The Marketing 32 Show

What happens when a Vietnamese-American dentist, raised by immigrant parents with the stereotypical "become a doctor or engineer" expectation, follows a path laid out by others (not by choice but by cultural programming), builds a successful multi-dentist practice in McKinney, Texas over 12 years, achieves every goal society tells him to achieve—profitability, growth, expansion, multiple associates, beautiful family, strong marriage—and then suddenly realizes he's on an endless hamster wheel of achievement that leaves him completely empty inside? Dr. Anthony Do does exactly that, and at his lowest point, lying in bed alone in the dark with his own thoughts, he experiences intrusive thoughts about not living anymore—not because his life is objectively bad (it's objectively good by every metric), but because he's been chasing happiness through achievement his entire life, and the moment he achieves something, the dopamine dumps and he's left searching for the next mountain to summit. In this incredibly vulnerable and profound conversation, Dr. Do reveals why the dental industry's obsession with growth, production, and achievement is creating a silent epidemic of burnout and mental health crises that nobody wants to talk about, why happiness is a fleeting emotion (not an identity), why the highest dopamine hit isn't at the achievement point but in the anticipation leading up to it (which means you're chasing a drug, not fulfillment), and why peace is not the absence of problems but the certainty that you will be victorious regardless of what problems come. 

Dr. Anthony Do grew up the son of Vietnamese immigrant parents who came to America to create a new life for their children. With that came the immigrant parent mindset: "I'm going to tell you what should happen for you." The expectation was stereotypical but powerful—be a doctor, be an engineer, achieve, succeed. As a child and teenager, Dr. Do had no concept of anything else. He didn't choose dentistry; he was told to pursue it. But as he reflects today, he realizes that's the story of his entire life: he was told to do something, so he did it. He became a dentist, then someone opened a practice and he thought "maybe I should do that." Someone said "you should talk to this guy about opening a practice," so he did. He opened his practice in McKinney, Texas, and over 12 years, he grew it into a multi-dentist operation with associates, expansion, and profitability. By every external metric, he succeeded. He had a beautiful marriage (to his high school sweetheart), two children, a thriving practice generating significant income. Everything looked perfect from the outside.

But internally, Dr. Do was dying. He reached a point where he asked himself a haunting question: "When do I stop?" Do I keep growing? Keep bringing on associates? Keep opening practices? Is there another mountain after this one? He felt trapped on an endless hamster wheel, jumping from one achievement to the next, always searching for the next goal to chase. This left him with an empty feeling inside. He started seeking answers in books—leadership books, psychology books, neurobiology of happiness, even religiosity of happiness. What he discovered through his reading was profound: happiness is not a state of being; it's a fleeting emotion or event. It's circumstantial. You're not "happy" as an identity; you experience happiness as a feeling that comes and goes. More importantly, he learned through neurobiology that the highest dopamine spike isn't at the moment of achievement but in the anticipation leading up to it. This is why a vacation is most exciting while you're planning it—once you're on it, the dopamine dumps and you're searching for the next experience. The same pattern applied to his achievements: open practice (dopamine spike in anticipation), open it (dopamine dump), what's next? He wasn't chasing fulfillment; he was chasing a drug.

The turning point came through faith. Dr. Do grew up Catholic but went through the motions—pews on Sunday, confirmation, the whole thing—without it ever really applying to his life. But when he hit rock bottom and was crying out for relief from these intrusive thoughts, he returned to faith. He started wearing a rosary and praying. The rosary is called a "rosarian" (rose garden), and as you hold each bead, you say a prayer, walking through the rose garden. As Dr. Do prayed, he found peace—not because the problems went away, but because his mind focused on something other than the intrusive thoughts. He then started reading the Bible himself (instead of having others read it to him), and it began to speak to him. One passage that became central to his transformation was "we walk by faith, not by sight." For his entire life, he had been operating by sight—judging employees and situations based on what he observed, making snap judgments that felt like truth. But walking by faith meant believing in people and outcomes even before he had evidence, operating from hope rather than certainty. This shift changed everything about how he led and how he thought about others. Another passage that resonated: "Blessed are those who believe but do not see"—believing without needing to see the proof first.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

In this grounded, operator-first conversation, Dr. Agarwal reveals why most practices don't know their actual metrics (they guess), how tracking just two or three key metrics (hygiene pre-appointment rate, production vs. collection ratio, and marketing cost per booking) can forecast your entire practice's future and unlock strategic planning, why production numbers lie but collection numbers tell the truth, how insurance companies follow predictable trends that you can get ahead of proactively, and why the real power of Practice by Numbers isn't just analytics—it's becoming a completely modular operating system for dental practices.

Most powerfully, she shares her golden nugget: saying yes to hard things, even when they make you uncomfortable, has served her well every time—because that's how you innovate, grow, and build something meaningful. If you've ever wondered why some practices seem to know exactly where their money is going and where to invest next while others are completely lost, how data-driven decisions could transform your practice, or why integrating multiple software tools might be costing you far more than consolidating into one modular platform, this episode will completely reshape how you think about practice management, data literacy, and what it really means to build software by dentists for dentists.

Dr. Aditi Agarwal has been in dentistry for 23 years—as a clinician for seven years as an associate, then as a practice owner for 19 years. In 2010, she made the bold (some might say risky) decision to open a startup practice in a depressed market during the height of the financial crisis. She quickly realized what she'd done—huge loan payments, survival mode, bills coming in constantly. But the real mystery was her case acceptance. As an associate, her case acceptance had been strong, but in her own practice, it plummeted. She was frustrated, confused, and wondering what fundamentally had changed about her as a clinician. Every night she'd come home stressed, asking her husband (who's an engineer) what could be wrong. One night, he said something that changed everything: "With most businesses, usually the answers are in the data." Dr. Agarwal didn't understand what he meant—she didn't see any data. But Rohit suggested looking at reports in her practice management system. He started creating spreadsheets to pull and organize that data.

Beyond those core metrics, Dr. Agarwal emphasizes understanding insurance patterns. Insurance companies follow predictable trends. If you track them over time, you'll notice patterns—and once you see those patterns, you can get proactive with patients. Instead of being surprised by insurance adjustments, you can communicate with patients beforehand: "Here's what your insurance likely won't cover." This reduces write-offs, reduces frustration, and transforms the entire dynamic. The evolution of PBN shows how customer-driven software should work. COVID forced practices to solve problems creatively—suddenly they needed online forms so patients wouldn't have to come in early to fill them out, digital consents to minimize touchpoints, ways to request reviews without staff having to ask, payment processing online because gyms were doing it. Customers kept asking "can you also do this?" and the team kept building. Now PBN includes AI receptionist capabilities, communications, appointment reminders, text messaging—essentially everything a practice needs to operate.

What makes PBN different from competitors is that it's completely modular. You don't have to buy everything. A startup practice doesn't need all features, but a multi-location practice does. PBN grows with you. Because Dr. Agarwal has lived through building a practice from ground zero, she understands the journey—and that lived experience is reflected in the product philosophy. The company is also owned and managed by a practicing dentist, not venture capitalists or Wall Street investors. This means product decisions stay customer-focused. Dr. Agarwal still practices two to three days a week (she loves dentistry—it's her "me time" and chill time), and she stays deeply connected to actual practice pain points. When she talks with customers about features and toggles, it's not from theory—it's from lived experience. She ends by sharing her golden nugget: say yes to hard things, even when they make you uncomfortable. Every time she's embraced a challenge and figured it out along the way, it's served her well. That philosophy—embracing hard things, saying yes to discomfort, figuring it out as you go—is exactly what created Practice by Numbers and what keeps it customer-focused and innovative.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

What happens when a software engineer who never planned to work in dentistry ends up as the CTO of a dental call center for seven years, learns the industry inside and out, takes a break to work with VC firms right when ChatGPT explodes onto the scene, helps companies understand this wild new AI technology amid the FOMO, starts building an AI CRM to pull insights from data, gets asked by dental connections if they can hook it up to practice management software, discovers they can do similar things in the dental space, and realizes the real opportunity isn't just pulling data—it's building an AI digital coworker that handles the monotonous tasks that convert leads and schedule appointments when offices can't? Connor Ludlow does exactly that, and after two and a half years of building, iterating, and working with thousands of dental practices, he's discovered something that most AI startups and dentists get wrong: AI isn't a silver bullet, and treating it like one is exactly how you end up with hallucinating chatbots, bad patient experiences, and hype that doesn't match reality. 

Connor Ludlow never planned to work in dentistry. He went to school as a software engineer and had friends starting a dental call center who needed a technical co-founder. He joined them, spent seven years growing that call center (starting as a coder, eventually managing operations and working directly with customers), and left deeply knowledgeable about the dental industry but ready for a break. During that break, he worked with VC firms helping companies understand ChatGPT and the new AI wave when it first exploded. He experienced the massive FOMO everyone was feeling about AI, went around talking with companies about what this technology could do, and decided to build an AI CRM that pulled insights from business data to help with growth. That actually worked well—they were using AI to extract insights from CRM data—but when he talked to his dental connections about potentially hooking it up to practice management software, they loved the idea. That’s how Annie was born. They started showing practices captured lead data and growth trends connected to their PMS, and one thing led to another: they realized the real opportunity was building an AI digital coworker that could actually take on the tasks that convert leads and schedule appointments—filling in the cracks when offices are closed, it’s a weekend, or they’re just too busy to capture every call.

Connor’s approach is refreshingly honest: AI is good at what it’s good at, and it’s okay if 14% of patients ask for a human. You just transfer them or leave them a voicemail callback option—same as before. But your upside is that the 86% you do interact with get handled, and you’re capturing calls you’d miss after hours or weekends. Think of it as a voicemail replacement that has upside instead of just downside. The tool mindset matters because if you expect AI to be a silver bullet, you’ll try to force it into situations where it doesn’t belong (like emergency calls) and then get disappointed when it doesn’t perform perfectly. But if you look at it as filling gaps—after-hours calls, recare outreach, appointment confirmations—it’s incredibly practical and ROI-positive.

Connor’s golden nugget hits at something important: only 3% of the population currently pays for any AI subscription. That means if you’re adopting AI now, you’re actually in the first 10% of early adopters—it’s not too late, and you’re not behind the times. The dental industry in particular is still massively underadopting this technology despite clear ROI. There’s FOMO about AI, but the reality is most people and most industries haven’t actually started using it yet. If you jump in now, you’re still early, and you’ve got time to figure out how to use it effectively. That’s not true for some technologies where adoption curves are steep and competitive pressure is high. For dentistry and AI, we’re still in the early innings.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

What happens when a girl falls into dentistry completely by accident starting in a dental lab (learning the prosthetic side and how quality impacts smiles), moves into dental offices, works in oral surgery, manages clinics serving developmentally disabled adults (learning the critical importance of trust and empathy), and finishes her clinical career working for a maxillofacial surgeon doing complex jaw resections and implant cases—always in management, never clinical, but always asking "why, what, how, and when" so deeply that she can train clinical staff to help doctors become more efficient? Lana Rivera does exactly that, and when she decides to leave clinical practice and build her own consulting firm, she names it NMG Practice Solutions (standing for "no me gusta"—Spanish for "I don't like that"—the family joke that she creates solutions for problems doctors don't like). Over 20+ years seeing practices from the inside out (literally how she fell into dentistry), she notices the same pattern everywhere: every single doctor is maxed out, completely taxed, stressed to capacity, with terrible team culture, no understanding of their referral patterns, overwhelmed finances, and the mistaken belief that working harder will fix it when the real problem is leaks in the bucket—broken systems hemorrhaging money and opportunity. In this incredibly practical conversation, Lana reveals why her approach is "inside out" (the opposite of consultants who come in with clipboards saying "do X, Y, and Z like I did elsewhere"), why financial pressure is almost always the first pain point doctors mention but rarely the actual problem, how case acceptance is often a massive untracked leak that doctors think is happening way better than it actually is, and why the single most important position most practices don't have is a dedicated Treatment Plan Coordinator—someone whose job is literally to close cases by understanding both the clinical reasoning AND the psychology of the patient, by having a healthy relationship with finances themselves so they don't project their own money anxiety onto patients, and by having the doctor's back completely so patients sense the confidence and commitment.

Lana Rivera's path into dentistry was completely accidental, but it set the foundation for everything she does today. She started in a dental lab where she learned the prosthetic side of dentistry and how quality impacts smiles. From there, she moved into dental offices, then oral surgery, then general dentistry working with developmentally disabled adults (where she learned the critical importance of trust and empathy), and finally finished her clinical career working for a maxillofacial surgeon doing complex jaw resections and implant cases. Throughout her entire clinical journey, she was always in management—never technically clinical—but always asking "why, what, how, and when" about everything so deeply that she could translate that knowledge into training clinical staff to work more efficiently. She describes her approach as "inside out" because that's literally how she fell into dentistry. When she decided to leave clinical practice and build her consulting firm, she named it NMG Practice Solutions. NMG stands for "no me gusta"—Spanish for "I don't like that"—which came from a family joke that she creates solutions for problems doctors don't like. It's her brand: fix the things that are broken, frustrating, and holding the practice back.

Over 20+ years of experience, Lana noticed an unmistakable pattern in every single office she walked into: the doctor was maxed out, completely taxed, stressed to capacity. Team culture was terrible, referral patterns unclear, finances overwhelmed. Doctors thought the solution was to work harder, but Lana could see the real problem: there were massive leaks in the bucket. Systems were broken, money was hemorrhaging, and effort alone couldn't fix it. This connects directly to what Alex Hermozzi describes as "the constraint"—the ceiling that a business hits where it can't grow beyond without fixing the actual limiting factor. Most doctors blame themselves and work harder, but the constraint is usually something systemic: unclear roles, broken communication, poor delegation, lack of case acceptance tracking, no dedicated treatment coordinator. When Lana starts working with a practice, the first pain point they mention is almost always financial. "Lana, I'm having a problem with my overhead. I don't understand my numbers. I don't know where my patients are going with their treatment plans." But finance is rarely the actual problem—it's the symptom. The disease is broken systems elsewhere that are leaking money and creating strain.

One of the biggest leaks Lana sees is case acceptance, and it's rarely tracked accurately. She had a discovery call with a practice owner who had no idea where their case acceptance actually was. They thought they were doing fine, but they hadn't measured it. When you actually start tracking case acceptance (instead of guessing), most practices discover it's 20-40%, not the 80-95% they thought. That's a massive leak. How do you fix it? Lana's first question is always: "Do you have a dedicated Treatment Plan Coordinator?" And the answer is almost always no—even in specialty practices. The treatment plan coordinator is one of the most essential and important positions a practice can have, but most don't. They might ask an assistant or office manager to also do it, but someone needs to be dedicated to the treatment plan coordination process because that immediately bumps case acceptance. Why? Because it's a dedicated hands-on touchpoint, and more importantly, because the coordinator understands both the clinical reasoning (why this treatment is necessary) AND the psychology of the patient. The coordinator has to have a healthy relationship with finances themselves—if they feel $1,000 is expensive for tires, they'll project that money anxiety onto a $3,000 crown and the patient will feel that hesitation. The coordinator needs to understand the diagnosis as deeply as the doctor so they can translate it into language the patient understands. When patients ask "Do I really need this? It's expensive and we have a Disney vacation," the coordinator with the doctor's full backing can say "yes, you do, and here's why" with complete confidence. That transcends to the patient.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

What happens when a dental hygienist working for an implantologist in Washington, DC gets asked to travel internationally teaching other dental teams how to support cutting-edge implant techniques, says yes, launches a 40-year speaking career while maintaining clinical work, moves to Singapore where she can’t practice dentistry, returns to the US and gets hired by Philips to be an educator delivering continuing education courses to dental professionals worldwide, spends 20 years in corporate education while building her own speaking business, and realizes that the common thread tying together her entire career—hygiene, device education, corporate training, and speaking coaching—is communication and influence? Lisa Copeland does exactly that, and through 40 years of speaking experience and thousands of interactions with patients, teams, and audiences, she discovers that every conversation truly does have consequences. If you’ve ever wondered why some practices have patients who enthusiastically accept treatment while others struggle to get case acceptance above 50%, why some dentists seem to effortlessly build referral relationships while others do excellent clinical work but stay small, or why certain speakers command rooms while others have credentials but no influence, this episode will completely transform how you think about communication, clarity, presence, and the power of making every conversation count.

Lisa Copeland started her career as a dental hygienist and spent 35 years in clinical practice. While working for an implantologist in Washington, DC who was one of the pioneers bringing implant techniques to the US, he asked her to travel internationally with him teaching other dental teams about their roles in the implant process. She said yes, and that moment launched a 40-year speaking career that would run parallel to her clinical work. She worked for a dental implant company, then when she and her husband moved to Singapore, she couldn’t practice dentistry. When she returned to the US, Philips hired her as an educator to deliver continuing education courses to dental professionals (dentists, dental assistants, hygienists) worldwide. She spent 20 years in that corporate role while simultaneously building her own speaking business called Communicate with Influence. The through-line of her entire career—hygiene, speaking, corporate education, and now coaching—is communication and influence. She eventually transitioned to full-time speaking coaching, helping others structure presentations and deliver messages that stick.

From 40 years of clinical and speaking experience, Lisa has learned something critical: every conversation has consequences. When a patient comes to the chair and says certain things, what they literally say is almost never what they actually mean. Patients are afraid of dentists. When a patient says “I need to think about it,” they’re usually saying “I’m afraid.” When they say “that’s too expensive,” they’re often saying “I’m confused or I don’t have enough information to make a decision or move forward.” When they say “I’m too busy,” they’re saying “I don’t trust you yet.” This is the tip of the iceberg—what’s visible on the surface. What lies beneath is what really matters. Missing these hidden meanings leaves money on the table and patients walking away without treatment they need. The same principle applies to team communication and speaking. The foundation of case acceptance is ensuring that every single team member is saying the exact same thing to patients. If a patient asks the hygienist a question and gets one answer, then asks the assistant and gets a different answer, and then asks the doctor and gets yet another answer, confusion sets in. And confused minds always say no. Patients will not move forward when they’re confused.

The second critical element is intentional handoffs. Instead of a patient finishing with the hygienist, going to the reception area, and then being taken to the doctor by whoever happens to grab them next, there should be deliberate transitions. The hygienist says to the receptionist (by name) “Carol, this is Mrs. Smith. She’s going to be waiting here for her appointment with the doctor. Mrs. Smith, Ange will be out to get you in just a few minutes.” Then when Ange comes out, she introduces herself: “Hi, I’m Ange. I’m going to be working with the doctor today. We’re looking forward to seeing you. Come on back and we’ll get you started.” Now Mrs. Smith has heard names and faces introduced intentionally—it creates continuity and confidence. This happens all day, every day, and it makes an enormous difference in how patients perceive the practice. The hygienist also plays a crucial role in priming the doctor. If the hygienist sees suspicious areas, she mentions them to the patient but doesn’t diagnose: “There are a few things I want the doctor to look at.” Then she tells the doctor exactly what she saw so he can reiterate the same information when he comes in. Where this often falls apart is with periodontal disease. The hygienist talks to the patient about periodontal disease and the need for scaling and root planing. The patient understands the situation. Then the doctor comes in and says “Yep, looks great” or doesn’t emphasize the same points, and suddenly everything the hygienist said feels dismissed. The patient hears conflicting messages and doesn’t move forward.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

What happens when a health tech executive laid off abruptly from his job tries to do the right thing by getting dental coverage for his family through the insurance exchange, spends extra on premiums for what he thinks is robust coverage, shows up for his dental appointment with his wife and four kids only to discover that his insurance has a six-month waiting period that means all five family members' visits are out-of-pocket, stands at the front desk as a puddle on the floor realizing he just got bills for thousands of dollars he can't afford to pay, and then hears the front desk lady almost whisper "we have this thing called a membership plan that would save you a lot of money"? Josh Rich does exactly that, and the moment he learns that a membership plan would have cost less per month, provided more value, included everything immediately with no waiting period, and applied all discounts right away, he can't believe he'd never heard of it before—and realizes that this is exactly why membership plans matter. Over 70 million Americans don't have any dental coverage at all. Membership plans are cheaper and better than individual insurance plans for uninsured and underinsured patients. And they're far more profitable to the practice than PPO patients or cash-pay-only patients. That personal experience becomes his north star when he joins Clerri, the dental industry's leading membership platform, after 15+ years in health tech (starting at Solution Reach as employee 106 at a company that grew to 800 employees, learning the dental and eye care markets, and watching firsthand how the right technology transforms provider practices). In this transformative conversation, Josh reveals the staggering financial impact of converting cash-pay patients to membership patients: a 76% increase in visit frequency, 176% increase in treatment acceptance, and 2.6 times fewer no-shows. He walks through why Clary's multi-layered team approach (dedicated onboarding specialists, long-term support reps, patient-facing renewal teams) drives higher enrollment and renewal rates than competitors. He shares the most underutilized membership growth strategy: positioning the membership plan as an employer benefit for small businesses in your community (retail stores, coffee shops, trade companies) who aren't offering dental to their employees—creating a pipeline of highly profitable, loyal patients. He explains Clary's groundbreaking integrations coming soon (including a native partnership with Cherry Patient Financing that shows pre-approved financing amounts in real-time so practices can help patients say yes to treatment), and most powerfully, his golden nugget: don't do practice ownership alone—lean into partnerships, relationships, and advisors who've been down the road before, because getting to where you want to go is best done surrounded by people who believe in you, not in isolation. 

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

What happens when a college student working at Barnes & Noble for $7.95 an hour sees a newspaper ad for an orthodontic assistant position (no experience necessary) paying $10/hour, takes the job in Columbus, Ohio, quickly moves into clinical coordinating across four locations, gets the opportunity to open an orthodontic practice from scratch with an orthodontist (and learns everything about designing and managing a practice on the fly), then goes to graduate school for a Master’s in Healthcare Administration (essentially an MBA for managing hospitals), works in hospital-based dentistry associated with teaching hospitals and residency programs, and realizes she can take enterprise healthcare techniques and apply them to private dental practices?

Erin Glending does exactly that, and after starting her consulting company in 2014 while still working in hospitals, she makes the full transition to consulting full-time during COVID when hospital systems became unmanageable, recognizing that private dentists suddenly needed the same systems, protocols, and reliability frameworks that hospital systems had been using for decades. In this incredibly practical and eye-opening conversation, Erin introduces the concept of High Reliability—a system developed in aviation, nuclear power, and the military, adopted by enterprise healthcare, but almost completely absent from dental practice management—and reveals why the difference between a thriving multi-seven-figure dental practice and one stuck at $50K/month production has almost nothing to do with clinical skill.

Most powerfully, she reveals that the entire culture shift of high reliability starts with one radical idea: problems that happen are NEVER people problems—they’re always system problems—which means if you have an underperforming team member or lots of errors, you don’t retrain or PIP the person, you redesign the system so that the error can’t happen regardless of who’s in the room. If you’ve ever wondered why some practices have teams that seem happy, engaged, and energized while others have constant turnover and burnout, why some doctors can work fewer hours and make more money while others work themselves to exhaustion, or what the real difference is between a practice that feels like it’s running on talent versus one that runs on design, this episode will completely transform how you think about systems, culture, burnout, and what it actually takes to build a reliable, sustainable dental practice.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

What happens when a mechanical engineer spends 10 years in high tech, quits cold turkey in 2005 with no great plan, builds a small consulting firm with his grad school roommate, pivots to start a dental marketing agency in 2009, focuses exclusively on dentistry by 2011, works with a general dentist who built a traditional corporate DSO from 2005-2015, watches that doctor exit and get bombarded by other doctors asking him how to build a group, becomes partners with that doctor's consulting company in 2018, spends years learning the DSO model inside and out, and comes to a profound realization: the DSO model is fundamentally broken—like a taxi service where the customer experience is terrible but the incumbent dominates because there's no alternative?

Ian McNickle does exactly that, and by 2021-22, instead of building another DSO, he interviews over 200 doctors across an 18-month period, asking them what stresses them out about private practice, what they'd like to delegate, what would attract them to join a group, AND crucially, what horror stories they've heard about groups. He also talks with investors, attorneys, accountants, and investment bankers to understand how to build something legally compliant, attractive to capital, and actually good for doctors. In 2024, he officially launches Icon Dental Partners as a DPO (Dental Partnership Organization)—not a DSO—with a radically different structure where the doctor's clinical autonomy, team employment control, work schedule flexibility, and branding all remain completely in the doctor's hands, while Icon handles HR, payroll, recruiting, IT, cybersecurity, marketing, financials, bookkeeping, accounting, leases, and legal.

In this eye-opening conversation, Ian reveals why DSOs concentrate too much power at the holding company level (where investors can change agreements and eliminate autonomy), how he decentralized Icon's structure so that what defines a doctor's control is in individual agreements that NO board change can touch, why he made his board majority doctors so they have a real seat at the table, and how Icon offers doctors the best of both worlds: the culture, control, and branding of private practice PLUS the negotiating power, expertise, centralization, and potential financial upside of a group.

Ian McNickle started his career as a mechanical engineer in high tech, spent 10 years there enjoying the work and management positions, but felt an itch to be an entrepreneur. Around 2005-2006, he quit his job cold turkey without a great plan—he admits in hindsight it was a dumb move, but when you're young and ambitious, you just go for it. He and his roommate from grad school started a small consulting firm in the northwest for a few years, then in 2009 partnered with another person to start a marketing agency. By 2011, they decided to focus exclusively on the dental industry. He built that company for many years while also getting to know dental practices as clients. One of his former clients was a general dentist who had built a dental group using a traditional corporate DSO model from 2005-2015. When that doctor exited his group, other doctors started asking him how to build a similar group. That doctor started a consulting company and approached Ian to be his partner in 2018, knowing Ian was an entrepreneur who understood the dental industry. From 2018-2021, Ian split his time between the marketing company and the group consulting company, learning deeply about the DSO models. What he realized was that the DSO model is fundamentally flawed. Doctors don't typically like it, it's not necessarily better for patients, and team members don't like it either. He compares it to the taxi industry—a terrible customer experience dominated by an incumbent with no alternative. But whenever you have that situation where customers aren't happy, there's an opportunity for disruption and innovation.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

What happens when you're born into dentistry (literally—dad's a dentist, mom's a hygienist), grow up stuffing envelopes and licking stamps, travel with your parents on humanitarian trips to serve orphans in Guadalajara, Mexico right after your first baby is born, and realize that patient experience and service is what lights you up? Rebecca Herring becomes a college professor of ballroom dance at the College of William and Mary, teaches kinesiology and dance majors, realizes after 15 years her body is done but her mind is not, goes back into dentistry with her passion for coaching and working with teams, works with private practices and small DSOs on the West Coast helping them grow multiple locations, takes a break to work in the veterinary industry's HR business partner role managing huge teams and C-suite leadership, then comes back to dentistry with a completely transformed understanding of compassion, empathy, tough conversations, growth, and development.

In this incredibly practical conversation, Rebecca reveals why the moment you have a "unicorn team member"—that one person who knows everything, knows where all the passwords are, knows how to schedule correctly, knows how to present cases, is the one everyone goes to for insurance problems—you've actually created a practice that ISN'T a system but a dependency that puts catastrophic stress on your strongest people. She shares what happens when that unicorn gets sick, has a family member pass away, or just burns out from being everyone's safety net: the whole practice collapses because you realize you never had a system, just one person.

She walks through why teams don't need to understand every clinical detail or every revenue cycle nuance, but they DO need to understand how their role connects to everyone else's (when the clinical team forgets to mark "procedure complete" in the back, the front office can't collect the full amount when checking out the patient), why you should stop asking "who dropped the ball?" and start asking "what part of our system allowed this to happen again?" (one question changes everything from blame to problem-solving), and why the most commonly missed systems are the ones that exist but haven't been detailed out enough that everyone truly understands every touchpoint. She explains how to implement a cadence for reviewing processes (revisit every six months), why you should assume every system has never been taught to anyone even if it has (because people make different assumptions), and how the EDGE method (Explain, Demonstrate, Guide, Enable) transforms how teams actually learn and own their roles. Most powerfully, she reveals that when team members feel valued and appreciated, they will give you more than you expect—and the opposite is also true: when brilliant A-players get stuck being the unicorn, they withdraw, get quiet, start calling out sick, and eventually leave. If you've ever felt stuck at a certain practice production level, wondered why team members who started great suddenly become disengaged, or realized you're completely dependent on one or two people holding everything together, this episode will completely transform how you think about systems, culture, and what it actually means to build a scalable practice that doesn't collapse the moment your best person has a bad week.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee that if you don't grow, you don't pay. We are truly invested in your growth and making a positive impact in the industry through ethical, honest marketing. As Rebecca powerfully illustrates in this episode, you can spend all the money you want on marketing and create all the demand in the world, but if your team doesn't have systems in place, if your front office doesn't know how to answer the phone or explain what you do, if your clinical team doesn't understand how their process affects collections, if you're dependent on a unicorn employee who knows everything—you will never feel the ROI. We don't work with everybody, but if you need help with marketing, head over to marketing32.com. We'll have a quick discovery call and find out if it's a great fit to work together. The best marketing in the world can't overcome broken internal systems, lack of clarity, and team dysfunction. When you combine smart, ethical marketing with solid operational systems, clear processes, and a valued team that understands how their role connects to the whole picture—that's when practices truly thrive and scale beyond their ceiling.

What happens when a 1992 Alaska Airlines flight attendant moves from Seattle to Eastern Washington, decides she can't leave her kids for four days at a time, falls into dentistry through a friend of a friend, and spends the next 30+ years discovering that every dental practice has essentially the same challenges but solves them so differently that results vary wildly based on culture, engagement, and systems? Callie Ward stayed with her first practice for 10 years, went back to school for a master's degree in education, taught for 3-4 years, then realized dentistry was where it was at and came back—managing single locations, multi-locations, teams from 4 to 30+ members. When her youngest graduated high school, she'd done every report for that practice and cleaned up everything, got bored, wanted more, and started understanding "the game of dentistry" beyond the day-in-day-out routine. She spent about eight years with Productive Dentist Academy, then took the entrepreneurial leap herself (because you have to walk the talk), worked with Support DDS during her non-compete year, and opened her own consulting firm. The name? Dash Dental Consulting—named after her grandma name from her grandson (who turns nine next week) because we're born, we die, and what's in the middle is our Dash—what do we do with that Dash? In this deeply practical conversation, Callie reveals why morning huddles must start with positivity and celebrating yesterday ("who can we shout out?") before unpacking opportunities (because neuroscience supports that we're more likely to try differently in safer environments), why the year you took technology from paper charts to computers you were taught "do things this way" but never told WHY (so you never questioned whether a different way might work better), and why the most successful practices aren't the ones with perfect systems but the ones willing to experiment and celebrate what they're learning as they're learning it. She shares why hiring "really nice people who are good with people" for front office doesn't mean they're great at collecting money or training patients to show up for appointments, why nobody told her at 25 that the goal of a shopper call is to get them on the schedule (basic, right?—but nobody said it), and why you can produce $3,000/hour but if you're not collecting and you've got $100K in the over-90-days bucket because Mary's been doing collections for 30 years and she's friends with everybody so it's uncomfortable to call, you'll never feel the ROI from marketing. If you've ever wondered why some practices with the same business model thrive while others struggle, how to create a culture where team members catch each other doing jobs well done instead of only focusing on negative, or what it really means to work ON your practice instead of just IN it, this episode will completely transform how you think about leadership, systems, accountability, and what it takes to build a practice where people actually want to show up.

Callie Ward never planned a career in dentistry—she was an Alaska Airlines flight attendant in 1992, moved from Seattle to Eastern Washington, and realized she couldn't leave her kids for four days at a time. A friend of a friend had a dental practice looking for somebody to hire, and Callie fell into dentistry. What she absolutely loved was the heart—the people. In a small town in Eastern Washington, patients became your family, you knew their families' families, the circle just got bigger with connections. She stayed with that first doc for about 10 years, decided she needed to go back to school, got her master's degree in education, taught for 3-4 years, then decided dentistry was where it was at and came back. She's managed single locations, multi-locations, teams as small as 4-5 members up to 30+ members. She transferred into consulting when her youngest child graduated high school—she'd done every report for that practice, cleaned up everything she could, and was bored. She wanted more and was starting to understand "the game of dentistry." It wasn't just the day-in-day-out routine; the business side was intriguing, and she likes to gamify things. She fell into consulting, had a friend doing it who made it look fun, and spent about eight years with Productive Dentist Academy. She loved her time there but knew she always felt like we need to walk the talk—if she's working with entrepreneurial dentists, she should be more entrepreneurial herself. She took a year off, worked with Support DDS during her non-compete, then opened her own consulting around 2022-2023.

Dash—her company name—is actually her grandma name. Her grandson (who turns nine next week) named her Dash, and it really fit into something she's passionate about: we're born and we die, and what's in the middle is our Dash. What do we do with that Dash? Looking back at being in the trenches, it was a great job, consistent, she loved it—but it wasn't feeding her, wasn't filling her cup. She was working with providers not necessarily in the mindset of having their team work ON the business. They were looked at as clock punchers (which we need), but they weren't involved in the process of growing the business. Once she got into the management role and started seeing that side, she became passionate about helping people who show up every day. How do we help them fill their cup? Even if their role is limited (there are only so many positions in a dental practice), what blew her away working with so many different practices is that we all have the same challenges, essentially the same business (different models, different sections), but how differently we solve those problems. How different the results can be based on culture, engagement, and systems. When she came into dentistry in '92, it was a book they were scheduling. She was the technology girl taking paper charts and putting them into computers. You do things the way you were taught but don't necessarily understand WHY you do it that way. In coaching, she started learning: well, why DO we do it that way? What if we tried a different way? Could we possibly see a different result? That became fun—looking at data, getting real numbers, basing decisions on facts, but then asking "what if we tried this?" and working with the team so THEY'RE telling her what their solution is, what they could try differently, instead of her telling them what to do.

It comes from teaching: she can't dictate to students "this is what you do" if she wants it to stick, if she wants them thinking outside the box. She has to ask questions that lead them where she's looking to go. But oftentimes they come up with answers she wouldn't have, and when they collaborate on that system or solution, they're more likely to do it because she wasn't just telling them what to do. She loves helping people feel great at end of day, helping docs learn how to communicate. They're really great at dentistry, but there's a whole human being behind that mouth. How do we help them connect to the human being FIRST before going to dentistry? That's where we see impacts. That's how team members continue to be passionate about their practice and not leave. COVID was brutal in the industry, and the docs seeing success are the ones able to create culture where their team is engaged, wants to show up, and looks at patients as if they're THEIR patients. The game of business is: well, there's this problem, how do we solve it? Do we have to keep solving it the same way? The irony is it takes a special person to hire a coach or consultant—it's somebody holding you accountable, it's uncomfortable, change is uncomfortable. But reality is if you've tried all the tools in your toolkit and you're still seeing the same result, you need somebody else's eyes. To Callie, consulting is like raising teenagers: if she did her job right, they're going to leave and be successful on their own. They can always come home, always have a meal, always realign, but if she did her job well, they don't need her. That's different than consultants who want to be needed, want to be right. She just wants to get them excited, line them up, get them fired up to be happy—empower them.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.