In this seminar transcript, Rick Kushner presents his "Lean & Mean" philosophy for dental practice management, arguing that most dentists are misled by conventional advice that emphasizes production and volume without regard to profitability. He outlines a series of systemic problems—high overhead, ineffective collection policies, inefficient staff use, poor office design, fear‑driven decision‑making, and market oversupply—that trap practices in mediocre earnings. Kushner reframes the discussion around three core principles: (1) developing a "volume posture" that gives a practice the flexibility to accept or reject new service opportunities; (2) rigorously defining and enforcing what constitutes elective versus non‑elective dentistry; and (3) relentlessly pursuing the most practical, sensible, and cost‑efficient ways to deliver quality care. He stresses that profitability, not production, should drive practice decisions, and that even small practices can achieve significant income gains by reducing overhead and improving collection rates without increasing clinical output. The talk also surveys the current dental market—decline of the "golden age," oversupply of dentists, rising consumer awareness, and the proliferation of subspecialties—using these trends to justify the need for a lean, profit‑focused approach. Throughout, Kushner balances criticism of existing norms with optimism that adopting his Lean & Mean framework can create growth, flexibility, and higher net income for practices of any size.
Topics
Profitability over Production: The Core Lean & Mean Philosophy
Kushner positions profitability as the primary driver of practice success, relegating production to a secondary role and emphasizing collection policies and net income.
Common Dental Practice Management Pitfalls
A catalog of widespread issues—high overhead, poor collection, inefficient staffing, bad office design, fear of malpractice, and misguided marketing—that hinder dentist earnings.
Market Economics and the Changing Dental Landscape
Analysis of macro‑level trends: the end of the "golden age," oversupply of dentists, rising consumer expectations, and the rise of subspecialties.
Volume Posture: Building Patient Volume for Flexibility
The concept of cultivating a high‑volume patient pool to create strategic options (e.g., accepting PPOs, handling market shifts) without sacrificing profitability.
Elective vs. Non‑Elective Dentistry: Definition and Enforcement
A strict framework for categorizing services, enabling dentists to prioritize essential care and protect margins by limiting elective work.
Cost‑Efficient Delivery: Reducing Overhead and Optimizing Collections
Practical tactics for lowering overhead percentages, improving collection rates, and streamlining staff utilization to boost net income.
Strategic Positioning for Opportunities (PPOs, Programs, Growth)
How a solid volume posture and low overhead give practices the choice to engage with external programs or decline them profitably.
Applicability Across Practice Sizes
Kushner emphasizes that Lean & Mean principles work for both $100k and million‑dollar practices, focusing on universal levers rather than size‑specific tactics.