By David Rice, DDS
I’m betting you didn’t go to dental school expecting to become a full-time people manager. Reality is, I’m also betting that’s exactly what most days feel like. See if this sounds familiar. It’s what my team and I hear every week.
“I was happy on the way to work. I was ready
to be my best self. I pulled in, parked,
walked in and within the first 5 minutes …
One of my front desk team members shared
their frustration with scheduling,
One of my hygienists gave me ‘that less than happy look’,
An assistant repeated the same mistake
we’d spoken about five times,
And I found myself wondering why it is I was doing
this dentistry thing in the first place.”
The same conversations, the same frustrations, the same problems and you find yourself wondering why things seem harder than they should.
- You’re working harder today than you were five
years ago. - You’re continually investing in expensive technology.
- You’re attending continuing education classes.
- You’re improving your clinical skills.
- Yet somehow, the people side of the practice continues to feel exhausting.
Ring a bell? You’re not alone.
The fact is, one of the greatest misconceptions in dentistry today is that many practice challenges are team problems. Very often, they’re not. They’re leadership, communication and accountability problems disguised as team problems.
The Greatest Threat to Practice Growth
Many dentists believe the greatest threats to growth are reimbursement, competition, artificial intelligence, team shortages or economic uncertainty.
Sure, those matter.
But after working with hundreds of dental practices, our team has observed some notable differences. The greatest threat to your practice growth and peace today isn’t reimbursement, competition, AI or team shortages — it’s communication breakdown.
And a communication breakdown is very expensive because it rarely appears on a profit-and-loss statement.
Instead, it shows up disguised as: - Team turnover
- Burnout
- Scheduling inefficiencies
- Reduced treatment acceptance
- Poor patient experiences
- Production stagnation
- Drama
- Frustrated leaders
- Difficulty growing
Most practices do not suffer from a lack of effort. They suffer from a lack of alignment.
Where Communication Breaks Down
Communication failures rarely happen because people are intentionally creating problems. They happen because leaders assume everyone understands their expectations when they don’t.
Have a look at where it goes sideways and ask yourself what hits home:
- Avoidance of Difficult Conversations
A team member consistently underperforms. Everyone knows it. Nobody addresses it. Days become weeks. Weeks become months. Months become years.
Then the behavior spreads because the rest of the team sees that poor performance carries no consequences.
The problem isn’t the employee. The problem is the conversation that never happened. - Lack of Role Clarity
Ask five team members who owns a particular responsibility and you may receive five different answers. Simple examples I’d ask today if I were you:
- Who owns unscheduled treatment follow-up?
- Who owns patient reactivation?
- Who owns insurance aging?
- Who owns same-day treatment opportunities?
When ‘ownership’ is unclear, everyone assumes it’s someone else’s job, and accountability disappears.
- Inconsistent Expectations
Many practices unintentionally create confusion because expectations vary depending on the day, the doctor’s stress level or the situation. When expectations are inconsistent, teams stop trusting the system and begin relying on personal interpretation. - Assumptions Replacing Communication
One of the most dangerous phrases in any practice is … “I thought someone else was handling that.”
Assumptions create gaps. Gaps create mistakes. Mistakes create frustration. - Failure to Address Problems Early
Small issues rarely remain small. A scheduling issue becomes a production issue. A communication issue becomes a culture issue. A performance issue becomes a resignation.
Problems don’t magically disappear as we’d hope. Most major practice problems begin as minor conversations that you and I postpone.
How Communication Problems Are a Production Problem
Communication challenges are often viewed as “people issues.” In reality, they quickly become business issues. Please re-read that. Communication is not a soft skill. It’s as critical as everything we do with a handpiece.
Consider a patient who leaves without scheduling treatment. It’s easy to assume your treatment coordinator (or admin team member) will follow up.
- The treatment coordinator assumes the patient needs more time.
- The front desk believes someone else has ownership.
- No one follows up.
- The patient disappears for six or more months.
- Their treatment never gets completed.
- They learn that the urgency is really so urgent.
- Their care is compromised, and
- The revenue is lost.
Was that a treatment acceptance problem? Or was it
a communication problem?
The same pattern appears everywhere. - Poor handoffs between hygienists and doctors
create patient confusion. - Unclear financial conversations reduce patient
confidence. - Missed reappointment opportunities create
hygiene gaps. - Inconsistent scheduling protocols create chaos.
- Poor communication creates cancellations, no-shows and unfinished treatment.
- The result is lower production, lower profitability
and higher stress.
Communication may feel intangible. Its financial consequences are not.
Every Team Is Perfectly Designed for the Conversations It Is Willing to Have
This may be the most important leadership lesson in dentistry. Culture is not created by mission statements. Culture is not created by posters on the wall. Culture is created by what leaders tolerate, avoid, reinforce and address.
If accountability conversations never happen, accountability disappears. If difficult behaviors are ignored, those behaviors become normalized. If expectations are unclear, inconsistency becomes the culture. Every practice is producing exactly what its communication system is designed to produce.
The good news?
You can redesign this in your practice right now.
Here’s Why We Struggle With This
If you’re reading this and thinking, “Guilty as charged,” that doesn’t mean you’re a poor leader.
It means you’re normal. Dental school taught us to be clinicians. It didn’t develop us as organizational leaders.
Most dentists graduate with extensive clinical knowledge but little to no education in: - Leadership
- Conflict resolution
- Team development
- Accountability systems and/or
- Performance management
As a result, many of us default to what feels safe; we avoid conflict, hope problems improve and take on more work ourselves to compensate.
Here’s the deeper challenge, and I know, superficially, if you’re like me, you’ve convinced yourself this is a positive character quality.
Because you genuinely care about people, you want to be liked, you want harmony and you don’t want to hurt feelings.
Unfortunately, avoiding crucial conversations most often creates greater harm over time.
The highest-performing leaders are not the most aggressive; they’re just the most willing to have honest conversations early.
Add the realities of patient care, production goals, team pressures, personal responsibilities and emotional exhaustion becomes inevitable.
The result is a leader who feels overwhelmed and a team that lacks direction.
Let’s Talk Practical Solutions That Create Immediate Improvement
The solution is not more meetings — it’s better communication systems.
- Weekly Leadership Meetings
You’re going to want to shoot the messenger. You’re going to wonder where you’re going to find the time. I’m okay with it, as every practice should have a dedicated leadership meeting.
Not a production meeting. Not a schedule review. A leadership meeting. This is where leaders discuss:
- Team challenges
- Accountability
- Key metrics
- Upcoming priorities
- Operational obstacles
Proactive leadership prevents reactive firefighting.
- Daily Huddles
A well-run morning huddle aligns the team before patients arrive. It’s a deeper dive, and if you’d like our exact recipe, visit bit.ly/4eJypja now. This meeting discusses:
- The most important action each individual team member will focus on today
- Same-day opportunities
- Unscheduled treatment
- Money
- New patients
- Potential challenges
Alignment reduces confusion and increases confidence.
- Role Clarity Documents
Every team member needs to know exactly:
- What winning is in your practice
- What they own
- Who can help when they need it
- How performance is measured
Clarity reduces conflict and increases accountability.
- Accountability Scorecards
If performance matters, we have to measure it. Simple scorecards create objectivity. Objectivity removes emotion and focuses conversations on outcomes rather than opinions. - Structured One-on-Ones
Most team members receive feedback only when something goes wrong. Friends, that’s a mistake. Routine one-on-one meetings create real relationships, trust, better communication and identify challenges before they become crises. - Performance Conversations
In short, the best time to address a problem is when it’s still small. You know it won’t get better on its own. Timely conversations prevent resentment, confusion and cultural erosion. - Consistent Communication Rhythms
Great practices operate on predictable communication systems.
- Daily huddles
- Weekly leadership meetings
- Monthly team meetings
- Quarterly reviews
Consistency creates stability. Stability creates trust. Trust creates predictable performance.
The Conversation That Changes Everything
Many dentists spend years searching for the next breakthrough. A new technology. A new marketing strategy. A new service. A new hire. Those investments can absolutely matter.
But often the greatest opportunity lies in conversations that haven’t happened yet. - The conversation about accountability.
- The conversation about expectations.
- The conversation about ownership.
- The conversation about performance.
- The conversation about character and culture.
When you and I, as leaders, become willing to have the conversations that matter, something remarkable happens. Stress decreases, alignment improves, patients feel the difference, teams become stronger and growth becomes easier.
Not because we found better people, but because we finally created a better system for people to succeed. It took my team and me years to see it and build systems to replicate this. If you’re ready for help, go to bit.ly/4eJypja.
FDA members get a 10% discount; learn more at floridadental.org/member-center/member-resources/ignitedds. Dr. Rice can be reached at david.rice@ignitedds.com.
Best-selling author, executive coach and founder of IgniteDDS, the nation’s largest community for new dentists and students, Dr. David Rice is a dynamic thought leader in the world of dentistry. With a passion for mentorship, leadership and business success, Dr. Rice travels the globe educating and connecting today’s top young dentists to their self-determined future.
As Editor-in-Chief of DentistryIQ and Adjunct Faculty at The Pankey Institute, Dr. Rice is at the forefront of innovation in dentistry, guiding professionals in clinical excellence, business mastery and leadership development.Best-selling author, executive coach and founder of IgniteDDS, the nation’s largest community for new dentists and students, Dr. David Rice is a dynamic thought leader in the world of dentistry. With a passion for mentorship, leadership and business success, Dr. Rice travels the globe educating and connecting today’s top young dentists to their self-determined future.
As Editor-in-Chief of DentistryIQ and Adjunct Faculty at The Pankey Institute, Dr. Rice is at the forefront of innovation in dentistry, guiding professionals in clinical excellence, business mastery and leadership development.
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