Every Problem Wears Shoes

I had a heart-to-heart with a smart client this week. After an on-site training, it was painfully clear to everyone but him that two employees were sabotaging his growth.

“Let’s cut the nonsense,” I told him. “Your practice isn’t stuck because of marketing. It’s not your technology. It’s not even your location. It’s your people.”

He paused for a beat and then smiled. “I know. This was a test. I wanted to see how those two would handle the training. Their severance letters are already typed up.”

I can’t tell you how many times this has happened. Doctors send employees to our events—or bring us on-site—not because they’re looking for answers, but because they already know the answer. They just want the confirmation.

The truth is, 98% of practices stall out around three million. Why? Because that’s when you’ve got about a dozen employees, and suddenly every problem in your business has a first name, a last name, and a pair of shoes walking through your office door. Payroll balloons, overhead climbs, patient expectations rise—and without systems to manage and develop people, your growth chokes on its own success.

Apple pulls in over two million dollars per employee. Google comes in near $2 million. Meta and Netflix are also in the multi-million-dollar range. Even Microsoft sits comfortably above $1 million per head. They all measure productivity per head and obsess over it. Meanwhile, the average orthodontic practice limps along at $250,000 per employee and calls it “good.” That’s fragile. That’s why so many owners look around and think, “Well, at least I’m not back at $1 million. Three million isn’t bad.” But that comfort is a trap. Costs eat you alive while you tell yourself you’re doing fine.

The Trap of Three Million

The path to three million is predictable. You open your doors, deliver great work, and word spreads. Patients are happy, revenue climbs.

But then you hire. At first, it feels manageable. Then it doesn’t. The very thing that fueled your growth (more people) becomes the thing that stalls it. Payroll rises. Overhead rises. Expectations rise. And the disengaged, the undertrained, the unmotivated? They drag everything down.

Gallup reports that 67% of employees are disengaged at work (i.e., not invested in the organization’s success). That means if you’ve got 12 people, 8 of them are just showing up for a paycheck.

Two might even be actively working against you.

Suddenly, your “team” is pulling you under. This is why so many practices stall at three million: the doctor is fighting the laws of gravity with a group of people that doesn’t even know which way is up. At three million in annual revenue, if you’re running less than $250,000 of revenue per employee, the math simply doesn’t math. It will break you.

Why People Become the Problem

When you don’t have a system for finding, onboarding, and developing talent, chaos takes over. You hire in panic mode. Training is sloppy. Expectations are vague. Turnover ignites. Frustration builds. Standards slip. That’s how practices slide into what I call “comfortable mediocrity.” The owner convinces himself that three million is a win. It’s not. It’s fragile. And fragility has an extremely short shelf life.

The practices that punch through stop winging it and start systemizing. They know what they want. I’ve helped the top 2% in our profession build Top Performer Profiles so you stop hiring the wrong people. They onboard with intention, clarity and measurable objectives. This is where I help top groups build 30-, 60-, 90-day plans. We set clear expectations. We do not tolerate randomness.

We show new hires the roadmap. All employees can see their pay scale ramp, required competencies and deadlines, KPIs over which they will have control in how they contribute (and what happens when they do or do not hit benchmarks).

Employees see an exciting future or we know they will go find it somewhere else. Finally, we show them how to grow and provide the systems and support to make it happen. The best employees in any industry or profession are attracted to opportunity.

On a scale of 1-10, how exciting is the opportunity road map in your practice?

Be honest.

What about the biggest, most successful group in your town? You don’t just want to be the best place for patients to receive care, you also want to be the best place in town for employees to work. Without this, you’re just spinning staff in and out like a revolving door. Ask me how I know. Between 2006 and 2012, we grew annual revenue per full-time employee (FTE) from $185,000 to $435,000. I can tell you without hesitation: everything gets better above $350k per FTE. Profitability, resiliency, and scalability all become possible without burning out the doctor or the team.

The BIG Takeaway: I wasn’t try to be cute with the title of this article. Every problem really does wear shoes. The good news? Every solution does, too.

Stop blaming your marketing, your location, or the economy. Start building the systems that turn people from your biggest headache into your greatest advantage. This is how you can stop running a practice and start leading one.

To help you get there, we’ve created a Revenue per Employee Calculator & Benchmark Guide. It shows you exactly where your practice stands, how you compare, and what it takes to hit the $350k–$400k sweet spot.

Download the free guide here.

Use it in your next leadership meeting. Know your number. Step into your strength. Invest in your people then get out of their way.