The Pacific Aesthetic Continuum's Podcast
Wondering what other dentists are experiencing and what solutions there are to the challenges in dentistry. Listen to what your colleagues are doing to improve the quality of their lives.
The Pacific Aesthetic Continuum's Podcast
From Burnout To 55 Percent Overhead: A Dental Business Playbook
What if a 10 percent drop in overhead could raise your income by 40 percent? We sit down with Dr. Tony Tamaro to map a practical path to 55–56 percent overhead while keeping care personal, ethical, and high quality. The key isn’t grinding more—it’s changing the model: price your time, not just your procedures; run a doctor-led new patient interview that builds trust in minutes; and align your days around comprehensive, quadrant-based care that reduces visits and raises production per hour.
Tony walks us through the numbers dentists often ignore. Salaries, including payroll taxes, should live near 20 percent; lab around 10 percent; rent roughly 3–5 percent. Many practices blow past those targets because they overhire and under-measure. We break down how to calculate hourly production and true procedure costs, why annual fee increases are responsible and necessary, and how to use real-time dashboards instead of waiting six weeks for CPA reports you can’t act on. You’ll learn how dropping insurance dependence, updating fees, and focusing on high-value procedures can stabilize cash flow and cut chaos.
We also dig into the human side. A 10-minute doctor interview before the exam—asking about goals, fears, and barriers—can transform case acceptance from 35 percent to 90 percent. Pair that with comprehensive diagnostics, clear visuals, and AI support to reduce doubt, and patients start owning their choices. By training in aesthetics, function, and occlusion, you can deliver bigger cases with fewer appointments, which means a calmer schedule, a smaller team, and a healthier business.
If you’re ready to run a dental business, not just a practice, this conversation gives you the framework, the metrics, and the mindset to get there. Subscribe, share this with a colleague who needs it, and leave a review with the one metric you’ll start tracking weekly.
For more information contact the Pacific Aesthetic Continuum at https://thepac.org.
Hi everyone, Dr. Michael Miyasaki here again. And we're having a great interview, but let me introduce everybody real quick. We have Garrett Caldwell, CEO of Cordell Lab and the Pacific Aesthetic Continuum, the PAC. So he's an overachiever, but I have another overachiever, and that's why I'm excited to have Dr. Tony Tamaro here today. And uh, real quick, I'll I'll read just a brief bio of Dr. Tomorrow. So he was a graduate of the University of Michigan School of Dentistry, where he got at the University of Michigan his three degrees, his master's, his bachelor's, and his dental. I don't know who he paid off to get all that, but he is um he has really dedicated his career to the advancement of dental education. Tony and I have been teaching for decades, and uh the best years of our life were when we were teaching together. And he is a member of Catapult Education. Tony is known for his expertise in restorative dentistry, in aesthetic dentistry, and in occlusion. So Tony does a lot of the big cases in his office, the uh complex occlusion cases. And he's a consultant, a key opinion leader for many uh dump manufacturers, laboratories, and he's published and lectures all over. So he's a busy guy. So Dr. Tamar and Garrett, thank you for joining us today.
SPEAKER_00:Yeah, you're welcome. Thanks, Mike. Yeah, thanks for having us.
SPEAKER_02:Yeah, but and you know, the the good part is we haven't even told people what we're talking to about today, but uh Tony and I were talking. Uh, well, he's been telling me this for a decade, but we were just talking uh a couple weeks ago about how he likes to advise dentists on how to keep their overheads at between 55 and 56 percent. So somewhere between 55 and 56.
SPEAKER_00:There's not much room maximum 56.
SPEAKER_02:Okay, put it with the goal of 55. It's it's a really broad range, sure. But anyway, so uh so Tony likes to he's he's owned his own practices and he gets them all in that range. And so I asked him, I said, Tony, how do you do it? So today what we're gonna do is Tony's gonna give us some of the broad ideas of how we can achieve this. So um, Tony, take it away.
SPEAKER_00:Sure. And uh, I just want to start by saying thank you and both of you for what you do for Dennis. Uh it's so appreciative. Well, what is crazy about this is uh perhaps one of your last podcasts you have bid Bill Blatchford on. And that's actually how uh Mike and I got to meet is uh I decided Bill Blatcher and I met in 1983. We were part of Quest, if you remember, way, way, way back. And you know, and back in those days, they would say if you produce a million dollars and collect 750, that's unbelievable. And I used to walk around and say, hey, I'll tell you what, you give me that in every practice, you give me that$250,000 that I can collect, I'll take 75%, you take 25%. And so Bill and I got to know each other. Then in about uh 1994-95, uh, there's a lot of us, uh, James Clem, Rise Poor, uh, a lot of people. Uh, Bill was our coach. He had started Blatchford Solutions, and he was our coach. And that's actually how uh I got to meet Mike uh at LBI, and we were all part of going there and getting educated. So that that was uh very memorable moments. And it was actually Bill that put me on the the track of dentistry that I always wanted to be in. And that's because prior to that, uh we had uh I had a business partner that we ran just on roller skates all the time. We had two offices, then we had three offices. In fact, what we used to do is we'd take a new graduate, the new graduate come in, nestitize my patient. I'd do the prep, they would pack the amalgam or take the impression for the gold. But the truth of the matter was that it wasn't going anywhere. I was just getting completely burned out, and it wasn't profitable at all. And I thought to myself, there has to be something more to dentistry. Well, I was blessed in that I grew up in a business. My parents owned a very, very, very strict Italian father, owned a good-sized Italian restaurant. And my father didn't have a credit card to the last two years of his life because he started track wanting to travel around the world. Never had a credit, everything was cash. And he had certain sayings that always stuck with me, such as a dollar in my pocket is much better than a dollar in someone else's pocket. So I started looking at dentistry and with Bill's coaching, and I thought, you know, today, even the ADA, I think uh on the the average overhead is somewhere between 72 and 75 percent in dental offices. And I looked at our profession and I said, you know, we go to school and we we go seven, eight years to school, and we be should should be rewarded as such. So I started looking at that and said, There's got to be more to this. This running around in roller skates, that's not what I want to do. But what I want to do is treat one patient at a time, the same way that anyone else would want to be treated when you go to a physician. I don't care what it is, you're the most important person for that. And there's people out there that want to have good, high-quality dentistry, see seeing one patient at a time and willing to pay for that. So, you know, I took a look at that and I decided. And again, with Bill's help back in '95, I stopped taking insurance. No insurance. Except there were some families that were with me when I started my practice and things like that. And you know, that perhaps we went to church with them. They had large families that we said, okay, you know, we're gonna, we're gonna keep those. They were there, they were they're our bread and butter, they helped us get started. And so, you know, back in those days, we did a lot of gold work and things like that. And and porcelain was just coming, etching was bonding, adhesive dentistry was just coming around the corner. And so, you know, it started being rewarding, but I still didn't like the percentage of overhead. So I started looking at my numbers and keeping track of those numbers. Now, if you take a look at the numbers instead of the percentages, you can get lost. Okay. An example of that would be if you do a million dollars, collect a million dollars. When I say do, I mean collect. And your overhead's 750,000. That's 75%. You have 250,000 one to reward yourself your salary and still run a practice on 250,000. And I said, that's not right. So in my lectures and what I should teach the dentist is that if I just get you down to 65% to start with, just decrease your overhead by 10%. You just increase from 250,000 to 350,000. You just increase your income by 40% by dropping it 10%. But the problem is this, and again, I love my colleagues, but they're not business people. One of the first things I say is don't ever be ashamed of what you do. It's a business. This is how you pay your bills. This people know what you make in the office, they collect the money. Don't ever be ashamed and of hard work and also to be ashamed of what you charge or what you do. The biggest issue is that most dentists think they sell items, but they don't think they sell time. And that's the hard one of the hardest things to convince dentists about what we do professionally. So that's where I start. And I show them, and I show them certain percents, such as your employee's salary, including social security contribution, should be no greater than 20%. If it is, you have an issue. The average practice today in most places between 30 and 40 percent salaries, and it's horrible. You you just can't do it. So, how do we change that? You know, I always tell people in the lecture, no one's gonna get fired here. But what we have to show the doctors is do you actually know what your hourly production is, your hourly collection? Do you actually know what it costs you to do a crown? What does it cost you to do a composite? What does it cost you to do a denture? And I have them figure that out. And I said, one of the first things you have to do is one, the very first thing, is take a look at your fees. And I ask them, it's 2025. In September, growing up in Michigan and Detroit, I knew every September the 2026 vehicles are coming out. Now, if you're thinking of buying a 2026 in August, you're thinking to yourself, well, let me see. I know that the 2025s are going to be cheaper than the 2026s. Why is it we allow almost every other industry, computers, everything, charge more? New Apple phone, new Apple Watch, charge more, but we feel guilty when we increase our fees, the cost of supplies, everything goes up. So to teach them the sense of business is what I it's like you won't lose patience over this, usually. You might lose a few, but you have to do it respectfully and do the right thing. This is how you make a living. So you know, I show them that, and then I teach them also like like for instance, your rent should be somewhere, you know, between like three to five percent, unless you own the building. And there's advantages to owning the building, which at some point hopefully a dentist can. And obviously, if you own the building, you want to pay yourself more rent within the realm of rent in your area because you can get checked on that, because that's income to you and your family at a lower tax bracket because it's a capital gain. So the hard issue is one teaching on the business, but I tell them there's a few important things to have a great attorney, a business attorney, an incredible accountant that knows, that stays up on things, and an incredible financial advisor. Unbelievable. Because if you have a great financial advisor, one of the first questions my financial advisor asked me, and I thought I could do it myself for years because my father taught me to stock market, and I thought, man, I'm good at this. I'm a dentist, I'm not a financial advisor. I don't care, you know, I just had a discussion with a physician that says, Oh, I do, I did great. And actually in 15 minutes, I showed them where they would have two and a half to triple time their net worth if they would have had a financial advisor do it. And the reason I say that is one of the first questions they ask me when I was sat down with them, I've had them now for over 30 years, and they've been fantastic is at what age do you never want to have to depend on dentistry to do to do dentistry to make a living? Or at what age is it that you feel you could walk away from dentistry and retire? And it for me, it was 57. I said, just 57, sounds good. But I build a new office in 57. It was 58 and a half. So, but yeah, that's that's how we start.
SPEAKER_02:So no, no, you're absolutely right. You know, I think it is uh you look at the percentages and your when the amount that you take home goes up, it's it is that big effect, like you're saying, 40% difference, even though it's you know the numbers less than a small percentage of your total collections, but it makes a big difference with your take home. So I think your your percentages are good. Now, like even in my practice, I have a hard time keeping my salaries at 20% just because uh you know, we're trying to be competitive in California. We've got Google and Facebook and everybody, Amazon even that are paying well and they have the benefits, you know, we'll pay for your education, we'll do all this. So we're trying to be competitive. What's your advice? I mean, is it if if I want to bring my let's say my team overhead is somewhere between 27 and 30 percent, and your target's 20, do I raise my fees? Do I get rid of some team? How how do what what's your recommendation? Because it's a there's a pretty big chasm there.
SPEAKER_00:Well, there's a couple of things. We do know that there's a very large amount of dental offices that are that I have too many employees. There, there's no question. Because back for years, people would say, I can't get that done, hire someone else. I can't get that done, hire someone. The truth of the matter is the word called efficiency. And like, you know, one of the things we've been blessed with, Mike, and Garrett knows this is that we have uh somewhat advantage in that we can do special type patients, full mouth reconstruction, occlusion, things like that. So the key is first of all to be known that to be different. Okay, what is it that makes your office different, exceptional? Okay, what is it that you do that perhaps put you on the map that someone else isn't on the map? And so I do believe that most offices their fees are not right. In fact, when um I was working in Chicago, we actually took a look one day at our fees, and the insurance, typical insurance fees were more than our fees. So it it, you know, if the insurance company's fees are more, you're you're behind. You know? Yeah. And so there are there are situations where there's too many employees, especially with today with computers and everything else and AI. I mean, yeah, that that's a fact. The key is again to be able to provide what we would call high production, high profit uh procedures, you know, whatever that is in your office, you know, and and it it's one of those things where you know, most dentists they sit there and they lollygag. They they, you know, they put as my assistant used to kick me under the chair, quit putzing around here. Yeah, you know, but the point is to do high-end procedures to know where your costs are, you know, and like you know, I I love it. I say for that 55 to 56 your lab bill and Garrett, I like this should be about 10%. But believe me, I love it when it's 58% in a month because my lab bill's 13. I love that.
SPEAKER_02:Yeah, and Garrett loves yeah, no, well, I think you're right. You know, like with the education, you're you're referring to like with the Pacific aesthetic continuum, the pack. You know, we try to tell the doctors we're trying to do comprehensive dentistry, but restore it with aesthetic restorations because not only do they look nicer, but a lot of times our preps can be a little bit more conservative because we're bonding them on, not just relying on the mechanical retention like you would an old gold crown or PFM of of old. But and I think you're right. You know, being able to open the doctor's eyes to uh this last weekend we were teaching for the pack, and you know, I was with a group of docs that have taken a few courses from us now. And I said, when now when you look at uh diagnosing, you're not thinking tooth-by-tooth dentistry, you're thinking comprehensive dentistry. And we don't want to over-treat. But then on the other hand, if the patient's got occlusal disease, let's say, and they're wearing the teeth down, maybe we can do something to kind of slow that down, which would be better in the long run to have their vertical dimension, their jaw joints will be better, their muscles will be better, and they'll have a nice looking smile. So it is something that we should at least give the patients the option of exploring. And then, you know, if they say that's not for me, you know, that's fine. But I think we should we should be able to identify, diagnose, and then explain to the patients what the uh advantages might be. So I think you're absolutely right. And that that really starts to skew things from you know where your production is to where all the other numbers fall into play, right? Right. Because like a practice that's let's say a typical practice that's doing, let's say, 650 a year in collections has a little bit uh they're they're running those numbers really tight versus a practice that could be doing$1.3 million a year in collections, they've got a little bit more leeway, you know, to give up. So if they've got uh team overhead that's maybe a little bit higher, you know, they're probably okay, that type of thing.
SPEAKER_00:So yeah. Yeah.
SPEAKER_02:So well, I hope you're enjoying this information provided by Dr. Tomorrow, and I hope you find it very inspirational. If you want to learn more about this, go to thepac.org at the t-pacpac.org and see where you can learn more about the education that the pack offers. All right, let's go back to listen to Dr. Tomorrow.
SPEAKER_00:One of the things that I tell them is very important is not only know your cost, but also to do quadrant dentistry. Okay. I mean, when you the patient accepts treatment, and I'm gonna get on that in a minute, when they accept treatment, if you're if you have four restorations or whatever in the right, the patient doesn't want to come back four different times. Just present it to them and show them the benefit of getting it done. You know, I'd rather work on six patients in six hours than 10 patients in six hours. You know what I mean? In other words, the number of patients you decrease treatment a day with longer procedures and it's more productive and less overhead. There's no question. So one of the biggest issues, and this is actually I'll be lecturing Friday in Detroit, a Detroit Dental District, and it's the name of the lecture is a new patient called Help. Where do we go from here? And I go through, but I have kept track for years and I have the statistics. And about 30 years ago, a little or third, I started getting 89 to 90 percent acceptance on my treatment. I changed one thing, and uh actually a couple of things. What I've changed was I stopped telling the patients they need to do something, and because everything we do, unless infection is involved, is optional. Everything because people can live without teeth. So when you have the attitude that, okay, I want you to own this dentistry, I don't want to own it. That's where we get in trouble as dentists, is we try to convince them to do something. I don't want to own it, I want them to own it. So when you get adapt that attitude, it's like someone just opened up the pearly gates and it's like you're free because it's the attitude of you first of all, you can present better. And I changed one major thing that that made a difference, and I just consulted with the DSO out east that was only getting 35% acceptance rate. And I said, I need you to change one thing, and the office manager didn't want to do it, and that is the first person that the patient sees, the new patient in the office outside of filling out the health forms, is me. I do about a 10-minute interview and I do an hour and a half new patient, new patient exam. And what I do is I sit down with them and I interview and I ask them what is your goal for your dental health? I want you to know that we're always here for you, that this is your dental home. Tell me about have you had any bad experiences? And I ask them, are you happy with your smile? Do you like your smile? Is there anything you would like to change? Is there anything at all that would stop you from having the dentistry done that I recommend? And what am I asking them if they can afford it? Okay, and offices, as you know, can have different financial ways to have them afford it. So that one changed thing made a huge difference, and now with AI, it's even higher, you know, because we take the human side because here's the statistic excuse me, 59% of the people pulled do not trust their dentist's diagnosis because years ago with the Reader's Digest article and and all kinds of things that you see, you know, they put 134 dentists in a room, like when Pearl ran their test, and less than 50% agreed on treatment. So, you know, I encourage the second opinion, I don't care about that, but just to have the freedom to say this is what I would recommend you'd choose. And they see, so the the key to that interview is on building a relationship, I'm building trust. And I share with them, it'd be like, I said, you know, this past a couple weeks ago, my wife and I celebrated 45 years of marriage. I said, if I asked her on the first date, if I would have asked her to marry me, uh, she told me to go away then. She still tells me to go away, but that's beside the point. But my point being is that most offices they have this routine. They put every patient in a box. They ask them when their last exam was, when their last x-rays were. You're gonna come in, you're gonna fill out the health form, you're gonna see the hygienist. We're gonna take a new set of x-rays that are needed, you're going to have a cleaning, and then the dentist is gonna walk in and do an exam. Listen to the hygienist, and now you're gonna present a two, three, four, five thousand dollar treatment plan. You've known this patient for five to ten minutes. Do you think they should trust you? But by you doing that interview, and I can't tell you how many times people have said, This is unbelievable. I've never had this type of exam, I've never had this type of relationship. In the trust, you're building the trust in the relationship. And that's what it's all about. I don't care what business you're in, you're in. I don't, and Garrett can say in the laboratory business, it's all about relationship and knowing that you have their best interest and being there for them.
SPEAKER_02:Yeah. Well, if I can make those changes and get my overhead to 56% on the high end of your scale, I'm good. No, I think you're I think you're absolutely right. You know, I I you know, we talk about the same thing that it starts with that comprehensive exam, build a relationship, feel the diagnosis, uh, the type of work you can do. So, you know, go through education so you can do uh larger cases. You know, you know the aesthetics, you know the function, the occlusion side, you marry those together. Now you now you can recommend bigger cases. And then the patients are interested where they really see that need. You're right. You don't try to force them into that, but you try to educate them so that they own that. And they say, you know, I you know, Dr. Tomorrow, I'd like you to provide that service for me because I know for my mouth that's what I need. And then you're doing more, you know, dentistry with fewer patients, which allows you to have a smaller team, which allows you to keep your overhead costs a little bit lower, and you pull start pulling all that together, and you can get your overheads down significantly. And I think you're right too, that a lot of us don't know that what our true fees are. And um, you know, sometimes there's certain clinicians I know I've talked to that get a little lazy at checking their fees, and everybody else has raised them, and and even if they can, they have not. So I think that's important that you try to maximize your return on on the time and everything because we're trying to provide the best service we can with the best materials we can. And being stressed out at doing that, I don't think you're absolutely right. Something that we signed up to get into dentistry to try to struggle like that. So um, so no, it's good. So good information.
SPEAKER_00:Yeah, there's you know, and I tell them, I said, if you, you know, a lot of dentists will say, Well, I give my end of the month figures to my CPA. And I said, and when do you get them back? Well, six weeks later, and I go, It's too late. It's too late. Okay, it's like, no, you need to know now. And and and you know, it's it's it's not so much it just makes it more fun. It really does. When when when you and believe me, even to this day, and I will I am in my 46th year of dentistry. It's I love dentistry more today than I think I ever have. And and and and I will tell you, the the biggest uh the thing that changed my life the most in our profession was seeking further education, um build and coaching, uh, meeting you guys, going to LVI, you know, getting educated, teaching. Teaching really keeps you on top of things, as you know, obviously. And also um just having good, good surround yourself with good, good colleagues and people. It really does. And always have that strive. I just think, but it just makes it so much more fun, so much more easier. Um, as I said at the beginning, we deserve to be rewarded financially. And um, you know, I I I always say dentistry doesn't make you rich, it's a vehicle to make you rich, investments in real estate, whatever, but it's a good vehicle, and and it also is an incredible vehicle to provide for your family. It really is.
SPEAKER_02:Yeah, yeah. Well, no, yeah, I think you're you're a great example of that. You've got a great family, you've got a great business, you've had, you've experienced so much, you've had a chance to travel, share so much with your colleagues, and you know, we really appreciate you doing that. And it's always great to have you here. And I hope I hope we can have you back that you can make time and uh share some more of the pearls so that you know we can really get dentists to understand. And it's one of the reasons why Garrett and I do this is it's not so much focus on the clinical side of dentistry, but more the business side of dentistry, where Garrett's always saying, you know, the dental practice today is a dental business. And, you know, before it was like a dental practice where we went in, had fun, and at the end of the month, we hope that our checkbook had some money left in there, right? And today, because everything is, you know, I not to say it's good or bad, but you know, the corporate dentistry in there and just everything that's changed, I think we do have to run it like a business to understand what it is that we're putting in and getting out from our practices to make sure that um, yeah, we're properly rewarded for our efforts, but just that we can take care of our teams and our patients. So it it is a different world than it was 40 plus years ago.
SPEAKER_00:Yeah, it is. And you know, I I I think even in the corporate world, um, I think it's um things can can happen to your liking, and uh, you know, you can achieve what you want to achieve and your goals and everything. You just you just have to, like I said, stop being a dentist for just part of the day. Be that business person, okay? Be that business person and and and think like a business person. And and believe me, I'd be the first to say, I was blessed because I had a father that taught me business. Like when I got out of school, I knew I had to match social security in my business. A lot of people don't know that to the what's this? You know, and and it's one of those things where if you don't know, then get educated. But surround your, I can't say it enough, surround yourself with good professional people. Don't be afraid to pay a good financial advisor or accountant, someone that can direct you, that understands your profession, and they'll guide you. I mean, I go back 30 plus years, and I would sit down and make a calendar with my team and say, you know, this is our goal for collections. This is how many days we're gonna work because I'm going duck hunting, pheasant hunting, fishing, or whatever. And this is how we're going to do it so much per day. But you have, if you don't plan it, if you don't write it down, there's an old saying it won't happen. And you just write those goals down and get your team fired up. And you know, you can have bonuses, which is another another time we'll talk about bonuses.
SPEAKER_02:Yeah, that sounds good. Well, no, I'm lucky that that I had you as my father to train me on how to do business. I knew you were going to say hey Garrett, I knew this was gonna go this way at some point.
SPEAKER_01:It's like well, I think we need to have every dentist manage a restaurant for a year before we practicing to appreciate what what how enjoyable it can be and what the potential is.
SPEAKER_00:It's funny. I have a friend and I talk about, I always tell them you have about five or ten minutes during your Interview to the for the patient to see how sincere you are. And I always I always ask, has anyone ever worked as a waiter or as a waitress?
SPEAKER_01:There you go.
SPEAKER_00:Because you only have you what's your tip? So I had a friend who used to put 10 one dollar bills on the table when he was eating. And he told the waitress or waiter, every time my glass of water is empty, I'm taking a dollar away.
SPEAKER_01:Yeah. There you go.
SPEAKER_02:Okay.
SPEAKER_01:No.
SPEAKER_02:There's the answer.
SPEAKER_00:Yeah. There you go.
SPEAKER_02:I just want to um, yeah, thank uh Dr. Tamara, Tony. Thank you for sharing your information. Thank you, Garrett, for uh being here. And uh it's great information. I think that should be, I think that uh that range 55 to 56 percent overhead is something we should all strive for. So every all all the pearls string them together, make a nice necklace, but then put them in action and let's get that 55 percent.
SPEAKER_00:All right, sounds good. Take care. Thank you. Thanks for having me. Thanks for coming. Bye bye. Yeah.