Your Dental Practice Doesn't Need Another January: September Already Has the Receipts

15 hours ago

13 min read

By Sarah Beth Herman, MBA, Founder & CEO, Dentistry Support®

Sarah Beth Herman CEO, Dentistry Support®

There is a sentence I hear every year around this time: “We’ll fix that in January.” We’ll finally organize our systems in January. We’ll address the employee issue in January. We’ll look more closely at overhead in January. We’ll get serious about accounts receivable in January. We’ll fix the schedule, improve our processes, revisit our goals, and somehow become more disciplined when a new calendar year arrives.

And every time I hear that, I have the same question: Why January? What information is January going to have that September doesn’t already have? Actually, I would argue that September knows significantly more. January had plans. September has receipts.

And that is what I want to talk about in this week’s Dentistry Support® FREE TRAINING. Not what you hoped your practice would look like at the beginning of the year. Not what was written on your vision board. Not the revenue number you enthusiastically put into a spreadsheet nine months ago. I want to talk about the practice that actually exists today.

Because there is still a meaningful amount of 2026 left, and before you start planning another year, I think we should pay attention to what this year has already taught you.

September Has More Information Than January Did

Think about what you believed your dental practice would look like when 2026 started. Maybe you were going to hire another hygienist. Maybe you were finally going to get the doctor out of some of the day-to-day administrative work. Maybe you were going to improve collections, clean up accounts receivable, or create a better insurance verification process.

Maybe you were going to open another location, promote someone, replace someone, introduce a new service, or increase production while finally reducing the number of hours you personally worked. Maybe this was going to be the year you took an actual vacation without checking Teams from the pool.

How is that going?

I do not ask that sarcastically. Some things probably happened exactly as planned. Some things did not. And some of the things you desperately wanted in January may not even be things you want anymore. That is useful information.

Business owners can become so committed to the version of the company they planned that they stop paying attention to the company they actually have. Changing your mind because you learned something is not failure. Sometimes it is responsible leadership.

GO FIND YOUR JANUARY LIST

Go find whatever you created at the beginning of 2026: your annual goals, business plan, spreadsheet, vision board, Notes app, or the document you enthusiastically created during the first week of January and have barely looked at since February.

Now place every meaningful goal into one of four categories: DONE, STILL MATTERS, DOESN’T MATTER ANYMORE, and I’VE BEEN AVOIDING THIS.

DONE: You accomplished it. Great. Allow yourself to finish something without immediately moving the finish line.

STILL MATTERS: It is not finished, but it is still important enough to deserve your time, attention, money, and resources.

DOESN’T MATTER ANYMORE: Maybe the business changed. Maybe your priorities changed. Maybe you learned that the service you intended to launch was not something patients actually wanted, or the position you planned to hire is no longer what the practice needs. You are allowed to delete a goal because new information changed the decision.

I’VE BEEN AVOIDING THIS: Pay attention to this category. There may be something on your list that has quietly moved from January to February, February to March, March to April, and eventually into that wonderful imaginary place called, “We’ll deal with it after the holidays.”

Before you create another action item, ask yourself: What decision am I actually avoiding? That is different from asking what else you need to research, who else you should speak with, or which book you should read. Sometimes you already have enough information. You simply do not like the decision the information is asking you to make.

You Don’t Owe an Old Decision Your Future Money

Here is something I want every practice owner reading this to write down: You do not owe an old decision your future money.

Maybe you purchased software eighteen months ago and your team barely uses it. Maybe you created a position that made perfect sense two years ago but no longer reflects what the practice needs. Maybe you launched a service patients expressed interest in, only to discover that very few of them were willing to purchase it.

Maybe you hired someone and have spent six months adjusting responsibilities, processes, and expectations in an attempt to make the original decision work. Or maybe you invested $20,000 into something and the strongest argument for continuing to fund it is, “But we’ve already spent $20,000.”

That is exactly where I want you to be careful. Research on the sunk-cost effect demonstrates that people can become more likely to continue an endeavor after significant money, effort, or time has already been invested, even when those previous investments should not determine the next decision (Arkes & Blumer, 1985).

Past investment can feel like a reason to continue. Sometimes it is not. Sometimes it is simply an investment that has already been made.

Instead of asking only, “How much have we already put into this?” ask, “Knowing everything I know today, would I make this decision again?” You may get a very different answer.

Your Practice Is Probably Paying for Things Nobody Has Questioned in Months

Businesses accumulate expenses the same way houses accumulate junk drawers. Nobody intentionally creates the junk drawer. It happens one item at a time.

Businesses do the same thing. One subscription. One workaround. One additional platform. One temporary service. One piece of software that solved an immediate problem. Then six months later, another platform is added that performs several of the same functions.

Three years pass, and money is leaving the bank account every month for expenses nobody remembers approving or evaluating. That is business drift.

What makes business drift difficult to recognize is that almost every individual decision probably made sense when it was originally made. It is the accumulation that eventually becomes expensive.

FIND THREE THINGS YOU’VE STOPPED QUESTIONING

Pull your actual bank and credit card statements from the last 60 days. Not only your accounting dashboard. Not only the beautifully categorized P&L. Look at the transactions.

Find three recurring expenses you have not personally questioned in the last six months. Do not automatically cancel them. Ask yourself: Why are we paying for this? Who actually uses it? What problem does it solve? Is that problem still relevant? Did we purchase something later that now performs the same function?

And one of my favorite questions: If this disappeared tomorrow, would anybody notice?

Maybe the answer is, “Yes. This saves our team hours every week and provides tremendous value.” Perfect. Keep it. But now you know why you are keeping it.

Everything in your business does not need to change. Everything should have a reason.

Stop Looking at Payroll Only as Salaries

Now I want you to look at payroll differently. Most owners naturally review payroll through names, salaries, and hours. Employee A earns this. Employee B works these hours. Employee C costs the practice this much annually.

I want you to remove the names for a moment and look at the work. If I showed you only the work being performed and removed the names of the employees performing it, would you design those positions exactly the same way today?

That is a very different question.

Dental practices are especially vulnerable to positions evolving unintentionally. Someone originally answers the phones. Then another employee leaves, so they temporarily take over eligibility. Later, the practice needs help following up on treatment plans, so they inherit that responsibility too. Then someone takes maternity leave, and another responsibility is added.

Two years later, the employee has a job that nobody intentionally designed. It simply developed over time. Then leadership begins wondering why responsibilities overlap, why certain tasks fall through the cracks, and why everyone feels exceptionally busy despite having a full team.

Research examining role ambiguity has found a negative relationship between unclear roles and job performance, with the strength of that relationship varying according to the type of work being performed (Tubre & Collins, 2000).

Clarity matters. And sometimes creating clarity requires leadership to acknowledge: Nobody actually designed this position. It just happened.

REMOVE THE EMPLOYEE’S NAME

Choose one position in your practice. For this exercise, temporarily remove the person from the position. This is not an exercise about terminating an employee. It is an exercise about evaluating the work objectively.

Ask yourself: What outcomes does the practice actually need from this position? What work needs to happen to produce those outcomes?

Now compare that with what the employee is currently doing. Would you design the position exactly the same way today? What belongs in the role? What no longer belongs? What could be automated? What could be delegated differently? What is duplicated somewhere else? What responsibilities were inherited simply because someone needed to do them at the time? And what work may no longer need to happen at all?

Sometimes businesses build positions around people instead of building positions around what the organization actually needs. That difference matters.

Revenue Is Information. It Is Not a Personality Trait.

Someone tells you, “Our practice did $5 million last year.”

Okay. Tell me more.

What did it cost to produce the $5 million? What happened to payroll? What happened to overhead? What happened to collections? How much cash is actually available? What does accounts receivable look like? How much debt did the business take on? How many additional employees were required? How many additional hours did the owner work?

Did the business become stronger, or did it simply become bigger?

Those are not necessarily the same thing.

You can have more patients than you have ever had and less money in the bank. You can experience record production while your team becomes increasingly exhausted. You can increase revenue while creating so much additional administrative work that the practice becomes more difficult to operate.

A larger practice is not automatically a healthier practice. I want us to become comfortable looking beyond the impressive revenue number and asking what that revenue actually produced.

Vision Is Exciting. Execution Is Tuesday.

Business owners love strategy. We are going to grow. We are going to improve case acceptance. We are going to create a better patient experience. We are going to reduce turnover. We are going to improve insurance collections. We are going to answer every phone call.

Wonderful.

Now tell me what happens Tuesday at 11:17 a.m. Who owns the follow-up report? Who reviews the outstanding claims? Who measures your call-answer rate? Who confirms that eligibility was completed? Who notices when the process is not working, and who is responsible for doing something about it?

Research on strategy execution has shown that organizations frequently struggle not because they lack strategic ideas, but because they struggle with coordination, communication, and adapting execution when conditions change (Sull, Homkes, & Sull, 2015).

More recent organizational research similarly emphasizes accountability, coordination, capability, and motivation as important components of turning strategy into results (Fletcher et al., 2025).

Vision is exciting. Execution is Tuesday. And execution is where the business actually changes.

Accountability Isn’t What Happens After Someone Makes a Mistake

We use the word accountability constantly, usually after something has already gone wrong. Someone missed a deadline. A task was not completed. Nobody followed up. An issue sat unresolved for three weeks.

Then leadership says, “We need better accountability.”

Yes. But accountability should have started much earlier.

Who owned the responsibility? When was it due? How would everyone know it was completed? What number were you measuring? Who was reviewing that number? What happened when things began moving off track?

Gallup research published in 2026 identified creating accountability as the lowest-rated of seven leadership competencies in its study. Fewer than half of leaders surveyed rated themselves outstanding or exceptional at creating accountability, and the research emphasized the importance of clear expectations and consistent leadership routines rather than reserving accountability only for corrective conversations (Harter & Tatel, 2026).

That matters because accountability is not simply the conversation you have after somebody fails. Accountability is part of the infrastructure that allows people to succeed.

FIND THE MEETING YOU KEEP HAVING

Think about your last several leadership or team meetings. Is there one problem that keeps coming back?

Claims are not being followed up. Phones are being missed. Documentation is incomplete. Patients are not being confirmed consistently. Treatment plans are not being followed up. Nobody is quite sure who owns a particular responsibility.

You discussed it last week. And two weeks before that. And probably sometime in July.

Write down the problem. Now ask: Who owns the outcome?

One person.

Ten people may contribute to the process, but who owns the result? When is it due? How will you measure whether it happened? Who reviews the measurement? What happens when the result is off track?

Then ask one more question: Are we having another meeting because we genuinely need another meeting, or because nobody actually owns the result?

Those are very different problems.

Don’t Accidentally Give Away the Rest of 2026

This may be the most important thing I want you to hear in this training: Please do not mentally end 2026 because we are approaching the fourth quarter.

September becomes October. October becomes busy. Then Thanksgiving arrives. December feels unusual. And suddenly everyone says, “We’ll hit it hard in January.”

No.

There is still an enormous amount of business year left.

An unnecessary expense removed now does not have to hit your bank account three more times. A difficult employee conversation held now gives that employee time to respond and improve. A broken process corrected now can operate differently throughout the fourth quarter. A better accounts receivable strategy can still improve collections this year.

A patient reactivation effort started now can still create appointments before January. A project you decide not to pursue can return dozens of hours to your team before the holidays.

There is a difference between panicking because the year is ending and pretending that time is not passing. I am asking you to do neither.

Research on goal-setting has consistently demonstrated the importance of specific, meaningful, and appropriately challenging goals, along with feedback and commitment to those goals (Locke & Latham, 2006).

You do not need seventeen new fourth-quarter priorities. You need to determine what actually deserves the remaining part of this year.

THE SEVEN-DAY BUSINESS EVIDENCE AUDIT

For the next seven days, stop evaluating your business only by intention. Look at evidence.

DAY ONE: YOUR GOALS

Find your original 2026 goals and sort them into four categories: Done, Still Matters, Doesn’t Matter Anymore, and I’ve Been Avoiding This.

DAY TWO: YOUR MONEY

Review 60 days of actual transactions. Identify at least three expenses you have not questioned recently and ask why they still exist.

DAY THREE: YOUR PEOPLE

Choose one position, remove the employee’s name, and look only at the work. Would you design that position exactly the same way today?

DAY FOUR: YOUR NUMBERS

Look beyond production and revenue. Review payroll, collections, accounts receivable, overhead, available cash, and debt. Then ask: Did our growth make the practice healthier?

DAY FIVE: YOUR OPERATIONS

Find one workaround your team now treats as a normal process. Ask: Why do we do it this way? Do not automatically accept, “Because we’ve always done it this way.”

DAY SIX: YOUR ACCOUNTABILITY

Find one problem you have discussed more than once. Identify one person who owns the outcome. Give it a measurement and give it a deadline.

DAY SEVEN: YOUR DECISION

Return to the I’ve Been Avoiding This category. Choose one item and ask: What decision am I actually avoiding?

Not, “What should I research next?” Not, “Who should I ask?” Not, “What should we discuss at Monday’s meeting?” What decision?

If you genuinely need additional information before making it, identify exactly what information is missing and when you will have it. But do not allow “I’m thinking about it” to become a permanent business strategy.

You Don’t Need to Tear Everything Apart

Please do not finish this training convinced that everything inside your practice needs to change. That is not the point.

Some things are working exceptionally well. Keep them. Some employees are exactly where they belong. Support them. Some expenses deliver tremendous value. Pay them. Some systems are doing precisely what you need them to do. Leave them alone.

This is not about changing things simply for the sake of change. It is about intentionality.

Not everything needs to change. But everything should have a reason.

And sometimes one of the most valuable things leadership can do is stop long enough to ask whether that reason still makes sense.

Before Monday’s Episode: Welcome to Season 6

There is a reason I wanted this to be our Dentistry Support® FREE TRAINING this week.

All summer on No Silver Spoons, we worked through The Human Side of Leadership™ during Season 5. We talked about authenticity, respect, integrity, and accountability. We talked about why employees stay stuck, why good people leave, what happens when leaders repeatedly rescue people, and the uncomfortable possibility that sometimes leadership itself may be contributing to the problem.

We finished Season 5 with one of the largest questions of the entire series: What will people remember about the way you led them?

Now, we are beginning something new.

Episode 141 officially launches Season 6 of No Silver Spoons.

And Season 6 is taking us somewhere different. We spent an entire season looking inward at who we are as leaders. Now I want us to turn that leadership toward the businesses we are actually building.

Because you can become significantly more self-aware as a leader and still operate a business that is unnecessarily difficult to run. You can care deeply about your employees and still have too much payroll. You can have wonderful people and inefficient systems. You can create a strong culture and still have unhealthy margins. You can increase revenue while simultaneously creating a company that becomes harder and harder to operate.

Eventually, leadership has to leave the notebook. Eventually, it has to produce something.

That is where Season 6 begins, and that is the conversation I am opening in Episode 141.

I am not going to give you Episode 141 here. I want you to listen to it. But before you do, I want you to carry one question with you:

Is the Business You’re Building Actually What You Intended to Build?

Not what you intended to build in January. Not what the organizational chart says you built. Not what your website makes it look like you built.

I mean the business that exists today.

The money leaving the bank account. The work people are actually performing. The responsibilities they actually own. The systems your team actually uses. The problems you keep discussing. The hours you are actually working. The company you are actually building.

This week’s Free Training asks you to look at the evidence. Episode 141 opens Season 6 by asking what you are going to do with that evidence.

Season 5 asked: Who are you as a leader?

Season 6 is asking: What are you building with that leadership?

And perhaps the most important question is this: Is the business you are building actually worth what it is costing you to build it?

That is where Season 6 of No Silver Spoons is headed.

I’ll see you in Episode 141, the beginning of Season 6.

References

Arkes, H. R., & Blumer, C. (1985). The psychology of sunk cost. Organizational Behavior and Human Decision Processes, 35(1), 124–140. https://doi.org/10.1016/0749-5978(85)90049-4

Fletcher, B., Goldstein, D., Kruszewska, A., & Vadehra, A. (2025). Execute to win: How healthy organizations turn vision into results. McKinsey & Company.

Harter, J., & Tatel, C. (2026). Accountability is leadership’s greatest weakness. Gallup Workplace.

Locke, E. A., & Latham, G. P. (2006). New directions in goal-setting theory. Current Directions in Psychological Science, 15(5), 265–268. https://doi.org/10.1111/j.1467-8721.2006.00449.x

Sull, D., Homkes, R., & Sull, C. (2015). Why strategy execution unravels—and what to do about it. Harvard Business Review, 93(3), 58–66.

Tubre, T. C., & Collins, J. M. (2000). Jackson and Schuler (1985) revisited: A meta-analysis of the relationships between role ambiguity, role conflict, and job performance. Journal of Management, 26(1), 155–169. https://doi.org/10.1177/014920630002600104

Disclaimer:

To learn more about Sarah Beth Herman, the author of all free training content you can read her bio here. These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based on your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. You should always consult with your own professional advisors (e.g. attorney, accountant, or insurance carrier). To the extent, Dentistry Support ®has included links to any third-party website (s), Dentistry Support ® intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, Dentistry Support ® makes no representations or warranties about the information provided on those sites. You can view our privacy policy and terms and conditions by clicking those pages in the footer of our website