How growing dental groups can multiply their leaders without selling, burning out or building an expensive C-suite
By Josey Sewell, RDH
I helped tell the growth story
For years I stood on stages across this industry and told a growth story. I was COO of a dental group that grew from zero to $40 million in six years, built alongside my business partner and an executive team we developed together. When the group sold, I shared in that sale, and it changed my life. It also made for a good story: a hygienist with an associate’s degree, a non-dentist in ownership, who dug into the business and helped take a group to market.
I’m still proud of that work. I also know now that I was part of a problem this industry doesn’t talk about enough.
Over the last seven years I’ve worked inside many of the fastest-growing dental groups in the country, and I’ve watched what happens on the other side of a lot of those deals. A lot of the dentists who sold aren’t happier. They miss owning their business and they miss their team. Some struggle with working for someone else, and some have watched what they built turn into something they don’t recognize.
Running to something, or running from something
When I sit with owners who have sold, or who are thinking about it, their reasons usually fall into one of two groups. Some are running to something. A liquidity event, a different kind of life, a new opportunity they’ve wanted for years. Those are legitimate reasons, and for some owners selling is exactly the right call.
Many others are running away from something. Sometimes it’s a partnership that turned difficult. Sometimes it’s the stress of being the dentist, the CEO and the clinical leader while also owning some piece of marketing and finance. Most of the time it’s a business that has slowly grown into something that eats their evenings, their sleep and their family’s time.
Very few people talk about what that role costs. I have watched too many owners build a business and sacrifice the exact things they were building it for. They wanted freedom, time and close relationships with their spouse and kids, and the business took all three. When selling looks like the only way out, people take it, and some of them discover that life on the other side isn’t what they expected.
The rush to sell has momentum from both directions. Buyers have spent a decade competing for practices, and owners heard the payout framed as the goal from nearly every stage in this industry, including mine. I’m not arguing against selling, and I’m not arguing against DSOs. Plenty of the groups reading this are DSOs, and everything that follows applies inside them too. My point is narrower. If you’re an owner wondering whether your only choices are to keep living with this level of stress or to sell, there is another model worth considering.
The org chart dentistry forgot to update
Think about how much has changed chairside in the last decade. Robots are placing implants. AI listens to patient conversations and drafts clinical notes. Software charts a perio exam by voice. We’ve changed how we diagnose, how we treat and how we market.
Now picture the org chart behind that chair. One dentist, two assistants, two hygienists, and one person up front holding the schedule, the financial arrangements, insurance, billing and the phones. Add an office manager once the practice gets busy enough. That model has barely moved in decades. Much of the working world rebuilt how teams operate during COVID, and most of dentistry went right back to the way it was.
For a single practice, the traditional model holds. It usually holds at two or three locations, and sometimes up to five. Somewhere in that range a gap opens up. The next stage of growth seems to demand a full leadership team: a marketing director, a finance director, someone in business development, and a clinical leader who isn’t also the CEO. Each of those is a six-figure seat. A chief marketing officer alone can cost well over $100,000 a year, and fractional executive support adds up quickly too. With margins as tight as they are, many owners look at that leap and see only two options. Keep carrying everything themselves, or sell.
A modern human capital model offers a third door.
Great dentists already know how to delegate
The best producers in dentistry are already experts at delegation. They know what it means to protect their highest and best use, the $1,000-an-hour clinical work only their license allows, and to hand everything else to an assistant or hygienist who can do it well. Nobody reading this would do their own sterilization after hours to save money. A chairside assistant who hands you the right instrument before you ask is the reason you can work at the top of your license.
Where many leaders struggle is carrying that same instinct out of the operatory and into the business. The scheduling, the follow-up, the reports and the recruiting all stay on the leader’s plate, as if the business side has to be a solo act.
A dental assistant magnifies the clinical impact of a dentist. A virtual assistant can magnify the operational impact of your leaders in the same way. The question I ask every leader I work with is a simple one: What is my highest and best use, and how can I delegate everything else?
What a hybrid team looks like
A hybrid team is an in-office team supported by committed remote team members, and increasingly those remote team members work alongside AI tools. Many groups already use remote support for phones, insurance verification and revenue cycle management. That work matters, and it’s a smart place to start.
What I’m proposing goes a step further. The same model can sit directly beside your leaders. The goal is to give the people you already trust the support to operate at a higher level, without hiring a stack of expensive executives to do it.
The clinical leader who is also the CEO
Picture an owner who leads multiple associates, wants to grow the existing practices, and is weighing additional locations. There are a lot of dentists to take care of. She is also overseeing marketing and finance and making sure the business is profitable.
Break down just the clinical leadership piece of that job. It includes meeting with dentists, training them, reviewing their cases, recruiting new associates and onboarding the ones who say yes. A significant share of that work is administrative. Someone has to schedule the meetings, pull each associate’s scorecard, post the recruiting ads, collect cases from the associate and organize them for review, and keep the calendar from collapsing.
A dedicated virtual assistant can carry all of that. The owner walks into a case review with the cases already gathered and the numbers already pulled, and spends her time on the part that requires a dentist’s judgment. The same assistant can help capture content and keep the owner’s professional presence active, which matters because in a growing group the CEO’s personal brand is part of how you recruit.
The office manager who runs the business
The office manager role has changed more than almost any other seat in dentistry. It used to be something like a super receptionist, someone who managed the front desk and the schedule and kept an eye on insurance. In the most successful groups I work with, the office manager now runs the business. In my own group we developed office managers capable of leading practices producing $3 million to $7 million a year, and that takes skill, training and an enormous amount of work.
Look at what sits on that person’s plate. She leads and develops the team, builds systems, reviews the numbers, watches collections, stays connected to marketing and HR, and holds people accountable while building culture. Picture her leading twelve to fifteen people. She wants every one of them to feel seen and valued, because that’s what drives retention and performance. She’s also the one pulling scorecards, prepping every one-on-one from scratch, writing up notes afterward and chasing the follow-up from each meeting.
Now give her support. Someone on her extended team pulls the scorecard automatically. AI helps surface what matters in that data, so she sees the three things worth discussing instead of forty rows nobody has time to read. It goes to the provider ahead of time so they can add context, and twenty-four hours before the one-on-one she has performance, satisfaction and the full story in front of her. She walks into that meeting and leads. She celebrates what’s working, she’s honest about what isn’t, and together they set a goal. When it’s over, the notes are written, sent and filed without her touching them.
That’s not a person disappearing. That’s a leader getting her job back.
For CEOs and CFOs, this is one of the most cost-effective moves available. Many organizations struggle to bring a leader in from the outside, because an outside hire doesn’t know the culture or the systems. Supporting the leaders you already have lets them operate at a higher level without that risk. Instead of collecting numbers, they review them and make decisions. Instead of chasing paperwork, they put their energy and talent into developing people. If you want your office manager to love you forever and never leave, get her an assistant of her own.
Remote is good, and AI-enabled is better
Remote team members alone already solve something. They give you capacity you can’t find in your local hiring market and coverage you won’t get from a nine-to-five local hire. What’s new is pairing that person with an AI copilot that takes the repetitive half of their job, so the human half gets bigger.
Two examples are already working inside dental practices. The first is an AI receptionist that answers on the first ring after hours, confirms tomorrow’s appointments, books openings, and checks eligibility overnight before anyone unlocks the front door. Many of those calls still need a person who knows the practice, and that’s by design. The AI protects access, and a trained person protects the relationship.
The second is in the revenue cycle. A claim comes back denied. A team member, in the office or remote, asks AI to summarize the denial and draft an appeal with the X-ray and perio chart attached. In seconds there’s a plain-language explanation and a first-draft appeal citing the plan’s own policy. A person still reads every word, signs it and sends it. Nothing that touches a patient or a claim leaves the practice without a human deciding it should.
A remote team member is still a person
I’ve spent many hours training remote team members for dental practices, and owners who have never hired one ask the same things every time. They want to know what happens when someone is late, who covers when someone gets sick, who does the training, and what to do if the person simply isn’t good at the job. Some owners tried remote support once and it didn’t work. I believe them.
Usually the missing piece is leadership. A remote team member is still a person, with a Monday morning, a bad day and a learning curve, exactly like the person at your front desk right now. Everything starts with clear expectations, real KPIs, a consistent communication rhythm, and standards held the same way every time. You train a remote team member the way you’d train someone standing in your office.
The language I use in every practice is high love, high accountability. High love means you know this person’s name, their goals and what’s going on in their life, and you invest in them because they matter. High accountability means the standard doesn’t move just because they aren’t in the building. You don’t lower the bar for someone you can’t see, and you don’t stop caring about them either.
Remote team members will expose a leader who has never had to lead clearly, because you can’t rely on hallway conversations and body language to cover for vague expectations. That isn’t a weakness in the model. It’s a mirror, and any leader willing to build a system around it can make it work.
Ten times the impact without ten times the cost
Dan Sullivan and Benjamin Hardy argue in 10x Is Easier Than 2x that doubling a business usually means doing what you already do twice as hard, with more strain and more sacrificed family time. Aiming for ten times forces you to rethink how the work gets done. I’d ask growing groups to apply that thinking to their team.
The modern human capital model lets your leaders multiply their output without multiplying payroll at the same rate. It starts with three things: building great systems, identifying the highest and best use of your top leaders, and giving each of them a committed virtual team member to carry the administrative load. With margins as tight as they are, that is often the difference between growth that feels sustainable and growth that pushes an owner toward the exit.
The most human-centered company still wins
The pressures on dentistry aren’t easing. Hygienists are leaving the profession, team costs keep climbing, reimbursements shrink every year, and turnover never seems to stop. In the middle of all that, the most human-centered company still wins. When patients and team members feel something different the moment they walk through your door, they stay.
Great cultures are not built by software. They are built by leadership. The technology gives your leaders their time back, so they can spend it on the people in front of them.
The future I believe in keeps practices in the hands of dentists who have a healthy relationship with their own business, one that doesn’t cost them their marriage, their health or their time with their kids. That future belongs to the owners and teams who show up for this work every day. I hope you see yourself in it, and I hope you give yourself and your leaders the support to build it.
Thinking about adding remote team members to your DSO’s support structure? See how Reach approaches it at getreach.co/gdn.
About the Author
Josey Sewell, RDH, is co-founder and CEO of joyFULL Growth, a firm that helps dental practices and groups build the leadership, culture and operational infrastructure to grow without losing the people who make them great. She began her career as a clinical dental hygienist and rose through hygiene, HR and operations leadership to become COO of a dental group that grew from zero to $40 million in six years, built alongside her business partner and the executive team they developed. A former EOS Implementer, she has spent the last seven years working with many of the fastest-growing dental groups in the country. She writes for dental industry publications and speaks on leadership, team design and the future of dental work.
