First week back - a week in dental business coaching

After almost a month away from my normal rhythm, I returned to my desk last Monday and stared at the accumulated emails, recordings, financial reports and tasks like a rabbit in the headlights. By Friday evening I had cleared about half of the backlog, and the conversations had given me a clear picture of what is happening in independent dentistry right now.

The white space problem is real

The most common anxiety remains white space in the diary. After the post-pandemic period, when many practices had more patients than capacity, the pendulum has swung. Consumer confidence is softer, patients are more cautious and treatment is being deferred. Empty surgery time is now appearing further ahead in diaries.

We cannot alter interest rates, taxation, international conflict or the mood created by the news. We can decide how a practice responds. White space is not one problem. It is normally the combined effect of weak financial information, inconsistent marketing, leakage in the patient journey, poor diary management and a team that has lost confidence in asking for the next appointment or the referral.

At the Bristol workshops last week we brought this down to a simple commercial truth. Every unused hour raises the operating cost of the remaining hours. In many practices, the cost of opening a surgery now sits somewhere between £720 and more than £1,000 per day. Once fixed costs have been covered, the later hours in the day create the margin. Lose those hours and the super-profit disappears very quickly.

The answer is not panic marketing. One coaching conversation returned me to a small hilltop restaurant in Ithaca called Myrtia. It is inconveniently located, unapologetically expensive and full. It wins through exceptional hospitality, confident positioning and targeted marketing.

That is a better lesson for a premium dental practice than a hurried discount or another free whitening offer. The best response to nervous consumers is to improve the experience and the communication. Sometimes that means better digital follow-up. Sometimes it means a fountain pen, good stationery and a handwritten note to a patient who has paused a significant treatment plan.

Management is being redesigned, not merely replaced

The second recurring theme was management strain. I heard from owners dealing with a practice manager resignation, stressed nurses, absent team members, recruitment gaps and too many decisions returning to the principal. One manager had given up her own annual leave to cover colleagues. Another owner was worried that exhausted nurses might leave while repair work disrupted the practice. These are not isolated human resources problems. They are warnings about the architecture of the business.

When a practice manager leaves, the question is not automatically, ‘How quickly can we replace them?’ The better question is, ‘What management structure does the business now need?’

Compliance, nursing leadership, patient journey, operations, finance, people and marketing are different responsibilities. They need named owners, written authority, protected management time, scorecards and a meeting rhythm. If those responsibilities are distributed informally, the owner becomes the integration point for everything and is soon back in the role of chief rescuer.

That message also sat at the centre of my Campbell Clubhouse session on leadership on Wednesday evening.

Managers manage systems. Leaders lead people. The owner’s journey is from brave warrior, doing everything personally, to considered architect, building the structure, and eventually to wise monarch, holding the vision and asking the important questions. Growth without that transition does not create freedom. It creates a larger and more expensive prison.

Turnover can hide the real story

Whilst sitting at the back of the room during Colin Campbell's Consultation Masterclass, Friday became a day of financial analysis.

I reviewed a series of management packs and produced visual reports covering profitability, clinician economics, capacity and maintainable EBITDA. The details varied, but the lesson was consistent. Turnover is not the same as financial health.

One practice had broadly stable revenue but a corrected EBITDA margin of only 2.2 per cent once errors and adjustments were dealt with. Another month looked poor until a large one-off surgery cost was separated from normal trading, revealing a much healthier underlying result. Elsewhere, an apparently profitable hygiene service needed to be tested against room use, clinician days and the opportunity cost of the surgery.

Owners must know their operating cost per utilised surgery per day, chair utilisation, average daily production, clinician contribution and true adjusted EBITDA. They must also be able to trust the data. A beautifully formatted spreadsheet containing the wrong clinical day count is still the wrong answer.

The same discipline applies to associate conversations. Reducing a percentage is a blunt instrument and normally creates a lose-win discussion. A better conversation begins by reassuring the clinician that this is not a pay cut, then walking together through the numbers and agreeing how both clinician income and practice profit can improve. Better utilisation, stronger diagnosis, improved treatment presentation, more appropriate delegation and a 90-day development plan are productive levers. Resentment is not.

Recruitment is changing shape

Recruitment remains difficult, but the market is changing. I heard that foundation dentists have all secured places this year, leaving nobody spare and prompting some clients to look more seriously at overseas sponsorship.

At the same time, pressure inside large corporates is creating a pool of experienced operations people and clinicians who want to return to independent dentistry, closer to patients and further from private equity targets.

The opportunity is to recruit with more imagination. One owner is considering an apprentice dentist whom she can mentor and develop. Another has appointed a business manager with decades of retail and corporate dental experience. The common factor is that the best appointments are not simply a pair of hands. They add capability to the organisation.

Hungry, humble and people-smart remains a better starting point than a glossy CV and an urgent need to fill a chair.

Growth requires a blueprint

Some of last week’s conversations were about survival and stability. Others were about acquisitions, second sites and eventual exits. I moderated an acquisition discussion involving two connected practices, formal valuation, deferred consideration, property and a staged clinical handover. I spoke with an owner planning a second location within 8 to 12 months, and with another group ready to replicate a successful multi-service model.

The warning is the same in every case. Integration is harder than acquisition. A second site does not repair weak systems in the first one, it reproduces them.

Before expansion, the business needs reliable management information, documented systems, a senior leadership team and clarity about who will carry clinical trust when the founder steps back.

The most interesting exit conversations are no longer simply about selling. Increasingly, owners ask whether they can build a ‘golden goose’, a business that is sufficiently profitable and self-managing that selling becomes a choice rather than an escape. That is a much better ambition, but it demands the same fundamentals: margin, management and a business that can continue without the owner being permanently available.

AI has arrived, but judgement still matters

This was also the week in which the practical potential of artificial intelligence became impossible to ignore. Recordings were turned into summaries and action plans. Financial data became clear, visual coaching reports. Gamma presentations made complex analysis easier for clients to absorb.

I saw how a practice can combine clinical notes, Gamma and a short video to produce a polished patient treatment plan within minutes. I also recorded a podcast about an Australian programme that helps practice managers build their own AI-assisted recruitment, onboarding, meeting and SOP systems.

My own rule is emerging: let artificial intelligence complete 80 per cent of the routine work, then apply 20 per cent natural intelligence. The final judgement, tone, challenge and empathy must remain human. Technology can increase our capacity. It cannot care about the client, notice what is not being said or take responsibility for the advice.

The Campbell Academy team and I are now exploring how these tools can strengthen business education at scale. The relaunch of Extreme Business under The Campbell Academy is planned for 1 September, supported by a broader team, a clearer learning pathway and a much larger library of resources. The old model depended too heavily on Chris Barrow being ‘always on’. The next model must deliver more value without recreating the same ceiling of complexity.

And finally, the coach is also a work in progress

My own weekly tracker contained the same issues I see in clients. Workflow backlog. Too little white space to train colleagues and work on the business. The need to extricate myself from work that no longer belongs to me.

The difference was that I could also see the wins: two exceptionally well-received Bristol workshops, a productive Campbell Academy management meeting, new client enquiries, a first run in five months, a week without alcohol, and an afternoon being Dad and Grandpa.

That is the honest overview of my first week back. The market is not easy, but its problems are visible and soluble. Know the numbers. Protect the diary. Build the management team before the next surgery. Market confidently when others retreat. Use technology to remove friction, not humanity. Build a business that supports a life, rather than postponing one.

There is plenty to do. I am pleased to be back.