The $250K Problem Every DSO Ignores

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Nearly 80% of DSO revenue flows through associate doctors.

Yet most organizations are hemorrhaging $100K-$250K per doctor through a brutal cycle: hire from desperation, provide vague mentorship, watch performance plateau, lose to turnover.

The problem isn't the associates. It's the absence of systems.

This Week: Dr. Eric J Roman

Dr. Eric J. Roman has coached over $1B in DSO revenue and trained more clinical directors than anyone in the industry. His insight cuts straight to the heart of what he calls "the thing behind all the things"—the dentist-patient relationship that drives practice revenue but remains systematically underdeveloped.

His philosophy: "Building systems that deliver love and free people to be their best."

The Crisis No One Wants to Name

We've normalized a cycle that would be unacceptable in any other industry:

• Hire from desperation (limited candidate pools)

• Provide vague mentorship (conversations without measurement)

• Watch performance plateau (no clear excellence standards)

• Lose to costly turnover ($100K-$250K per departure)

• Repeat the cycle

The dental industry has settled for calling all licensed dentists "qualified" when reality shows vastly different performance levels under the same job title.

The hard questions we're avoiding:

• How do we know if an associate is doing well?

• What's the baseline of good?

• Who owns the responsibility for making them great?

Why Traditional Approaches Fail

Mentorship Without Structure Most programs are conversations without measurement, guidance without goals, relationships without accountability.

Managing vs. Developing Clinical directors spend time putting out fires instead of preventing them. They manage problems rather than develop solutions.

The Wrong Metrics Groups track production but ignore the behaviors that drive it—patient communication, case acceptance effectiveness, team integration.

The Two-Problem Framework

Dr. Roman's breakthrough insight: associate struggles aren't one problem—they're two interconnected challenges requiring parallel solutions.

Problem 1: Associates Don't Know How to Succeed

• No clear recipe for excellence beyond clinical skills

• Limited case acceptance and communication understanding

• Missing accountability systems for growth

• Lack of team leadership frameworks

Problem 2: Clinical Leadership Systems Are Incomplete

• Undefined standards for associate performance

• No systematic onboarding and development approach

• Absence of measurable KPIs that drive change

• Leadership teams without development tools

Game Tape for Dentistry

Elite athletes have used game film for decades to analyze performance and accelerate development. Every play gets reviewed, learned from, optimized.

Dental teams have never had this capability—until now.

Through AI-powered platforms like Avora, coaching now operates with unprecedented visibility into clinical encounters. The technology captures patient communication dynamics, case presentation effectiveness, and decision-making patterns that have always been invisible.

This isn't surveillance—it's insight that transforms every appointment into a development opportunity.

Real-time coaching support: AI processes conversations while doctors focus on patient care, providing gentle prompts for case acceptance opportunities and evidence-based treatment suggestions.

Post-appointment analysis: Every interaction becomes data for development. How does this doctor handle objections? Where do cases get accepted or lost?

Systemic performance insights: Instead of guessing why production varies, leadership teams get objective data on behaviors that drive results.

The Associate Growth System

For Associates: Direct coaching with clear success recipes, quarterly performance reviews, accountability systems, and ongoing development—removing guesswork from excellence.

For Leaders: Monthly system-building sessions installing six core frameworks: standards, KPIs, accountability rhythms, onboarding protocols, and leadership cadences.

What makes this different:

• Systems > Personalities (repeatable regardless of who's in the room)

• Measurement > Management (benchmarks tracked every 90 days)

• Development > Damage Control (proactive vs. reactive)

• Retention = Investment (associates stay when they feel developed)

  
  

The Compound Effect

Consider the mathematics: if advanced coaching improves performance by just 1% per appointment—better case acceptance, stronger patient relationships, more efficient treatment planning—the compounding effect across hundreds of appointments creates transformational growth.

What if every appointment became a coaching moment? What if invisible patterns became actionable development insights?

Building Systems That Deliver Love

Dr. Roman's approach isn't about micromanagement—it's about creating structure that enables human flourishing. The right systems provide clarity, support, and pathways for growth that make excellence feel inevitable rather than accidental.

When associates know what's expected, have tools for success, and receive consistent development, they don't just perform better—they become leaders who scale clinical excellence throughout the organization.

Ready to dive deeper?

Get Dr. Roman's complete framework: "Human-Centered Coaching, Powered by AI" - his full positioning statement with implementation strategies and systematic development approaches.

[To Download the complete positioning statement fill out the email form →]

Coming next week: Our next advisory expert Margaret McGuckin, MBA shares insights on the Full Arch Business Model in Dentistry

What's your biggest challenge with associate development? Share in the comments below.

Avora Advisory Insights features expert perspectives from industry leaders shaping the future of clinical excellence and dental operations. Each advisor brings deep expertise and unique insights that are transforming patient care.