Just Two Minutes: When Growth Makes Life Harder

Bite-sized dental wisdom in under 2 minutes.

Everyone loves to believe that once you “make it,” business gets easier.
More patients, more money, bigger team… fewer problems, right?

I can tell you that’s not how it works.
If anything, the decisions just get harder.

In the beginning, you say “YES” to survive.
That’s exactly what we did when we opened our first practice.
We said “YES” to every insurance plan—including Medicaid.
Because at that stage, a butt in the seat was better than sitting around doing nothing.
Even if you weren’t being paid well, at least you were building momentum.

But once we grew, those same yeses started costing us.
Low reimbursements weren’t worth the chair time anymore.
We had to start dropping the insurances that didn’t make sense.
And here’s the part people forget: that sounds easy on paper, but it’s not.

You now have to train your staff on how to explain it to patients—why their plan isn’t accepted, or why their insurance won’t cover what they thought it would.
That’s not just a billing change—it’s a leadership challenge.

Same thing happened with equipment.
When we first opened, we bought a pano instead of a CBCT.
It seemed logical at the time—I wasn’t placing implants yet, and it saved some money up front.
But it ended up holding us back.
I had to delay offering implants because we didn’t have the right equipment.
If I were doing it again, I wouldn’t let that decision limit growth.
It’s always easier to buy something early than to play catch-up later when your schedule is already full.

Then of course there’s space.
We outgrew ours fast.
Which sounds like a good problem to have—until you’re faced with the decision:
Do we expand? Do we move? Remodel? How much do we invest, and when?
Every one of those choices affects cash flow, the team, patients—and your own stress level.
The higher you go, the harder those calls become.

And it’s not just clinical.
A couple years ago, I launched a salivary testing company—Peri Health.
But between that, our practices, Ordo, Milo, and two kids, it wasn’t sustainable.
Peri Health was taking the most work, causing the most friction, and giving back the least.

I had to shut it down.
And believe me—that was way harder than saying yes to starting it.
Letting go of something you built always is.
But that’s what growth forces you to do: not just more… but better.

Everyone loves the idea of adding more—more success, more projects, more opportunity.
But real growth isn’t about adding.
It’s about knowing what to subtract.
And the higher you go, the harder those decisions get.

That’s the tradeoff for success.

-Dr. Alex

P.S. If you’re early in your career thinking it all gets easier—just wait.
The good news? The hard decisions mean you’re moving in the right direction.