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The Dental Management Pyramid

A dental practice is like a team. There is a leader—the dentist—and a series of team members who all participate to create the best organization possible. The difference between an athletic team and a dental practice, however, is that the coach in a dental practice is both a player and a producer. This leaves the practitioner with little time to focus on the development of management systems and the routine modification of these systems to meet the changing needs of the practice, services, and patients.

Although many practitioners continue to expand their clinical skills on a regular basis, management systems are often ignored. As a result, practice productivity and profitability decrease, and stress levels increase. Crisis management becomes more of a norm than an exception, and hardworking practices begin to lose their profitability.


Levin Group Management Pyramid

The pace of a dental practice is increasing today. Most practices have already outgrown their business systems, which is the source of a great deal of stress. As the practice continues to expand, these same systems will begin to break down and cause:

  • Less-than-optimal profitability
  • An increase in the number of years until retirement
  • Higher staff turnover
  • Daily frustration

Most practices have demonstrated significant gaps in their basic management systems, which leaves them 30% below production and profit potential. The Levin Group management Pyramid functions as an analogy to building these systems in a dental practice (Outlined Below). This internal tool can be used to quickly evaluate any practice’s management systems and to develop a clear plan to improve and reach various objectives. Practices range across all levels of the pyramid. Just like Abraham Maslow’s hierarchy,1 a practice cannot move to Level II, III, or IV without mastering the previous level via documented business systems.


Levin Group Management Pyramid Outline:

Level I: Basic Management Systems

Customer service, scheduling, hygiene, practice financial management, patient financial management, budgeting, third-party reimbursement, accounts receivable, inventory, laboratory management

Level II: Leadership Skills/Team Development

Vision identification, mission statement, goal setting, team building, policy communication, team motivation, team compensation packages, incentive systems

Level III: Case Presentation

Verbal communication and selling skills, patient motivation, patient acquisition, elective service identification, fee-for-service presentation, acceptance

Level IV: Strategic Planning

Situation, objectives, strategy, tactics, control

Any time one level is not appropriately addressed, all levels on the Levin Group Practice Management Pyramid will suffer. A practice cannot omit any section of the pyramid if they are to be truly successful. Each building block is necessary for the structure to be sound. For instance, one of the key factors that contributes to decreased profitability and increased stress in dental practices is that a practice with outdated management systems will not have addressed the second level, Leadership Skills/Team Development. A practice that may have excellent management systems and excellent leadership skills at one point in the practice cycle may later find that it has outgrown its management systems or leadership level at another. Inevitably, when practice management systems are inadequate, leadership skills also begin to falter.

How frustrated are you today? Are you on the road to financial independence? Levin Group takes a building block approach to the Practice Management Pyramid. Each block must be placed one at a time with a step-by-step expert approach at the correct pace. Here is the order:

  • Level One: Basic Management Systems—The first level of success from a practice management standpoint is that of basic management systems. Although the scheduling system is a large component in this tier, emphasis should also be placed on hygiene, financial management profitability, patient financial management, customer service, verbal skills, insurance controls, and administration.
  • Level Two: Leadership Skills/Team Development—Team building begins with leadership. The team looks to the practitioner as a role model in every area including attitude, 100% quality care of patients, customer service, ethics, honesty, and desire for change.
  • Level Three: Case Presentation—Case presentation is just as much about education as it is about the relationship between the patient and the doctor. It is an art that must be mastered for the practice to be successful.
  • Level Four: Strategic Planning—It is not simply important to have a strategic plan, but also to follow it with implementation. This is a key management section that few practices achieve.



Each level of the Levin Group Management Pyramid will be further explained in subsequent editorials. Although some clinicians may attempt to advance through the pyramid without completing each level, incomplete management will result in other areas and the lack of effective systems will ultimately resurface. The only way to make the Practice management Pyramid successful is to follow step-by-step, in the same manner used to build anything else.

*Founder and CEO, Levin Group, Baltimore, Maryland.



1. Maslow A. Maslow on Motivation. New York, NY: John Wiley & Sons, 1998.

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