Why evolving into the role of CEO and delegating tasks is key to creating a mature business and avoiding burnout.

By Roger P. Levin, DDS

When I use the term “entrepreneurial orthodontist” I am referring to an orthodontist who enters practice by either opening or buying a practice. For those who want to become an entrepreneur today there is excellent academic science around the best way to get started. However, there doesn’t seem to be as much academic emphasis on how to go from start-up to mature business. Orthodontists (like many entrepreneurs) are particularly susceptible to starting or buying practices and never converting that practice into a more mature organization. This can lead to flattening of practice production, challenges during difficult times, and burnout.

What Is an Entrepreneur?

There are many definitions of an entrepreneur; however, when I think of an entrepreneur I think of someone who has started a business, is most likely in debt, is working very hard to make it successful, and is racing to grow it fast enough to pay off the debt. The truth is that most new entrepreneurial businesses fail in under 5 years. And keep  in mind that many entrepreneurs take little or no income for years as they work to build their businesses.

Fortunately, orthodontics is different. There is only a very small fraction of orthodontic practices that fail. In fact, it used to be quite normal for an orthodontist to open a practice almost anywhere and have it grown to maturity within 5 years. The practice typically outpaced debt and provided an income to the orthodontist at the same time. 

Still, the entrepreneurial orthodontist is required to work hard as they are probably the person who is managing all the financial accounts, going out to meet potential referring doctors, managing human resources including recruiting, hiring, and training new team members, and working late into the evenings or coming back to the office on the weekends (or working from home) to complete paperwork, perform administrative tasks, and work up cases. 

From Entrepreneur to CEO

In Levin Group’s 30-year study of the top 10% performing orthodontic practices, we found 17 principles that these practices generally have in common. One of those principles is that a top 10% orthodontist gradually delegates more and more responsibility to others and focuses more exclusively on patient care, patient relations, and referrals. This can only happen by converting the entrepreneurial business into a mature organization, with the orthodontist functioning as the CEO.

The other downside of not moving from entrepreneur to CEO is burnout. Burnout is a serious issue in orthodontics today. There are an increasing number of orthodontists who are experiencing stress and anxiety, which leads to fatigue and eventually burnout. Burnout is different from fatigue and takes longer to recover from. It is far better to avoid it altogether.

To prevent burnout, doctors must start offloading responsibilities to other team members. Another one of the principles of top orthodontic practices is having a well-trained office manager. This person runs every business aspect of the orthodontic practice, allowing the orthodontist to move into what we at Levin Group call Level 4 Leadership.

As a Level 4 Leader the orthodontist arrives early in the morning, attends the morning meeting, and sees patients as directed by the orthodontic assistant throughout the remainder of the day. The Level 4 Leader’s day ends on time, there is no additional administrative work to complete, and the orthodontist goes home. This sounds like an unattainable utopia but it’s really what happens in a top 10% practice. 

Many entrepreneurs do not know when to start making the shift. One important thing I can tell you is that you don’t do it overnight. You create a plan to begin to move responsibilities to others. Here are some steps you can take:

Evaluate the team and their capability. If you don’t have all the basic foundational systems in place with scripting and measurement, then the rest won’t matter. Make sure the team can take on additional responsibility by identifying the next skill set enhancement for every team member and arrange for any training they need.

Begin to identify which actions and tasks can be delegated to the team. In most cases we find a minimum of 30 actions or tasks the doctor can offload to the team through positive delegation almost immediately. When we list out these tasks orthodontists are shocked at what they have been doing and why they have been doing it for so long. The truth is that it has simply become a matter of habit. 

Help the team to develop an independent decision-making mentality. They must know that you trust them and that you understand they will give it their best. They will make mistakes, but you must think of mistakes as teachable moments rather than punishable ones. Use mistakes as an opportunity to advance the knowledge, skill set, and confidence of a team member.

Learn to say no. When team members come to you with questions about actions or tasks that you feel they can manage themselves, push back politely. Ask them what they think. Ask them why they are asking you. Or simply say to them: “Whatever you think is best.” They will quickly learn their areas of responsibility and decision-making.

Rely on your office manager. The office manager is the buffer, protecting the orthodontist’s time and continually watching out for ways to help the team.

The conversion from entrepreneur to mature organization is not easy. It takes time, thought, and a clear understanding of the orthodontic practice. Without basic foundational systems this jump will never be made. Once systems are in place the team can be trained at a higher level to accept delegation. Further, the office manager needs to be measured for performance and not rewarded for simply making it through another year. Training of office managers is a critical activity in moving from entrepreneurial orthodontist to practice CEO.

The downside of not converting from entrepreneur to CEO is a flattening or declining level of production and referrals, stress, anxiety, and eventually burnout. The key to orthodontic practice success is to make the leap from entrepreneur to CEO. OP


Roger P. Levin, DDS, is the CEO and founder of Levin Group, a leading practice management consulting firm that has worked with over 30,000 practices to increase production. A recognized expert on orthodontic practice management and marketing, he has written 67 books and over 4,000 articles and regularly presents seminars in the United States and around the world. To contact Levin or to join the 40,000 dental professionals who receive his Ortho Practice Production Tip of the Day, visit levingroup.com or email [email protected].