Before we discuss the philosophy of attaining the next plateau, permit me to address some issues that were raised in numerous e-mails to me regarding my previous article. Obviously, I won't touch on all the feedback, but rather on those areas I feel were of most concern.

If we postulate a solo dentist, there are physical and time limitations that preclude limitless growth. Regardless of the gurus you hire and study with, I believe there are limitations in the solo practice. Might there be some extraordinary individual somewhere who can prove me wrong? Maybe. But I have not met him/her in my 46 years in this business. And I have met some extraordinary dentists with some extraordinary practices.

Let's imagine two areas - let's make them circles with the same ten-mile diameter. And within each of these circles exists a group of 10,000 people that are exactly the same in every way - economically, socially, intellectually, ethnically, etc. Now, in one circle, we'll have one dentist. And in the other circle we'll have ten dentists.

Do you think the one dentist has greater practice potential than the ten? Of course! This holds true for all of us. We live in a real world. For example, in the suburban area in which I practiced, my sphere of influence (my drawing area) was about a four-mile radius. Sure, I had patients from as far away as Europe as well. But, let's face facts. The vast majority of my patients came from a 4-5 mile radius of my office. If thirty dentists practiced within a mile of me, we'd all be hard pressed to gather enough patients to survive. If three dentists practiced near me, it would be a lot easier to grow and thrive. So, location, location, location. Supply and demand. The old adages prove true and create limitations.

What's a good indication of practice potential? I believe it's the number of active patients a practice has. I define an active patient as one who has been in your office at least once in the last 18 months.

Suppose you have 500 active patients. And you see 80% of them twice a year for recall, generating $250 for each of them, for a total of $100,000. If this practice is "average," the hygiene production will be 23% of the total. So this practice - to be "average" - has the potential to gross $434,000. If you have 1,000 active patients, your potential is $868,000.

What I've tried to illustrate is two main factors in practice size/growth: (1) the number of patients matters, and (2) notice I said that they had the potential to achieve.

Let's discuss the numbers first. Can you have 500 active patients and produce $238,000 per year? Sure. Can you produce more than $434,000? Sure. How much more? I don't know the exact number, but it isn't "the sky's the limit." I believe you'd have a very real problem trying to make this into a $600,000 to $700,000 practice. It's just not there. Now bear in mind, I'm discussing G.P. type practices, not esoteric practices limited to high fee procedures.

Okay, we've discussed the possible limitations of a practice and the possibility of realizing a practice's true potential.

This is how, I believe, one attains the next plateau. There are no gimmicks to propel a mediocre practice, presided over by a mediocre dentist and a mediocre staff, to grand heights.

If you're on the bottom rung of the dental success ladder (i.e., the $ 250,000 to $ 350,000 level) and aspire to progress, you need to realistically assess your demographics - your supply/demand situation. Then you need to become introspective. I have observed that most practices stuck at this level have owners who are unsure of themselves - financially. They carry a family philosophy of scarcity. And, until they overcome their poor and fearful mentality, progress is impossible. They need to be convinced of their self worth and the value of the services they render before they can progress. Workshops by Avrom King or Sandy Roth would be appropriate places to facilitate change, in my opinion. Then, practice management consultation to put good, basic business practices and strategies into place to assure a smooth-running office with appropriate staff.

Once convinced of the value of the service we provide, it's a natural next step to want to provide the very best care possible. This won't happen with a one-day CE course here and there. I believe it needs a commitment to a philosophy, and the commitment involves time and money. This is why the scarcity philosophy must be overcome! You can't/won't commit if you feel poor. And you can't gracefully attain the next plateau without the training and inspiration of, for example, the Pankey Institute.

So, we progress from personal change to sound business principles in the practice with appropriate staff to a philosophy of quality care we're proud to render. And we're comfortable receiving a fair fee for such care. This journey can take a few years. It's not without pain and tribulation along the way. But true progress is never easy. This journey, for most who embark - not all! - should allow the practice to reach the $500,000± level.

The next plateau, I feel, requires a marketing effort to expand your sphere of influence to a wider circle, in order to attract the number of good (not insurance-oriented) patients needed to generate the higher numbers. One of the reasons we hear about some phenomenal rural practice doing one million a year is probably because he/she is the only dentist within a 25-mile radius and is swamped with patients from which he/she can choose - those patients who appreciate and want the best dentistry they can provide.

The journey through the plateaus is not for everyone. Some will be content to be insurance-based and gross $250,000 forever. They will never crack their scarcity shell and will think and act "poor" and be comfortable with that lifestyle. And that's okay.

Others will aspire to more. And for those who do, I have provided a guide. Not the only guide, to be sure - but a guide that I believe provides a solid framework for success. No quick fixes. Rather, a steady, sure growth in knowing yourself and knowing your work and knowing your patient.

For most of you, the next plateau is available. You have to "feel it in your bones." And step up, pay the price and take it.