May 16, 2025
I've been thinking a lot lately about what separates orthodontic practices that really take off from the ones that seem to plateau after a few years. Sure, good clinical work matters. But here's what I've noticed: the practices that scale successfully almost always have one thing in common - strong leadership at the top.
That might sound obvious, but I think a lot of us in orthodontics don't realize just how much our leadership style affects literally everything in our practice. Your team's performance, how patients feel when they walk in, whether your systems actually work, even your bottom line. It all comes back to how you lead.
When you're just starting out, you can probably get by on clinical skills alone. But once you want to grow beyond just you working on patients all day? That's when leadership becomes make-or-break.
This is where most of us struggle, myself included. We know we want to "grow the practice," but what does that actually mean?
I learned this the hard way: vague goals create confused teams. Your team can't help you get somewhere if they don't know where you're trying to go.
Spend some real time thinking about what you want your practice to look like in five years. More locations? Specialized services like airway treatment? A certain number of patients per month? Whatever it is, get specific about it.
Then - and this is the part most people skip - share that vision with your team. Not just once during a staff meeting, but regularly. People work harder when they understand what they're building toward.
Make your mission and values real. Don't just put them on a plaque in the waiting room. Talk about them. Reference them when making decisions. Show your team how day-to-day work connects to the bigger picture.
Break big goals into smaller pieces. Saying "we want to double our patient base" is overwhelming. Saying "we want to add 20 new patients this quarter" gives people something concrete to work toward.
Your vision becomes the filter for everything else. Should we hire this person? Does this marketing campaign make sense? Will this new technology help us get where we're going? When you have a clear vision, these decisions get easier.
Here's something that took me years to figure out: as you grow, your success depends less on how good you are at orthodontics and more on how good you are at helping other people be great at their jobs.
I used to think I had to be the best at everything in my practice. Big mistake. What you really need to be is the best at finding good people and helping them succeed.
Hire for personality, train for skills. You can teach someone to use your scheduling software. You can't teach them to genuinely care about patients or work well with others.
Get serious about onboarding. Those first few weeks set the tone for everything. Don't just throw new hires into the deep end and hope they figure it out.
Regular check-ins are crucial. Not just annual reviews, but quarterly conversations about what's working, what isn't, and where people want to grow.
Give your best people opportunities to develop. Send them to conferences, let them lead projects, create pathways for advancement. Good people leave when they feel stuck.
When your team feels supported and challenged, they take ownership of their work. That's when scaling becomes possible, because you're not trying to manage every single detail yourself.
This is probably where most practice leaders mess up. As your team grows, communication gets exponentially harder. What used to be simple conversations become game of telephone.
Weekly team meetings are non-negotiable. But don't make them boring. Focus on victories, important metrics, and real challenges that need solving.
Use technology to stay connected. Whether it's Slack, Teams, or whatever, have a way for people to communicate quickly about day-to-day stuff.
Create safe spaces for feedback. Anonymous surveys, regular one-on-ones, whatever works. Your team often sees problems before you do.
Actually listen when people talk. This sounds basic, but most leaders are already thinking about their response instead of really hearing what's being said.
Good communication prevents so many problems before they start. When everyone knows what's expected and feels heard, everything runs smoother.
This might be the toughest leadership skill to develop, especially for perfectionists. If you try to control every detail as you scale, you'll become the bottleneck that stops your own growth.
I remember being terrified to let my associate handle certain cases. What if they didn't do it exactly how I would? But here's what I learned: "exactly how I would do it" isn't always necessary. "Good enough to meet our standards" is usually fine.
Trust your team with real responsibility. Give people ownership of projects, not just tasks. Let your treatment coordinator actually coordinate treatment without checking every decision.
Create systems that work without you. If something only functions when you're personally managing it, it's not a system - it's a dependency.
Focus on outcomes, not methods. Tell people what you need accomplished, but let them figure out how to do it.
Delegation isn't about losing control. It's about creating space for you to do the things that only you can do - like strategic planning, major decision-making, and growing the practice.
Culture happens whether you plan it or not. The question is: do you want to intentionally shape it, or just let it develop randomly?
I've seen practices where the culture was amazing when they were small, but it got diluted as they grew. New people came in, the original values got lost, and suddenly the whole vibe changed.
Write down what matters to your practice. Not just for marketing materials, but as a real guide for how people should behave.
Recognize the behaviors you want to see more of. When someone goes above and beyond for a patient, make sure everyone knows about it.
Address problems quickly. If someone's attitude is bringing down the team, deal with it. Even if they're clinically excellent.
Create traditions that reinforce your values. Team lunches, patient appreciation events, whatever feels right for your practice.
Your culture is what happens when you're not in the room. Patients can feel it the moment they walk in. Make sure it's something you're proud of.
You don't need an MBA, but you absolutely need to understand what drives profitability in your practice. Too many orthodontists are great clinicians but terrible business leaders because they ignore the financial side.
Know your key metrics. Case acceptance rates, cost per new patient, average treatment value, staff costs as a percentage of collections. These numbers tell you whether your growth is healthy or not.
Budget with purpose. Don't just wing it with expenses. Plan for marketing, staff development, equipment upgrades.
Review your financials monthly. Not just to see if you made money, but to understand what's working and what isn't.
Make data-driven decisions. When you're considering hiring someone or investing in new technology, make sure the numbers make sense.
Financial leadership means making decisions based on facts, not just gut feelings.
Here's something I wish someone had told me earlier: you don't have to figure this all out by yourself. Some of the best leaders I know work with a coach or consultant.
Leadership coaching can be incredibly valuable. Especially for things like emotional intelligence, conflict resolution, and decision-making under pressure.
Orthodontic consultants have seen what works. They can help you avoid common mistakes and implement systems that have been proven in other practices.
Having outside accountability makes a difference. It's easy to let things slide when you're only accountable to yourself.
Don't think of getting help as a sign of weakness. The most successful practice owners I know are constantly learning and getting outside perspective.
Scaling a practice means constant change. New team members, updated systems, growing pains. How you handle the difficult moments defines your leadership more than anything else.
Communicate changes before they happen, not after. People hate surprises, especially at work.
Include your team in decision-making when possible. They're more likely to support changes they helped create.
Explain the reasoning behind changes. "Because I said so" doesn't work with adults.
Stay calm when things go wrong. Your team is watching how you handle stress and uncertainty.
The way you lead during challenging times determines how much your team trusts you when things are going well.
Scaling an orthodontic practice isn't a solo project. It requires getting good at leading people, not just treating patients. The practices that grow successfully have leaders who can cast a vision, build strong teams, communicate effectively, and create systems that work without constant supervision.
If you're serious about growing your practice, start developing your leadership skills now. Get a mentor, work with a consultant, read books about leadership, whatever works for you. The clinical skills that got you started won't be enough to get you where you want to go.
Leadership isn't about having all the answers. It's about creating an environment where great work happens consistently, even when you're not directly involved. That's what makes scaling possible.
