The four leaks every fee-for-service practice has and how to plug them.

Most of the practices we step into are clinically excellent. The dentistry is genuinely beautiful. The reviews are five stars. And yet production sits flat year over year.

It is almost never a marketing problem. It is four leaks, in this order:

The leaks, in order of cost

The first is the unanswered inquiry. High-intent cosmetic and biologic callers reach voicemail at 2:14pm on a Tuesday and book with the next practice on Google. The second is the un-presented plan — comprehensive treatment that gets quietly downgraded to single-tooth dentistry at the operatory door. The third is the un-followed-up consult: a six-figure case sitting "pending" in the PMS for fourteen months. The fourth is the un-reactivated hygiene patient, who is also the next decade of restorative.

The most expensive new patient is the one you already paid to acquire and never saw again.

Plug them in that order. Conversion first, because it costs you nothing and unlocks every other number. Acceptance second, because the patient is already in the chair. Follow-up third. Reactivation fourth. Do not skip ahead — the leaks compound from the top.