The E-Myth for dentists

May 1, 2007
Why most dental practices don’t work and what to do about it

by Michael Gerber and Amy Morgan

Why most dental practices don’t work and what to do about it

Editor’s Note: Michael Gerber, the creator and CEO of E-Myth Worldwide and In the Dreaming Room, tools to revolutionize small businesses, is working with Pride Institute to bring his teachings to dentists. In this article, he describes the E-Myth and the obstacles he observes small business owners encountering that prevent them from realizing their true potential. Amy Morgan, Pride’s CEO, adds her insights on the application of these concepts to the world of dentistry.

Nineteen years ago, when Dr. Jim Pride read the original E-Myth, the book that sparked a series and transformed the way small business owners run their companies, he was amazed at its tremendous applicability to dentists. The E-Myth’s teachings strike at the heart of the business dilemma facing dentists. When confronted with the full weight of running a practice, a dentist’s reaction is often:

  • Why didn’t they teach this to me in dental school?
  • Can I hire someone else to run my practice for me?
  • Isn’t it possible to just do the dentistry and not worry about the business?

Dentists feel overwhelmed with the business end of dentistry because they embark on practice ownership with a false assumption, the “entrepreneurial myth” or E-Myth, which states: If you understand the technical work of a business, you understand a business that does that technical work. Dentists are trapped by the very thing they love, the technical work, which confines them to approaching their practices as technicians. This leads to frustration because they need more than a technician’s skills to run a practice successfully. The way out is to discover the possibilities open to them not only as technicians, but also as managers and entrepreneurs.

The E-Myth is the root cause of small business failures and the reason why owners suffer from stress, burnout, and financial instability. For example, the book spotlights a baker who produces excellent breads and pies and therefore assumes that she will be successful at owning a bakery. The error is that the baker tries to solve the business problems of the bakery by doing what she knows best, i.e., baking more and more breads and pies.

How does the E-Myth apply to dentistry? Assume that as the end of a month approaches, your production is $3,000 below your goal. This shortfall will inhibit you from meeting your expenses, causing you stress and financial strain. If you had two additional hours to spend that month on solving your problem, and you could only do one of the following three things, what would you do?

  1. Prep a three-unit bridge for a patient who will pay in full on the first appointment;
  2. Hold a staff meeting to brainstorm new ways of filling the schedule, not only for the current month, but for future months, as well; or
  3. Meet with your hygienists to inspire them to promote restorative procedures from the hygiene chair.

If you answered one, then you are trying to solve your business problems from the role of technician. After a certain period of time, technicians discover the limitations of simply being good practitioners. Doing a three-unit bridge will solve the production shortfall for the moment, but it will do nothing to reveal the root cause of the problem (such as system breakdowns in scheduling, marketing, or treatment acceptance) or solve the problem for the future. The skills of the technician are insufficient for dentists to create a successful dental business and enterprise.

It is the work of the entrepreneur to lead the enterprise. What is an entrepreneur? It is the dreamer in us, who sees a vision different from the present and is the catalyst for change. The entrepreneur lives in the future, never in the past, and rarely in the present. An entrepreneur would address a $3,000 production shortfall not merely by solving the problem, but by implementing new systems, skills, technologies, and goals to minimize shortfalls and achieve even higher production levels in the future.

Running the business is the focus of the manager. The manager is pragmatic. Without him or her there would be no planning, no order, no predictability, and no consistency in the business. The manager craves order. Whereas the entrepreneur’s time frame is the future, the manager primarily focuses on the past, and would solve the production shortfall by looking at systems improvements and other solutions that worked in the past and apply them to the present.

The technician is the doer, whose credo is: If you want it done right, do it yourself (sound familiar?). The technician loves to do the work. His or her focus is not dreaming about things, but doing them. As long as the technician is working, he or she is happy. Therefore, the technician lives in the present.

The truth is that for the dental practice to be successful, the dentist/owner must be able to balance all three roles effectively. The technician does the work, the manager runs the day-by-day practice, and the entrepreneur plans and directs the future of the enterprise. Therefore, in order to grow the practice, a dentist needs to advance from working in the business to working on the business.

Today, the E-Myth is especially important for dentists to understand and overcome. The average baby boomer dentist in America is 52 years old and has only $225,000 in retirement savings!

This woefully inadequate level of savings, we believe, is the result of dentists running their practices as technicians and failing to develop their managerial and entrepreneurial abilities. How do dentists expand their reach and become more successful?

First, by changing the way they think. The E-Myth offers a new paradigm for technicians who own their businesses to discover the world of entrepreneurial opportunity. We invite dentists to look at their world with fresh eyes, a beginner’s mind, and a blank piece of paper.

Let’s start by unleashing the entrepreneur - the inventor, goal setter, visionary, and dreamer - within us. A business without a dream is like a life without a purpose or vision. So, dentists, your first step is to dream. We invite you to enter the “dreaming room,” where you can create new and better ways of providing dental services, caring for patients, and reaching new successes.

To explain why it is urgent for dentists to stop doing and begin dreaming, consider the following story: A young man was sitting at the deathbed of his father, who was about to expire. With his last gasping breaths, the father whispered to the son in a creaky old voice, “Matzah balls! I ... want ... matzah balls!” The smell of matzah ball soup being prepared in the kitchen by the boy’s mother permeated the room, and the old man was requesting some for his last dinner. The son rushed to the kitchen to ask his mother for the soup, then returned empty-handed to say, “I’m sorry, Pop, but Mom says she’s saving the matzah ball soup for after the service.”

The point is, what are you saving yourself for? A time when your staff members aren’t getting pregnant or life isn’t hitting you so hard on the side of the head? No time will ever be perfect. The time to dream and formulate your vision for the future is now.

In order to earn a seat in the dreaming room, you first need to rise above the six forces described below that pull you down and prevent you from daring to dream.

The Law of Momentum

Have you ever known early in a particular month that it was going to be a bad one, with frustration, inefficiency, low production, and high stress? Have you experienced patients canceling, staff underperforming, and the practice in general moving in the wrong direction, but the momentum seems so overwhelming that you simply cannot apply the brakes? In times like that, imagine how you would react if someone said, “Wait a minute. Take a step back. Think about new ways to schedule so that the month doesn’t have to be bad.” It would be easy to respond, “Leave me alone. I’m too busy doing what I’m doing to think about how to do it better!” If this sounds familiar, you’ve been taken by the force of momentum, the unhappy state of speeding in the wrong direction, yet feeling unable to stop yourself. Momentum challenges us all, but in the dreaming room you can embark on a new direction in which to steer your life and practice.

The Law of Stagnation

Over time, the accumulation of your experiences becomes organized in your mind to trigger predictable responses. These may include beneficial admonitions such as, “Don’t touch the hot stove.” But your responses may also include self-limiting precautions such as, “Don’t fall in love,” or “Don’t take chances beyond those which provide predictable positive experiences.” These responses become habitual. So it is that someone who has been taught to view creativity as risky simply stops being creative. When you’re in the prime of your career, we hope you are investing in new technologies, advancements, skills, goals, and visions for your practice. When stagnation gets in the way, it becomes more comfortable to cling to the status quo. Are you caught in the rut of being unhappy with your practice, doing the same thing while wanting different results? How many times do we hear dentists complain about an insurance issue or a staff problem - only to learn that they have been plagued by the same problem for years and have never taken steps to resolve it and move on. Because the law of stagnation tells you not to take risks, it stops you from finding new pathways.

The Law of Small Steps

In order to grow your practice, you need to strive for big goals and celebrate the small steps toward them. However, when the small steps are all there are, and you have no overriding vision to steer toward, this is an impediment we call the law of small steps. This viewpoint paints the world as a dangerous place, one in which you must be, above all else, cautious. Caution leads us to believe that life is best lived by taking only small steps. Such a limiting approach to life eventually makes it difficult to take large steps, let alone giant leaps. You can easily lose the energy to grow if you confine yourself to small steps.

The Law of Failing Imagination

As we experience the laws of momentum, stagnation, and small steps, they exert a forceful impact upon our choices, causing us to lose our natural ability to imagine, to conjecture, to create, to paint pictures that don’t exist anywhere but in our mind’s eye. Think back on the last six staff meetings. Did you and your team do any problem solving? If so, how much of it was imaginative and creative, sparking fresh, new ideas, rather than reverting to the comfortable, safe solutions of the past? It is easy for dentists and staff members to suspend imagination when it feels more secure and comfortable simply to continue doing the familiar. If you want the new patient experience to be better, or patients to be more loyal and committed, logic would say try a new approach. This means setting your imagination free.

The Law of Failing Memory

When our automated responses are geared to continuing our momentum in the wrong direction, stagnating, taking only small steps, and failing to use our imagination, our memory becomes impaired. The thing we fail to remember is ourselves. It is so easy to run the practice on autopilot and forget that it must first meet the needs, wants, and desires of the owner before it serves others. This is a problem particularly for dentists, who are attracted to their noble profession because they enjoy serving others. As a business owner, your well must be full before you can offer a drink to others. How many times have you given staff salary increases when there was no increase in profitability? How many times have patients objected to paying for something not covered by insurance, and instead of challenging that mindset, you simply said OK and failed to inspire them to embrace needed treatment?

The Law of Self-Negation

All of the impediments above result in self-negation. When your practice is stagnating, it feels as if you are, also. Your dissatisfaction with your practice leads to an unhappiness with yourself. If you live safely, act safely, and dream safely, you will lack surprises, wonder and excitement. If this is the state of your practice, you need to throw off the burdens holding you down and discover a new way of facing your world so that you can grow professionally and personally.

Embrace a New Law: Affirmation

If you have been in practice for many years and have accepted the routine, the safe, and the comfortable, there will come a time when you will feel unfulfilled and uninspired. You will wake up one morning to find that you have lost your passion. You are likely experiencing the fate of the technician who has not stepped beyond. Consider the baker who wakes up one day drowning in a pile of unfinished pies, unpaid bills, disgruntled staff, and unsatisfied customers. The baker needs to commit to breaking old patterns and finding new pathways. This involves discovering the law of affirmation, which is a new and positive way of thinking that counteracts the negativism leading to past defeats.

Affirmation means creating and pursuing new possibilities that you really want to achieve. The first step to opening this new door is to dream about your future. Once you realize the limitations of the technician and are ready to enter the world of the entrepreneur, an exciting journey awaits you. It begins by allowing you to paint a compelling picture of the kind of practice you would really like to have. Next, you will design the steps to get there.

After you set your vision and goals, you will need to communicate them to your staff and patients, and then implement them.

Progress begins by being aware of and overcoming the forces that hold you down. Are you ready to discover the possibilities that await? If so, then allow yourself to dream as the first step in your personal and professional growth.

Editor’s Note: Michael Gerber will be the guest speaker at Pride’s National Alumni Meeting in August. For more information, call (800) 925-2600.

Amy Morgan is CEO and lead trainer of Pride Institute, the firm helping dentists master the business side of their practices. For information on Pride’s acclaimed management program, educational products, and flagship courses, call (800) 925-2600 or visit

Michael Gerber is the founder and CEO of E-Myth Worldwide and In the Dreaming Room. He is the bestselling author of The E-Myth, The E-Myth Revisited, The Power Point, The E-Myth Manager, and The E-Myth Physician, as well as a sought-after speaker and creator of the E-Myth Mastery Program. For more information, call (800) 221-0266 or visit or

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