a patient, they typically don’t move forward.

I’m not saying to omit things or not educate the patient. It’s interesting. I had a bilateral hernia procedure last July and I chose an expert. He’s done thousands and thousands of cases. Older guy. People fly from other countries to this guy. He’s up in Ohio. All of the communication with him was him just putting me at ease. Your case is going to be so easy. It’s going to go by quickly. I could do this with my eyes closed. He never really got into the details, because I think he knows when he does that with patients, they get scared. This can be kind of a terrifying procedure. So everything was easier, faster, better. That’s it.

Actually, Brian Tracy calls that the “-er” factor. Kind of like Amazon. What do they do? Faster with Amazon Prime. Better or equal quality. You can see that with them highlighting reviews. That’s how I buy things. If I’m looking at the same product, this one has 4.9 stars, the other one has 4.5. Better, faster, easier, cheaper, lower down payments. That’s just an add-on and something tangential here to mindset shift number five.

[16:19] Shift six: rewarding top performers

And lastly, mindset shift six. How do you reward top people in the practice? How do you reward top team members in the practice? This is a direct quote from an eight-figure practice. This was a director of sales, and she was saying that their TCs are commission based.

When I talk to practices, and I talk to hundreds of doctors every year, a lot of times they’re paying far too high hourly and low commission. It should be switched. It should be kind of minimum wage or close to it, but with tremendous upside on your goals, on new patient starts, on revenue added to the practice. We have a process for this. You can drop us a line and we’ll send you all kinds of ways and ideas and concepts on how to incentivize your entire team, not just the TC role. Very, very important with salespeople.

[17:31] The numbers

So here are the numbers. What changes when the mindset changes? Your close rates could be 75% or higher. You can add at least up to $1,000 in production for every new patient start. And you can double your capacity. This is huge. You could go from three new patient consults a day to six.

So change your thoughts, change your practice. The takeaway is when you change your thoughts, you can change your practice. Thanks so much for watching.

The post The 6 Treatment Coordinator Mindset Shifts That Take Close Rates to 75% appeared first on HIP Creative.

Episode: Marketing for Orthodontists and Dentists in 2026

Show: GrowOrtho

Host: Luke Infinger, Founder and CEO, HIP Creative

Published: [07-2-26] | Last updated: [07-2-26]

Summary: Effective marketing for orthodontists follows an order: build a strong local brand first, make the practice findable second, and only then amplify with paid ads. Skip the sequence and you waste an estimated 30 to 40 percent of your ad budget on leads you can’t reach or convert. The fastest wins are usually already sitting in the practice: a Google Business Profile with 100-plus images gets 500 percent more calls, calling a lead within five minutes and following up six times raises contact rates sharply, and getting digital leads into the chair within 72 hours keeps no-show rates from doubling. Paid ads work, and they can perform 10 to 20 times better once the brand and findability are in place, but they are the last layer, not the first.

Topics covered: marketing order and sequence, how patients find a practice, SEO and the map pack, short-form vs. long-form video, the five by six follow-up method, the ads-before-foundation trap, landing pages and ad creative, Google Business Profile optimization, reviews, the 72-hour rule, lead economics, and a local Dream 100 referral strategy.

Key entities: Luke Infinger, HIP Creative, GrowOrtho, Google, Google Ads, Meta (Facebook and Instagram), YouTube, TikTok, ChatGPT, Perplexity, Yelp, Opus Clip, Invisalign, clear aligners, Google Business Profile, American Association of Orthodontists (AAO), Chet Holmes, Microsoft, Time magazine.

By Luke Infinger CEO & Co-Founder, HIP Creative | Author |

Luke Infinger has spent more than 12 years helping dental and orthodontic practices grow through marketing, software, and education. He is the founder of HIP Creative, which works with 580+ dental and specialty practices across the country, and the creator of Practice Beacon, a lead-tracking CRM built specifically for dental and orthodontic teams. His work has included taking practices from regional obscurity to nationally recognized growth benchmarks, among them helping an orthodontist become the fastest-growing in the country by 2018. He is also the author of multiple books on practice growth and a sought-after speaker for dental continuing education events.

LinkedIn: https://www.linkedin.com/in/luke-infinger-b36a001b/

A practice owner wants more patients this week, so the conversation jumps straight to paid ads: run Meta, run Google, turn on the faucet. Ads can absolutely move volume, but they are almost never the first thing a practice needs to get right.

Marketing works in an order, the same way orthodontic treatment does. You don’t start a case with rubber bands. There’s an evaluation, then phase one, then phase two, then the finishing details, each in sequence for the best result. Marketing has its own sequence: brand first, findability second, amplification last. Layer paid ads on top of a strong local brand and they can perform 10 to 20 times better in lead volume, lead quality, and show rate. Layer them on top of nothing and you burn money.

This post walks the whole sequence Luke Infinger lays out in the episode, with the numbers behind each stage, so you can find the leaks in your own practice before you spend another dollar on ads.

The costliest mistake in practice marketing is running paid ads before the foundation exists. When nobody in the community recognizes your name, ads have nothing to reinforce. You’re a cold offer from an unknown practice, and the leads reflect it: hard to reach, slow to respond, and prone to no-showing. An estimated 30 to 40 percent of ad budget gets wasted on poor conversions when practices jump ahead like this.

The sequence Luke Infinger uses at HIP Creative is brand, then findability, then amplification. Brand is your reputation and positioning in the community. Findability is everything that makes you show up when people search. Amplification is paid advertising to the masses. Ads belong last because they multiply whatever foundation is underneath them. Most practices haven’t optimized their organic presence, so paying to accelerate a weak foundation just spends money faster.

If your ads are striking out right now, that’s the signal. You’ve skipped ahead, and the fix is to back up and build brand equity through community outreach and a boots-on-the-ground strategy before you scale spend.

Roughly 90 percent of patients search online for a dentist or orthodontist, and 72 percent of those searches still begin on Google. That share will shift as more people use large language models like ChatGPT and Perplexity, but Google is still where the majority start. Of the people who search, about 70 percent click one of the top three results, which on mobile and often desktop is the map pack: the map, the website link, and the click-to-call button clustered at the top. People rarely scroll past it. If your practice isn’t ranking in one of those first three positions, you miss most of the available traffic, which is why local SEO matters so much.

Patients also take their time. On average, a patient researches for about two weeks before engaging, and interacts with your brand five to seven times before taking action. A mom weighing Invisalign for retreatment isn’t calling on the first visit. She’s reading, comparing, and checking you against competitors. And 76 percent of people judge a provider’s credibility on how the website looks, feels, and functions. You can tell the best story in your market, but with no team photos, no video, and no clear new-patient process on the page, you lose patients who never call.

Short-form video dominates how people consume content, especially for procedures like implants, braces, and aligners. But the move that pays off most is to record long-form video, publish it on YouTube (which is itself a search engine), and optimize the thumbnail, title, description, and tags so it ranks. From there, a tool like Opus Clip can cut that long-form video into short clips for YouTube Shorts, Instagram, Facebook, and TikTok. You get the SEO benefit of the long-form asset and the reach of the clips from one recording.

The trap Luke Infinger sees constantly is practices pouring their time into trending TikTok videos. Those videos can go viral, but when you check who’s actually watching, it’s rarely people in your radius. Thousands of views from outside your community will never become patients. Reverse the priority: make the videos your local audience is actively searching for, moms researching treatment, young adults researching retreatment, smile aesthetics and whitening. Rank those on YouTube, embed them on your website, and use an LLM to generate an FAQ section under the embedded video, which helps the page rank. Then, if you still have time, add the fun trending videos for personality. They show who you are; they just don’t fill the schedule.

Follow-up used to be a single phone call. Now it takes a system. The five by six method means you call a new prospective patient within five minutes and have a process to follow up at least six times.

The five-minute window is not arbitrary. Your likelihood of contacting a patient drops by 400 percent if you don’t call within the first five minutes. And following up at least six times produces a 70 percent increase in the likelihood of both contacting and qualifying that lead. This is where automation earns its keep: a notification to the front desk to call immediately, another prompt to call within two hours, another the next business day, with text messages going out after each attempt. And leave a voicemail every time. Every voicemail, text, and email is a breadcrumb, and when a lead sees all of them together, it clicks: “Oh, that’s the practice I looked at the other day.”

That layered cadence matters because attention is scarce. A Microsoft study published in Time magazine found human attention spans have dropped below that of a goldfish, roughly six to seven seconds. People are inundated with spam texts, emails, and social feeds, so a single missed call disappears instantly. Multiple coordinated touches create the priority and urgency that get someone to act.

Beyond the wasted budget, the mechanics of most paid campaigns are broken. About 77 percent of paid ads point to the homepage of a website, which is generic by design and matches no specific offer. If you’re running a campaign for $500 off braces or clear aligners for the month of July, the click needs to land on a dedicated landing page where the headline, the offer, the colors, and the graphics all match the ad. A homepage can’t do that.

The creative itself is usually the opposite of what works. Practices commission highly produced videos and polished Canva graphics, and that polish often reads as an ad and gets ignored. Content that looks organic and natural, selfie-style, casual, the way a real creator posts, tends to resonate more because it doesn’t feel like advertising.

Underneath all of it is what Luke Infinger calls the congruence effect: closing the gap between your clinical reality and your brand. Every doctor believes they’re the best in their market, and many are excellent clinically. But when their brand looks nothing like best-in-class, the two are out of alignment. Think of the hole-in-the-wall restaurant only locals know versus the beautiful, magazine-featured spot with the Michelin chef. The restaurant that lasts is the one where the best food and the best presentation collide. If you believe you offer the best care, you have an obligation to build the brand and system that lets you treat the most people, because if you don’t, a less-skilled competitor with better marketing will.

Your Google Business Profile is one of the fastest levers in the whole system, and most practices barely use it. Profiles with 100 or more images get 500 percent more phone calls. When HIP Creative runs a practice profit diagnostic, the average profile has about 15 images. Loading it up with real photos is one of the clearest paths to showing in the map pack and earning more calls.

Reviews are the other half. 87 percent of prospective patients read reviews before choosing a provider, and Google rewards recency, not just totals. A practice with 500 reviews that stopped collecting them loses to a practice with 120 that’s actively earning and responding to new ones. And a perfect 5.0 is not the goal. A 4.9 rating outperforms a flawless score because it reads as real and human. Every practice eventually gets a difficult patient and a bad review; that imperfection actually helps. Reaching the three-pack pays off directly: you get 93 percent more calls once you’re in that top-three map cluster.

Once amplification is working and digital leads are coming in from your website, Meta ads, or Google Ads, speed to appointment becomes the constraint. The 72-hour rule is simple: if you don’t get a new digital lead into the practice within 72 hours, three days, the no-show rate doubles or triples.

The practical implication is scheduling. You have to hold open a few appointment slots specifically so digital leads can be seen quickly. A lead who has to wait a week and a half has time to cool off, book elsewhere, or forget entirely. Protecting near-term availability for fresh leads is what converts the money you spent generating them.

Once brand, findability, and follow-up are in place, ads make sense as the amplification layer. The economics are worth understanding before you turn them on. A lead generated organically through SEO, your website, and your YouTube videos costs roughly $30 once you divide the cost of building those assets across the patients they bring in. A paid lead can cost about six times more, around $180. Same patient, six times the price.

That sounds bad until you run the return. Luke Infinger’s point is that he would happily pay $180 per lead if he could keep scaling, because $180 in can return roughly $6,000 in gross revenue. That’s gross, not profit, but the math still supports paying up for volume once the foundation makes those leads convert. The mistake is paying the premium before organic is optimized, so you’re overpaying for leads a weak brand can’t close.

The advanced play comes from Chet Holmes: write down the most connected people and places in your own town, then pursue them with discipline. This is a local version of the Dream 100. Your targets might be local podcasts, neighborhood Facebook groups, popular community accounts, or people with local YouTube channels. They might be other businesses serving the same families, and for the aesthetic adult patient, med spas offering Botox, injectables, facials, or peels are a natural fit. An Invisalign special promoted to a med spa’s audience is a warm match.

The underlying goal is to increase your sphere of influence and your trust in the local community, then convert that trust into referrals. Finish with the self-audit Luke Infinger leaves practice owners with: if your best patient referred you to a friend, and that friend googled you, what would they find? Would a competitor rank above you? Would your site impress them, or would the photos look old and the video be missing while the practice across the street has the state-of-the-art site? Go online and search like a patient who doesn’t know you. Compare yourself against whoever ranks in your market, click through, read the copy, watch the videos, and ask honestly whether you’d choose you. Most doctors who run that exercise spot exactly what to fix within minutes.

At what age should a child first see an orthodontist? The American Association of Orthodontists (AAO) recommends a first orthodontic evaluation by age 7. Depending on airway considerations some evaluations happen sooner, followed by observation, phase one, and phase two treatment as needed. Luke Infinger uses this to make a point about marketing: like treatment, marketing has a correct order and sequence.

How fast should a practice call a new patient lead? Within five minutes. Waiting longer cuts your likelihood of contacting that lead by 400 percent. Pair the fast first call with at least six follow-up attempts across calls, texts, voicemails, and emails, which raises your odds of connecting and qualifying by 70 percent.

How many images should be on a Google Business Profile? Aim for 100 or more. Profiles with 100-plus images earn 500 percent more phone calls, yet the average practice profile has only about 15. Adding real photos of the office and team is one of the fastest ways to rank in the map pack.

Is a perfect 5.0 star rating better than 4.9? No. A 4.9 rating with fresh, recent reviews outperforms a perfect 5.0 because it reads as real and human rather than staged. Google also rewards practices that keep earning and responding to reviews over ones that stopped collecting them.

How much does a paid patient lead cost compared to an organic one? An organic lead runs about $30 once asset costs are spread across the patients they produce. A paid lead can cost roughly $180, about six times more. The paid premium is worth it once the foundation is in place, since $180 in can return around $6,000 in gross revenue.

Map pack: The cluster of the top three local business results Google shows with a map, website link, and click-to-call button. It captures roughly 70 percent of local search clicks.

Five by six method: Call a new lead within five minutes and follow up at least six times across calls, texts, voicemails, and emails.

72-hour rule: Get a new digital lead into the practice within three days or the no-show rate doubles or triples.

Congruence effect: Closing the gap between a practice’s clinical quality and how good its brand looks, so both signal best-in-class.

Dream 100: Chet Holmes’ strategy of identifying the most connected people and places in your market and pursuing relationships with them deliberately.

Google Business Profile: The free Google listing that controls how a practice appears in local search and Maps, including photos, reviews, hours, and calls.

Order and sequence [00:00]

We’re going to talk about marketing for orthodontists and dentists in 2026, and the first thing I want to talk about is order and sequence. I’ve talked to thousands of doctors at this point and thousands more business owners, and the way culture is programmed is that we want everything now. I fall into it too: how do I get better prospective patients today? A lot of those conversations end up turning into paid advertising, so people jump straight to ads. How can we run Meta ads, Facebook and Instagram, and Google Ads? That’s great, but there’s an order and sequence to it, and ads are typically not the first thing you need to get right for your marketing to work.

It’s like the question of when a child should first see an orthodontist. Age 7. Depending on what you believe about airways it may be sooner, but the AAO states age 7. Then there’s an observation, maybe phase one treatment, phase two treatment, and something like rubber bands, which get introduced later in treatment. To have success with patients, you need the treatment in the right order and sequence for the best results. The same is true for marketing.

What I find is that for practices with the best brand in their community, once you start to layer in digital like Meta ads and Google Ads, it can work 10 or 20 times better in attracting volume, better quality leads, and getting people to show up. We’re going to break that down and probably break a lot of the myths you currently believe. So let’s talk about how patients find you. This is no surprise: 90 percent of patients search for a dentist or orthodontist online.

How patients find you [02:37]

72 percent of those searches still begin on Google. That will change as more people use LLMs like ChatGPT, or something like Yelp or Perplexity, but the majority still use Google. 70 percent of the clicks happen on the top three results, and on a phone, sometimes even desktop, we call that the map pack: the map, the website, the phone call. People don’t look past it. If you’re not positioned in one of the first three positions, you’ll miss most of the traffic. So SEO is very important, and it’s becoming more complex with AI as people generate more content. The caveat is that search engines don’t love content that’s purely AI-generated because it doesn’t sound human. There are frameworks: I could take this video I’m recording, give it to AI with my voice, my real results, my case studies, and my stories, and syndicate that across multiple mediums. That’s how you want to create content. Creating content straight from an LLM is typically not the way to go if you actually want to rank.

Before people ever call you, they’re vetting you online. On average, a patient researches for two weeks before engaging. Yes, there are impulse buyers, and yes, on Meta you can get in front of someone right then, and yes, some people search Google and click to call right away when their dentist says it’s time for Johnny to see an orthodontist. But if a mom is researching, or if I want to be retreated and I’m looking at Invisalign or clear aligners this time, I’m spending about two weeks researching. Who’s answering my questions? Then, once I want to see the orthodontist, how am I finding them and interacting with their brand? On average, a patient interacts with your brand between five and seven times before taking action.

And 76 percent of people judge credibility on how the website looks, feels, and functions. You could tell the best story, but without images, great photos of you and your team, or videos of you explaining the new patient process, you’re losing patients. Take this information and plug all the leaks in your bucket, because most people are already sitting on hidden gaps and revenue opportunities. If you fix what you already have, you could be as busy as you want, or at least understand your true baseline before you start adding things.

Video that actually works [06:27]

People are taking in video in the masses with short form. We still watch long-form like Joe Rogan, but for implants or orthodontics, brackets and aligners, a lot of those videos are short form. What you can do is record long-form videos for YouTube, optimize the thumbnail, headline, description, and tags, then take a tool like Opus and create short-form clips to post as YouTube Shorts and on Instagram, Facebook, and TikTok. YouTube is a search engine, so you gain the SEO benefit and the clips.

What I see a lot of dental, ortho, and medical offices doing is spending their time on TikTok trending videos. That’s not inherently bad, but the reality is most people watching those aren’t in your community. If a TikTok goes viral, you’re getting thousands of viewers who will never become patients. When I ask offices what videos they’re making, they only point to trending videos. I’d reverse that. Create videos people are actually searching for in your community: moms doing research, young adults researching retreatment, smile aesthetics, whitening. Get in front of those people with YouTube, then use those videos for short-form clips. If you still have time, add fun trending TikToks for personality, but they largely aren’t bringing you patients in your community. Those long-form YouTube videos can also live embedded on your website, and you can use an LLM to add FAQs below the video, which is good for ranking.

The five by six method [08:43]

Years ago, follow-up looked completely different. For a dental or orthodontic practice it wasn’t even an email, it was maybe a phone call. There’s something called the five by six method: you need to call a prospective patient within five minutes, and you need a process to follow up at least six times. On average, there’s a 400 percent decrease in your likelihood to contact a patient if you don’t call within five minutes. And there’s a 70 percent increase in likelihood of contacting and qualifying if you follow up at least six times.

That’s where automation comes in. Maybe there’s a notification to your front desk to call right away, another to call within two hours, another within 24 hours, the next business day, with text messages going out after each call. And you should leave a voicemail, absolutely, because all these things are breadcrumbs connecting the dots. If you hold up your phone today, how many missed calls do you have? I already have six or seven. How many left a voicemail, sent a text, sent an email? If someone does all those things, I go, oh, that’s that thing I clicked on the other day. I ordered a Tempur-Pedic mattress and forgot about it, and there was this cadence: calls, voicemails, emails, a text. Oh yeah, I’ve got to schedule that, and then I got it done.

We’re inundated in today’s culture with spam texts, from lenders and politicians, plus emails, Facebook, Instagram, TikTok. You have to do something to stand out in a very noisy world. There was a study, I believe by Microsoft, published in Time magazine, that proved humans have a shorter attention span than goldfish, something like six or seven seconds. We forget what we were just doing. Even as you listen to me now, you may be texting or checking your schedule. Focus is at an all-time low. We bring priority back up by placing urgency around it. That’s how you get people to take action.

The trap: ads before the foundation [12:00]

Now let’s talk about the trap, which is ads before the foundation, what I mentioned at the start. The costliest mistake in this space is running paid ads before the foundation exists. An estimated 30 to 40 percent of ad budget is wasted on poor conversions when you jump ahead and build on a bad foundation. Nobody knows who you are, so we’ve got to create brand equity, the positioning in your community, first.

77 percent of paid ads point to a homepage of a website. A Google Ad clicking to a homepage isn’t specific. Is the call to action right? Is the headline optimized? There needs to be a dedicated landing page. If I’m running a campaign for $500 off braces or clear aligners, only for July, a July 4th special, the page needs to match: the headline, the colors, the graphics, is there a video? And with paid ads, people think highly produced videos or beautiful Canva graphics are the answer, but a lot of that doesn’t resonate because it looks too polished. Content creators walk around selfie-style or take a photo of something. How can we look organic and natural in our ads? There’s a whole formula you’ve probably been misguided on.

So there’s a better way. If you’re striking out with paid ads, saying these are bad leads, we can’t reach them, they won’t respond, we can’t get them to show up, then you’ve jumped ahead and you don’t have the right foundation or brand equity in your community. You need to plan community outreach and a boots-on-the-ground strategy. I have a whole course on community outreach, and we can drop the link. That’s what you focus on first. Back to the order: brand, then we layer in findability with SEO so you can get in front of searches, and then amplification, getting out to the masses with paid ads. I call this the congruence effect.

The congruence effect [14:48]

The congruence effect is closing the gap between your clinical reality, how good you are, and your brand. I’ve never talked to a doctor who thinks they’re second or third best; they’re number one. You’re excellent at your craft, you’ve gone to school forever, done specialty residencies. But when I look at people’s brands, they don’t resemble best in class. We have to close that gap so everything is congruent. You’ve probably been to a hole-in-the-wall spot only locals know about, and it doesn’t look that good, and then a beautiful new restaurant with a Michelin chef featured in the magazine, which may not be as good as the hole in the wall. When those two things collide, the best food and the best presentation, that’s the restaurant that lasts. That’s what you want to be as a dentist or orthodontist: the best care and the best marketing. If you believe you can offer the best treatment, you have a moral obligation to build the strategy and system to treat the most people, because if you don’t, who will?

Findability [15:50]

So let’s talk about findability. In terms of Google Business Profiles, you get 500 percent more phone calls with 100 images or more on your profile. On average, when we do a practice profit diagnostic, there are about 15 images. So how do you get a lot more images on there, so Google rewards you by showing you in the map pack and getting more calls?

87 percent of prospective patients read reviews before choosing a provider. Google rewards people who keep getting reviews. If you have 500 but stopped, Google rewards the person with 120 who’s actively getting them today and responding to them. And a 4.9-star rating beats a perfect five, because it doesn’t look perfect, it looks real and authentic. Every business has had a difficult patient, so you’re going to get dinged, it’s going to happen, but that 4.9 actually performs better because it’s human. You get 93 percent more calls once you reach the three pack, that map pack. If you’re not in the top three, you’re missing out on tons of prospective patients.

The 72-hour rule [17:39]

I talked about the five by six method; now the 72-hour rule. Once amplification starts and you’re getting more prospective patients from your website, Meta ads, or Google Ads, if you don’t get them into the practice within 72 hours, three days, your no-show rate is going to double or triple. So you have to create some slots within the schedule to get those digital leads in quickly.

When ads make sense [18:32]

Now ads make sense. We’ve gone through brand, findability, amplification, and now you add advertising. A lead organically coming from SEO, your website, and those YouTube videos could be about $30 if you break down what it cost to create those assets and divide it across the patients you get. A paid lead could be six times higher, so the same patient at six times the cost. Would I pay $180 if I could keep scaling and getting more patients? Yes. Because I could put $180 in and get about six grand out. That’s gross revenue, not profit, but it still makes a lot of sense.

The advanced play: a local Dream 100 [19:28]

Where I’m going is that people haven’t optimized organic and they’re jumping ahead to paid. Now the advanced play, from Chet Holmes: write down the most connected people and places in your own town, then go after them with discipline. Maybe it’s a local podcast, neighborhood groups, people with YouTube channels, or the popular accounts and community groups on Facebook. Maybe it’s other local businesses serving the same families. For the aesthetic adult, maybe it’s the med spas, the people offering Botox, injectables, skin peels, facials, or massages. Can I get in front of that audience? Would they be interested in a special around Invisalign? Probably. So how do you get the most referrals from your sphere of influence, and how do you increase that sphere and your trust in your local community?

Here’s what I’ll leave you with. If your best patient referred a good friend, and that friend went to the internet and googled you, how would they interact with your brand? Would the competitor come up first? Would they get to your website and not be impressed, old photos, no video, while the practice across the street has the most state-of-the-art website, photos, and video? Go online and search like a patient who doesn’t know you. Research yourself against whoever else is ranking. Click through and experience the site, read the copy, look at the photos, watch the videos, and ask: would you choose you? Most doctors who do this exercise say, you know what, I really need to improve on X, Y, and Z. It becomes obvious. Do that exercise and it will pay dividends. Thanks so much for watching.

Ready to find the leaks in your own practice marketing? HIP Creative runs a practice profit diagnostic that maps your brand, findability, and follow-up against best-in-class and shows you exactly what to fix first.

The post After Growing 580+ Orthodontic & Dental Practices, Here’s What Works in 2026! appeared first on HIP Creative.

For a decade, SEO had one simple goal: rank higher than everyone else.

That rule just died.

Patients are not typing “orthodontist near me” and clicking through five websites anymore. They are asking ChatGPT. They are reading Google AI Overviews. They are using conversational tools that skip the ten blue links entirely.

Here’s what most practices have not realized yet.

AI search engines do not rank practices. They select them.

If you are not selected, you are invisible. Your beautiful website does not matter. Your years of “doing SEO” do not matter.

This shift changes everything.

Get your Free SEO Audit: https://hip.agency/contact/

Grab your copy of Orthodontic Practice SEO: Amazon: https://www.amazon.com/dp/B0GGBWLBLR Apple: https://books.apple.com/us/book/orthodontic-practice-seo/id6757766846

Traditional search worked like a phone book.

You searched. You clicked. You compared. You decided.

AI search collapses that entire process into one conversation.

Instead of forcing patients to research five options, AI tools recommend providers directly. Often just one or two practices. That’s it.

This is not a ranking system. It’s a trust system.

Google’s AI Overviews answer questions directly at the top of results. ChatGPT does not pretend to be a search engine. It acts like a knowledgeable assistant guiding decisions in real time.

When a parent asks, “Who’s the best orthodontist for Invisalign for my teen near me?” the AI does not say:

“Here are ten websites. Good luck.”

It says:

“Based on your needs, I recommend these providers.”

If you are not in that answer, you do not get a second chance.

Classic SEO rewarded keywords, backlinks, page optimization, and technical performance.

All of that still matters, but it’s no longer enough.

AI engines work differently. They summarize instead of list. They cite instead of rank. They select sources instead of pages.

Instead of ordering websites by relevance, AI evaluates who appears trustworthy, who demonstrates real expertise, and who can be safely recommended without risk.

This explains why some practices with fewer backlinks or lower traditional rankings suddenly appear in AI answers while others with “strong SEO” vanish completely.

AI is not asking, “Who optimized best?”

It’s asking, “Who do I trust enough to recommend?”

Every AI search engine relies on the same decision framework. ChatGPT, Google AI Overviews, Gemini, Perplexity. All of them.

They look for three core signals.

1. Topical Authority

Do you own the topic, or are you just scratching the surface?

One Invisalign page optimized for keywords no longer signals expertise. AI looks for topic ownership. A full ecosystem of content proving you understand the subject from every angle.

Cost and financing. Treatment timelines. Comparisons versus alternatives. Maintenance and care. Suitability for teens versus adults. Risks, outcomes, and expectations.

If your site answers only one of these, AI assumes you are not the expert.

2. Verifiable Credibility

AI does not trust claims. It trusts proof.

It actively scans for board certification, recognized provider tiers, awards and “best of” recognition, years in practice, case volume, and external validation.

These signals matter more now because AI must justify its recommendations. It cannot guess.

3. External Trust Signals

AI does not rely solely on your website. It cross-checks reviews across multiple platforms. Not just Google. Authoritative directories. Press mentions. Industry listings. Community validation.

The more independent sources confirm your legitimacy, the more comfortable AI becomes recommending you.

For years, SEO rewarded focus.

Pick a keyword. Optimize a page. Build links. Win.

AI rewards depth.

When someone asks about Invisalign, AI does not want a sales page. It wants confidence that you are the authority.

That’s why topical clusters matter now. One core Invisalign page. Supporting pages on cost, care, timelines, and alternatives. FAQs written in clear, extractable language. Structured formatting AI can easily parse.

This is not about writing more content for the sake of content.

It’s about removing doubt.

AI selects practices that leave no unanswered questions.

Here’s where most practices fall short.

They have credibility. They just do not surface it clearly enough for AI to verify.

AI strongly favors practices that explicitly showcase board certification with outbound verification links, awards tied to authoritative publications, review volume across multiple platforms, mentions from high-authority websites, and transparent doctor bios with credentials and education.

This is why press placements and authoritative citations now punch far above their weight.

A single mention on a trusted outlet can matter more than dozens of generic backlinks. AI recognizes the source.

Traditional SEO is competitive. AI visibility is compounding.

Once AI begins recommending a practice, it appears repeatedly in similar conversations. Each mention reinforces authority. The practice becomes a default choice.

This mirrors early Google SEO, but with fewer spots and higher stakes.

In classic search, being number five still meant traffic.

In AI search, being number five often means nothing.

Only the selected practices win.

This is not theory. It’s execution.

Here’s what actually moves the needle.

Shift from pages to topic ecosystems. Own entire treatment categories, not just keywords.

Surface credibility aggressively and clearly. Credentials, awards, and experience should be impossible to miss.

Expand reviews beyond Google. AI pulls from multiple platforms. Diversification matters.

Secure authoritative citations, not random links. Focus on sources AI already trusts.

Structure content for AI extraction. Clear headers, FAQs, concise answers, and schema markup.

Actively monitor AI recommendations. Search manually. Track visibility. Learn from who’s being selected and why.

SEO did not disappear. It evolved.

The practices that will win over the next decade are not the ones chasing algorithms. They are the ones building undeniable credibility.

AI does not reward clever tricks. It rewards certainty.

In a world where patients increasingly let AI guide their decisions, the question is no longer “How do I rank higher?”

It’s “Why should AI trust me enough to recommend me at all?”

Answer that convincingly, and rankings stop mattering.

The post Your Old SEO Methods Don’t Work Anymore | Here’s Why appeared first on HIP Creative.

You just walked a patient through the perfect treatment plan. The clinical exam went smoothly. Your explanation was clear. The parent nodded along. Then you open the financial folder and watch their face change.

“This feels like a lot of money.”

Your stomach drops. Your mind races through rebuttals. You feel the conversation slipping away.

Here’s what most treatment coordinators miss: that moment is not the problem. It’s the opportunity. Every objection you hear is a patient asking you to guide them through uncertainty. When you reframe resistance as a request for leadership, everything about your consults changes.

Orthodontic treatment is not an impulse buy. It costs thousands of dollars. It takes months or years. It requires trust in someone who just met your family twenty minutes ago.

If patients could confidently make five to seven thousand dollar healthcare decisions on their own, treatment coordinators would not exist. There would be no consult rooms. No case presentations. Patients would click “buy now” and show up for their first appointment.

The fact that objections exist proves people need guidance. They want the outcome. They crave confidence. They’re asking you to help them feel safe moving forward.

What sounds like resistance is actually uncertainty reaching for direction. When a parent says they need to think about it, they’re not saying no. They’re saying they don’t yet have enough emotional clarity to say yes. When someone mentions cost, they’re not attacking your fees. They’re asking you to bridge the gap between price and value in a way that makes sense for their family.

Patient objections in dental practices surface because people care deeply about making the right choice. They care about their child’s smile. They care about their budget. They care about whether this decision will pay off years from now. That care creates anxiety, and anxiety creates questions that sound like obstacles.

Your job is not to overcome those obstacles. Your job is to guide people through them.

Most orthodontic teams are taught to treat objections as barriers to crush. That language alone creates a fight you don’t need to have.

Patients are not pushing back to say no. They’re reaching out for validation so they can say yes.

They want to know their concern is normal. That other families have felt the same way. That their fear makes sense. That someone who does this every day understands the weight of the decision sitting in front of them.

When a patient says, “This feels like a lot of money,” they’re not attacking your treatment plan pricing. They’re asking if this investment delivers results worth the sacrifice. When they say, “I need to talk to my spouse,” they’re not stalling. They’re honoring the fact that financial decisions this size require partnership.

Shift from defending to guiding and watch the entire tone flip. The consult becomes collaborative instead of transactional. Patients lean in instead of pulling away. The energy in the room changes because you stopped treating their concern as a problem and started treating it as a signal.

That signal tells you exactly what the patient needs to hear next. Listen for it.

Here’s the truth most teams miss: resistance rarely starts when the objection leaves their mouth. It begins earlier in the patient consultation process.

Patients do not suddenly decide to object at the financial discussion. Objections are the result of misaligned pacing, unmet emotional needs, or broken rapport that occurred several steps before they said a word.

Maybe you rushed through the clinical explanation because you had another patient waiting. Maybe you skipped the step where you ask what’s most important to them. Maybe your body language shifted when you opened the financial folder. These micro-moments stack up, and by the time you present fees, the patient is already guarded.

This is why scripts for handling objections fail.

Even the best language collapses if the person delivering it feels uncomfortable talking about money or doubts the value of the treatment. Patients sense this instantly. Confidence, or the lack of it, is communicated nonverbally long before you discuss numbers. Your tone, your pace, your posture, all of it telegraphs whether you believe in what you’re offering.

When you rush to explain, justify, or counter objections, patients feel unheard. When you lean on memorized responses, they feel managed. Both reactions raise resistance instead of lowering it.

People do not buy when they feel guarded. They buy when they feel safe. Safety comes from connection, not convincing.

The most effective orthodontic consultations are not driven by clever phrasing. They’re driven by calm, empathetic leadership.

Patients trust certainty that’s quiet, not loud. They trust confidence that doesn’t need to prove itself. They trust professionals who believe fully in both the provider and the outcome. That belief shows up in how you hold silence, how you answer questions without defensiveness, and how you stay present when the conversation gets uncomfortable.

Empathy must come before explanation.

Patients decide emotionally first. Logic only works after anxiety drops. When you lead with education instead of empathy, you overwhelm people who are already nervous. You pile information on top of fear, and fear wins every time. When you lead with empathy, education becomes welcome instead of threatening.

Picture a parent sitting across from you. Their thirteen year old needs braces. They’ve already Googled horror stories about pain and cost. They’re worried about whether their insurance covers enough. They’re concerned their kid will hate them for making them wear metal. They’re calculating whether they can afford this and still take the family vacation they promised.

Now imagine you open with, “Let me walk you through our payment options.” You just skipped the part where you acknowledge everything swirling in their head. You treated them like a transaction instead of a person.

Instead, try this: “I know this is a big decision. A lot of families feel nervous about the cost and the time commitment. That’s completely normal. Let’s talk through what matters most to you, and we’ll figure out the best path forward together.”

See the difference? You just lowered their guard. You made space for their anxiety. You signaled that you’re here to guide, not pressure. Now they can actually hear what you say next.

This is why objections handled with patience and validation often dissolve on their own. The patient wasn’t looking for a debate. They were looking for reassurance that someone gets it.

High performing teams do not eliminate patient objections. They normalize them.

They understand that objections are signals, not problems. Signals that something needs to be clarified, slowed down, or emotionally supported. They don’t view objections as roadblocks. They view them as guideposts showing where the patient needs more help.

These teams stay externally focused instead of retreating into their own heads. They watch body language. They notice breathing, posture, tone, and energy. They catch the micro-expressions that reveal doubt before the patient even says a word. They stay in sync with the patient instead of racing toward the close.

They treat objections as moments of alignment rather than conflict. Instead of trying to win an argument, they guide the patient back to clarity. They ask open ended questions like, “What part of this feels uncertain for you?” or “Help me understand what’s holding you back.” These questions invite honesty instead of triggering defense.

High performers also debrief after tough consults. They don’t just shrug off a “no” and move to the next patient. They ask themselves: Where did I lose rapport? What signal did I miss? How can I improve the orthodontic patient experience next time?

This approach doesn’t feel like selling. It feels like leadership. And leadership is what patients are looking for when they walk into your practice.

If objections feel heavy or frequent in your orthodontic practice, start here.

Reframe objections internally before responding. They’re not attacks. They’re requests. When a patient voices a concern, pause for one full breath before you answer. That pause lets you shift from defense mode to guide mode. It also signals to the patient that you’re really listening.

Acknowledge emotion before explaining anything. Validation lowers resistance faster than information. Say things like, “I hear you. That makes sense.” or “A lot of families feel that way at first.” You’re not agreeing with the objection. You’re acknowledging that it’s real for them.

Pay attention to where objections are being created earlier in the process. Many are preventable through better expectation setting and rapport building. If patients consistently object to cost, ask yourself: Did I build enough value before I presented fees? Did I connect treatment outcomes to what they told me they care about?

Focus on connection first, solutions second. Patients cannot hear logic when they feel unseen. Spend more time in the discovery phase. Ask what brought them in today. Ask what they’ve heard about braces. Ask what concerns them most. The more you understand their world, the easier it becomes to speak directly to their needs.

Build conviction in the outcome, not just the script. Confidence is felt before it’s heard. If you don’t fully believe that your practice delivers life changing results, patients won’t believe it either. Spend time remembering why you do this work. Look at your before and after photos. Read testimonials. Reconnect with the transformation you create every day. That conviction will show up in your voice, your pace, and your presence.

In orthodontics, trust is not built by avoiding objections. It’s built by how you show up when they appear.

When teams stop bracing for objections and start welcoming them, consults become calmer, clearer, and more effective. Patients feel supported instead of sold. Decisions feel aligned instead of pressured. Case acceptance rates climb because people finally feel safe saying yes.

Objections are not the moment the sale is lost. They’re often the moment trust is won. Every concern a patient voices is a chance to prove you’re different. A chance to show that you’re not here to push. You’re here to partner.

The practices that win are not the ones with the smoothest talkers. They’re the ones with the steadiest leaders. The ones who stay calm when patients get nervous. The ones who listen more than they speak. The ones who make people feel seen, heard, and supported through one of the biggest decisions they’ll make for their family.

Your patients aren’t resisting you. They’re asking you to lead. So lead.

Start today by changing how you think about the next objection you hear. See it as an invitation. Respond with empathy. Guide with confidence. Watch what happens when you stop defending and start connecting.

That’s how you transform case acceptance. That’s how you build a practice people trust. That’s how you create results that stick.

The post Why Orthodontic Objections Disappear When You Do This! appeared first on HIP Creative.

Your team thinks they’re selling braces.

They’re wrong.

What patients actually buy is certainty. Certainty about cost, timing, next steps, and whether they’re making the right call for their kid or themselves. When you don’t create that certainty fast, you get the same complaints every practice has: they ghosted us, bad lead, they said they needed to think about it, they price-shopped, they no-showed.

Here’s what hurts: your leads aren’t bad. Your process leaks certainty.

Fix that, and your team won’t need to push harder. They’ll just need to get clear, confident, and better at leading conversations. The kind of leadership that feels like service instead of sales.

Get your copy of the Practice Paradox and the Personality Assessment: https://ion.agency/practice-paradox-book

Whether someone is choosing braces, clear aligners, or even deodorant, the psychology stays the same: people move when they feel safe taking the next step.

That’s why calls fall apart even when your team says all the right things. If the prospect feels confused, guarded, uneasy, or overwhelmed, you can keep talking. You’ve already lost. Not because they hate you. Because their brain is protecting them from a decision that feels risky.

So the question becomes: How do you manufacture certainty, fast, without sounding salesy?

Let’s break it into five levers: mindset, voice, speed, follow-up, and simplification.

A lot of practices hate the word “sales.” They picture a used-car lot: fake smile, pressure, manipulation, take the money and run. That’s exactly why they struggle.

Here’s the reframe: sales isn’t taking. Sales is giving. If your team believes sales is something you do to people, they’ll avoid it, rush it, or apologize for it. If they believe sales is something you do for people (clarifying, guiding, simplifying), they show up differently.

Two guardrails matter: integrity and a true desire to help paired with belief that the service will positively impact the patient’s life. Violate those, and you’re back in the version of sales everyone hates. Hold those two guardrails, and closing isn’t predatory. It’s service.

Why this matters to certainty: Certainty doesn’t come from convincing. It comes from leadership. People relax when they feel guided by someone who knows what they’re doing and genuinely has their interests in mind. If your team doesn’t buy that idea, every tactic in this article turns into a script. Scripts don’t create certainty.

The fastest way to kill a call isn’t the wrong sentence. It’s the wrong cadence.

Two things matter most: tonality and tempo. Tone and tempo communicate what words can’t: calm confidence, leadership, empathy, impatience, uncertainty, awkwardness.

The Real Phone Skill Is Emotional Control

When your scheduler or treatment coordinator sounds rushed, unsure, or overly chirpy, the prospect doesn’t feel guided. They feel processed. And if the prospect doesn’t feel guided, they don’t feel safe.

Use Anchoring Questions to Uncover What Creates Certainty for This Person

Three questions shift the call from “schedule this” to “understand why this matters.”

“How long have you been thinking about straightening your teeth or bringing Johnny in?” This tells you whether they’re a “yesterday” person or a “two years” person. Very different energy, very different barriers.

“Why did you feel like now was a good time to address this?” This reveals the trigger: pain, bullying, a dentist referral, a life event, a deadline, a job, a wedding. The trigger is often where certainty lives.

“Why did you decide to come see us?” This exposes perceived differentiation or lack of it. It also surfaces competitive context without you sounding defensive.

These questions aren’t cute. They build certainty because they make the prospect feel understood. And they give your team leverage to connect the consult to what the person actually cares about.

If You Sense Uncertainty, Address It Immediately

If someone sounds uneasy, uncertain, confused, or guarded, you can’t just continue your flow and hope it resolves itself. You need to pivot and handle that emotion right now. Or you won’t have their attention for the rest of the call, and you’ll often earn a no-show.

Use something playful as a pattern interrupt (something they don’t expect) to regain attention. The point isn’t the exact line. The point is: certainty requires attention, and attention disappears when emotion turns skeptical.

The Underrated Skill — Being Comfortable With Silence

Most teams panic during silence and start filling space with nervous checking: “Hello?” “Did you get that?” “Can you hear me?” Don’t do that. Embrace the silence. The person just answered an unexpected call. You don’t know what they’re doing. If you can sit through a few seconds, you keep authority and flow.

Why this matters to certainty: When you talk like a leader (steady, calm, unhurried), you lend your certainty to the other person. When you sound nervous, you amplify theirs.

If you’re treating online leads like they’re 2012 leads, you’re getting cooked.

Amazon has trained consumers. If something doesn’t have the two-day delivery vibe, what do people start thinking? “Do I really need this?” “Maybe I’ll find something similar I can get tomorrow.” That same consumer expectation bleeds into choosing an orthodontist. If you don’t respond fast, if it’s hard to schedule, if it takes forever to get clarity, people don’t wait patiently. They move on or talk themselves out of it.

The Five-Minute Rule Isn’t Aggressive. It’s Reality.

Studies show that if you don’t follow up within five minutes, there’s a 400 percent decrease in ever getting in touch. Calling back within 60 seconds can boost conversions by 391 percent. Whether you obsess over exact numbers or not, the operational takeaway is undeniable: your speed determines whether you’re still top of mind.

Here’s what should sting a little: five minutes should be your worst day. Because in a digital world, five minutes can feel like an hour. Nobody submits a form and then sits there doing nothing, waiting for your office to call. They go right back to scrolling, eating dinner, getting pulled into life. And when you finally call, you’re no longer “the answer.” You’re “some unknown number.”

Certainty Collapses When You’re Not Top of Mind

When your callback is slow, you trigger confusion: “Who is this?” “Where are you calling from?” “Why are you calling me?” That confusion isn’t neutral. Confusion is uncertainty. Uncertainty is delay. Delay becomes ghosting.

If you want more conversions, stop treating speed like an operational detail. Speed is part of your sales system.

“Bad Leads” Are Often Just Cold Opportunities, and Your Follow-Up Must Match Human Behavior

Most practices overuse the term “bad lead” as emotional protection. It feels better to say “they were a bad lead” than “we didn’t create enough certainty fast enough.”

Here’s the reframe: a bad lead is someone you truly can’t serve. Someone without teeth, no pulse, extreme mismatch. Everything else? That’s not a bad lead. That’s an opportunity that either isn’t ready yet, lost excitement, didn’t feel safe, or didn’t get enough follow-up to stay warm. It’s not always that the leads are bad. It’s that the opportunities have gone cold.

The Simplest Reason Follow-Up Fails — Nobody Answers Unknown Numbers (Including You)

Most of us do not pick up calls from numbers we don’t know. So why is your team shocked when prospects don’t answer?

This is why you need a specific cadence: call, voicemail, text, email, repeat. That multi-touch pattern creates recognition: “Oh right, I did request that.” It builds association. And it reduces the emotional friction of picking up.

Micro-Impressions Before the Consult Decide Whether They Show Up

This might be the most overlooked certainty killer in orthodontics: the little irritations that happen before the patient ever meets the doctor. Being put on hold for minutes (feels like forever). The office not answering. Getting disconnected and not being asked for a callback number. Having to call back and re-enter the queue.

These micro-impressions create a subtle story in the patient’s mind: “This is going to be a pain.” That story produces uncertainty. Bottom line: If your front-end experience feels clunky, you can’t treatment-coordinate your way out of it in the consult.

If you want more same-day starts, stop turning the consult into a college lecture.

Here’s a real-world example of a practice that aggressively simplified the consult process: 30 minutes total per new patient exam, records done fast (an eight-minute window), doctor in the room for one to two minutes, treatment coordinator does most of the explanation and fee conversation, they deliberately trained and timed the team to move faster, and fee presentation is simple and consistent.

The insight isn’t “everyone must do 30-minute exams.” The insight is: complexity creates hesitation. When the doctor spends 20 minutes explaining the science of orthodontics, the patient walks out thinking, “Wow, this is a big deal. I need to go home and digest this.” In other words: you made it feel heavy, risky, and uncertain. Simplification doesn’t mean low quality. It means low friction.

Fees — Answer the Real Question Without Overwhelming Them

The patient’s number one question at the consult is: “How much is it?” When offices avoid this, they don’t create certainty. They create suspense. And suspense is not your friend in a high-consideration purchase.

One practice’s approach: Lead with one simple plan ($300 down and a monthly that stays under $200). Don’t lead with four options. Options create overwhelm. If they ask about pay-in-full, then you introduce that. If $300 today is a barrier, step it down: $150 today and draft the other $150 in one to two weeks. This strategy isn’t about discounting. It’s about making the decision feel manageable.

On the Phone — If You Won’t Quote Fees, You Still Must Remove Financing Fear

When people hear “payment plans” and “financing,” they often assume interest, credit checks, banks, and paying more over time. So if your team says, “We have great payment plans,” that’s not certainty. That’s vague reassurance. And vague reassurance reads like sales fluff.

Instead, proactively clarify: zero percent interest, no credit checks, in-house financing, no banks involved. That removes uncertainty. And when uncertainty drops, people move forward.

Stop Trying to Differentiate With Tech Patients Don’t Understand

Some practices try to win by talking about technology (CBCT, bonding techniques, fancy bracket systems) as the primary differentiator. The general public has low dental IQ. Most people don’t know what those things are, and they aren’t buying them up front.

What are disruptors winning on? Speed, convenience, little resistance, affordability, and a cool brand. You can wow them clinically once they’re in and committed. But at the decision point, patients buy what reduces friction and uncertainty.

You don’t need a new script. You need a new operating system. Here’s a practical checklist, organized by where certainty is won or lost.

Phone: Create Certainty in the First 60 Seconds

Train the two T’s: tonality and tempo. Start coaching cadence, not just words. Add the three anchoring questions: How long have you been thinking about it? Why now? Why us? The moment you hear uncertainty, pivot and address it. Don’t keep going like nothing happened. Get comfortable with silence. Nervous filler kills authority.

Scheduling —Stop the Endless Loop With Wide Net Statements

Replace open-ended scheduling chaos with two-option narrowing. “Specific date or day or first available?” “Morning or afternoon?” “1 p.m. or 3 p.m.?” This approach prevents the call from dragging and keeps you leading.

Speed — Protect Momentum Like It’s Revenue (Because It Is)

Treat five minutes as unacceptable in normal conditions. Aim to call back before they exit the browser whenever possible. Build operational systems that make fast response normal, not heroic.

Follow-Up — Assume They Won’t Answer and Build Recognition Anyway

Use the cadence: call, voicemail, text, email, repeat. Stop labeling unresponsive people as “bad.” Most are just cold. Clean up micro-impressions: reduce holds, avoid disconnects without callback capture, and tighten the front desk experience.

Consult — Simplify Until Decisions Feel Easy

Reduce information overload. Don’t make treatment feel like a complicated life event. Standardize a simple fee presentation. Lead with one clear path. Introduce alternatives only if asked. Remove financing uncertainty with clear language (zero percent interest, in-house, no banks, no credit checks).

Your practice isn’t competing only on clinical outcomes anymore. You’re competing on how fast you respond, how easy it is to schedule, how confident your team sounds, how predictable your process feels, and whether the patient understands the money without anxiety.

People don’t buy braces. They buy certainty. If you want more starts without feeling salesy, stop trying to close harder. Start building a system that makes the next step feel obvious, safe, and simple. That’s what your market is actually demanding now.

The post Patients Keep Saying No? Here’s What You’re Missing appeared first on HIP Creative.

In this episode of the GrowDental podcast, Luke dives into the r/Dentistry subreddit to answer real questions from practice owners struggling with marketing and growth. What emerged from those conversations is a framework that challenges everything most dentists believe about their biggest constraint.

Get your copy of the Practice Paradox and the Personality Assessment: https://ion.agency/practice-paradox-book

A dentist buys a South Florida practice. Previous spend: $5,000 monthly on ads. New plan: hire a strategist, reorganize, cut costs. Result: phones go silent, patient flow crashes.

The owner’s instinct? Panic. The real question: Was $5k the problem?

Here’s what actually happened. Spend less, get less. That part is simple math.

The complicated part lives downstream. What happens after someone calls or fills out a form? Because in most practices, the enemy isn’t your marketing budget. It’s operational leakage. Missed calls. Weak follow-up. Zero visibility into what your website produces.

If that’s your reality, more ad spend won’t solve growth. It will scale your waste.

This framework is for owners who want to grow the right way. Plug the leaks first. Scale what works second.

Most budget arguments skip the only question that matters. Are you stewarding the opportunities you already pay for?

Marketing is not magic. Marketing is volume. Turn it up and you get more attention, more inquiries, more exposure of whatever’s broken underneath.

In the South Florida case, the most predictable outcome occurred. They cut spend and lead flow dropped. That doesn’t prove the original budget was right or efficient. It proves it was producing volume. But the real insight is this: ad spend is relative.

Consider the context. Where exactly are you? Miami versus a suburban market are different games. How competitive is your local area? How big is the practice now, and how fast do you want to grow?

A flat number like $5,000 monthly means nothing without those answers. In some markets it’s average. In others it’s conservative. In others it’s reckless.

But even if your spend level fits your market, your biggest constraint may still be operational, not marketing.

Want one metric that exposes the truth fast? How many calls are you missing right now?

Not what your team thinks. Not what feels right. The hard number.

Here’s the reality most owners avoid. The average abandoned call rate sits between 20 percent and 40 percent of calls going unanswered. Pause on that.

If you miss one out of four calls, you don’t have a lead generation problem. You have a conversion capture problem. And if a meaningful chunk of those missed calls are new patients, you’re bleeding revenue daily without knowing it.

Why This Matters More Than Your Ad Budget

The compounding effect looks like this. Your missed call rate is 25 percent today. You crank marketing spend up. You push your team beyond capacity and that missed call rate climbs to 40 percent or higher.

So you spend more. You get more inquiries. You lose more opportunities because your systems can’t absorb the volume. This is how practices convince themselves marketing doesn’t work, when the truth is they never fixed the bucket.

Where to Find the Truth (Not Opinions)

Most practices already have the data. Owners just don’t look.

You likely use a VoIP system. Those platforms show call stats, including abandoned call rate and missed calls. The next step isn’t just the percentage. It’s segmentation. What percentage of missed calls are new patient calls? That one metric tells you whether your next dollar goes to ads or operations.

One strategist asks a question almost nobody can answer. “In 2025, how many new patients did your website bring you?” Common response: silence.

This isn’t a minor gap. It’s a fundamental business blind spot.

If you can’t measure what the website produces, you can’t evaluate whether your site does its job, whether your online scheduling gets used, whether your forms get answered, or whether you’re losing patients quietly while telling yourself the website is decent.

The Website Isn’t Just Branding

Sure, a website informs people. But in the context of practice growth, it has a job. Turn interest into action. If you don’t know whether it’s doing that, you’re operating on vibes.

The Practical Audit Most Practices Never Do

If your lead flow feels low, take a hard look at where you’re bleeding. Start with two questions. What are the form submissions and appointment requests like? Where are those requests being routed, and who owns follow-up?

Because “we don’t get website leads” is sometimes code for something else. Requests go into an inbox nobody monitors. Notifications go to the wrong person. Patients get a slow response and ghost. The follow-up experience feels cold and transactional.

In other words, the website might be working. Your process might not.

A lot of dentists talk about Google versus Facebook like it’s personal preference. It’s not. It’s about patient intent and what your practice can handle.

Here’s the breakdown. Google is more bottom-of-funnel because you capture existing search intent. People actively looking. But it’s also more competitive, and demand is limited by how many people search in your area. Meta (Facebook and Instagram) is more top-of-funnel. You reach people who could become patients, but you often need workflows and automations to warm them up and convert them.

Here’s the operational reality most practices miss. If your follow-up is weak, top-of-funnel leads die. If your phones aren’t answered consistently, bottom-of-funnel leads die too. The platform won’t save you from poor stewardship.

This is why fixing leaks first is so powerful. It makes every channel work better.

If your schedule isn’t where you want it, your instinct may be to throw money at marketing. Sometimes that’s right, but only after you validate the fundamentals. Here’s a practical sequence.

Step One — Pull Your Phone Data Today

Log into your VoIP system. Find your abandoned call rate and missed calls. Identify what percentage of missed calls are likely new patients. If you’re missing a big chunk of calls, that’s not a marketing problem. That’s an operations problem that marketing will only magnify.

Step Two — Review the Follow-Up Experience (Not the Theory)

A simple but revealing approach: listen to phone calls and evaluate customer service like a real consumer would. If you want to remove self-deception, do what one doctor did. Call your own practice pretending to be a patient to screen the phone experience.

This isn’t about being sneaky. It’s about being honest. Owners often assume the experience is good because the team is nice. But nice doesn’t always mean confident, efficient, or conversion-minded.

Step Three — Audit Your Website Conversion Path End-to-End

Don’t argue about whether the site looks good. Ask how many appointment requests come in. Are submissions truly zero, or just disappearing? Who is responsible for responding, and how fast?

If you discover leads are coming in but not getting handled well, the fix might be far cheaper than increasing ad spend.

Step Four — Only After the Leaks Are Plugged, Decide Whether to Scale Spend

At that point, scaling marketing becomes rational because you’re scaling a machine that can actually capture demand.

A practical benchmark: marketing spend often falls around 5 percent to 12 percent of collections. Don’t treat that as a rule. Treat it as a reality check and tie your decision back to your market competitiveness, your growth goals, and your operational readiness to handle more volume.

One more sharp point: if you truly want to grow aggressively, you may need to think in terms of the percentage of where you want to be, not just where you are. That can work, but only if you’ve already fixed the conversion bottlenecks.

Sometimes, after you do the audits above, you’ll confirm something important. Call volume is genuinely low. Website requests are genuinely low. You’re not leaking opportunities. You simply don’t have enough opportunities.

In that case, the advice is direct. You just need to spend more. But even then, don’t blindly hire anyone who sells ads. Use a vetting process that protects you from expensive mistakes.

Find a reputable marketing company with case studies and testimonials from doctors you’d actually want to emulate. Ask to speak with three to five of those doctors. Do real research, then make an educated decision.

That last part matters. Dentists often buy marketing like they buy equipment, based on features. But marketing is closer to hiring. You’re paying for execution quality, strategy alignment, and consistency.

If you remember one thing from this entire framework, make it this. Marketing doesn’t fix a leaky practice. Marketing exposes it.

If your phones go unanswered, if your follow-up is inconsistent, if you don’t know what your website produces, then scaling marketing is like pouring water into a bucket with holes. You’ll feel busy, spend more, and still wonder why the finances don’t add up.

But if you plug those holes, if you maximize stewardship, then marketing becomes what it’s supposed to be. A predictable lever you can pull to grow.

The owner in the South Florida story didn’t discover that marketing is bad. They discovered something more useful: their spend was driving demand, and the moment they removed it, demand dropped. The correct response isn’t to argue about whether $5k is too much. The correct response is to build a system that can reliably convert whatever demand you create, then scale with confidence.

The post Reddit Q&A – Your Dental Practice Is Bleeding Patients (And Marketing Isn’t the Problem) appeared first on HIP Creative.

Orthodontists pour millions into technology, systems, and clinical training. Those investments matter. But zoom out and look at which practices actually grow year over year. The differentiator is not the scanner, the wire sequence, or the aligner system.

The practices that grow treat patients like people, not procedures.

In a world full of convenience, automation, and self-checkout everything, genuine human experience has become the rarest competitive advantage in orthodontics. At HIP, we have seen it across hundreds of practices: when your team becomes truly patient centric, your results follow.

This is not a nice-to-have. It is the engine behind case acceptance, referrals, and retention.

Here is what that actually means and how you build it.

Orthodontic treatment is not just a mechanical process. Patients carry their smile into every room they walk into for the rest of their lives. Confidence. Insecurity. Pride. Avoidance. Whether someone feels free or guarded, their orthodontic journey shapes all of that.

Forget the emotional stakes and you lose the patient.

Every interaction with your practice either reinforces their confidence or feeds their fear. In today’s world, where everything is automated and transactional, that emotional experience matters more than ever. Patients expect clinical excellence. They remember how your team made them feel.

That feeling brings them back and keeps them talking about you.

A lot of practices believe their growth will come from their scanner, their bracket system, their aligner protocols, their dashboard, their workflow.

Technology matters. It supports efficiency. It shortens treatment times. It allows for predictable outcomes.

But patients cannot tell you the difference between wire systems. They have no idea what your software does. They can tell you if your front desk greeted them warmly. They can tell you if your space felt clean and inviting. They can tell you if they felt remembered or forgotten.

The truth is simple: technology creates capability, patient experience creates loyalty.

Before a patient ever sees a TC, an assistant, or the doctor, they are already forming their opinion. They are evaluating whether they feel safe. They are reading whether your team is present or overwhelmed. They are noticing whether they are interrupting you or welcomed.

A great first impression includes clear signage and easy navigation so patients know where to go, a clean and bright environment that signals professionalism without feeling sterile, a genuine greeting that acknowledges them immediately, and eye contact plus warmth so they feel seen instead of processed.

If this first moment goes sideways, you have already lost ground. If it goes well, everything else becomes easier.

The treatment coordinator room is the most pivotal space in the practice. It is where excitement becomes commitment or where uncertainty grows into hesitation.

Practices that win in this room keep the handoff tight, smooth, and confident. They remove the left-alone-in-silence moments that create anxiety. They treat the patient as the hero of the story, not the object of a procedure. They engage on a human level before diving into clinical detail.

When patients feel known instead of managed, they say yes more often and they stay excited throughout treatment.

This is where many practices unintentionally lose the patient experience altogether.

Routine appointments easily slide into autopilot. The assistant has done this exact wire change ten times today. The patient knows the drill. Everyone falls into the rhythm. That is the danger.

A patient who feels invisible mid-treatment becomes disengaged. They stop wearing rubber bands. They lose excitement. They feel like a number.

The practices that maintain loyalty during routine visits do one thing consistently: they never stop seeing the patient. That means personalized notes that allow any assistant to pick up the conversation, asking about the football game or the prom or the test or the birthday or the struggle, staying energetic even in routine appointments, and celebrating small steps toward the end result.

Efficiency does not cost empathy. Efficiency creates space for empathy.

Many offices treat retention like the checkout lane. Here are your retainers, congrats, call us if something breaks.

Retention is where practices lose referrals and where they could be gaining them.

Retention works best when the team celebrates the finish line with real enthusiasm, when debond day is treated like a milestone worth cheering for, when the patient leaves feeling proud of what they accomplished, when the team makes the experience fun and memorable and personal, and when you reinforce why wearing retainers matters without guilt or shame.

When the final memory is a great one, patients become raving fans. And when they inevitably need retreatment years down the road, they come back to the place that made them feel cared for, not the cheapest or closest option.

Your team is human. They get tired. They get overwhelmed. They deal with difficult patients. They have personal stress.

When they are stretched thin, the first thing to disappear is the patient experience. That is why the culture has to carry the weight, not individual moods.

A consistent patient experience comes from clear standards, strong systems, personal accountability, team cohesion, morning huddles that reinforce connection, and leadership that models presence and empathy.

This is not about perfection. It is about direction. A one percent improvement every day builds a culture that becomes unstoppable.

At HIP, we say it often: you do not build a great practice by focusing on teeth. You build it by focusing on people.

Clinically excellent orthodontists are everywhere. Patient-centric teams are rare.

The practices that become market leaders are not the ones with the newest tech or the flashiest marketing. They are the ones patients talk about long after the appointment is over because the experience made them feel something real.

If you want to grow, improve your systems, and elevate your team, start with the one thing your competitors cannot copy: the way you make people feel when they walk through your door.

Do that consistently and your practice becomes unforgettable.

The post Why Patient Experience TRUMPS Technology in Orthodontics appeared first on HIP Creative.