One playbook, different results by location — dental groups

Multi-site variance — one brand, one playbook, and a fourfold spread between locations

PRESENTATION — WHAT THE OPERATOR SEES

Same signage, same fee schedule, same scripts, same marketing. One office grows 12% and another is flat, and nobody in the room can say why. The regional blames the market, the marketing vendor blames the operator, and the group average conceals both.

DIFFERENTIAL — LIKELY CAUSES, MOST LIKELY FIRST

01
The spread is the industry base rate — variance between sites is normal, not an anomaly

Practices are drawn from a wide right-skewed distribution, so any group of locations will contain sites several times apart on demand before anything is wrong.

Monthly new patients per practice: 0–19 for 38.8% of practices, 20–39 for 19.0%, 40–59 for 14.9%, 60–79 for 9.5%, 80 or more for 17.7%. Planet DDS's own reading: "That is a 4x difference in new patient acquisition between the top tier and the bottom tier." Case acceptance is equally wide — 9.8% of practices below 30%, 9.1% at 90–100%.

Planet DDS, 2026 Dental Industry Outlook Deep Dive (n = 8,500+ practices, 2025 data) — the only published new-patient distribution in dentistry

NOT THIS IF — Every site clusters tightly on new patients, acceptance and retention, and only production differs — then the variance is in fees, mix or collections, not in demand.
02
Chair count and chair efficiency, not market

Sites differ in operatories and in how hard each operatory works, and per-chair output moves growth more than square footage or catchment does.

Revenue per chair (Planet DDS's own metric name): DSO segment average $205,690, median $156,741 across 59,139 chairs; solo segment average $236,286, median $184,502 across 2,099 chairs — solos run 15% higher on average and 18% higher on median. Planet DDS's chair-efficiency quadrants: Small and Efficient (under 14 chairs, over $118K per chair) 995 offices growing 7.58%; Big and Efficient 289 offices at 6.85%; Big but Inefficient 1,050 offices at 6.27%; Small and Inefficient 233 offices at 4.41%.

Planet DDS, 2026 Deep Dive, chair-efficiency analysis

NOT THIS IF — Per-chair output is within a narrow band across every site — then capacity is not the differentiator.
03
Day-of-week scheduling, not demand

A site carrying a heavier share of structurally low-production days starts every week behind, regardless of how many patients call.

Average Friday production is $7,388 against Tuesday at $10,152 — Friday runs 27% lower. Against an average daily production per provider-practice of $8,764, a single misallocated day per week is a material annual gap.

Planet DDS, 2026 Deep Dive, peak-day analysis

NOT THIS IF — Every site runs the same operating days with the same provider coverage on each of them.
04
Retention degrades with group size, and it degrades unevenly by site

The patient base at some sites empties faster than at others, so those locations run acquisition to stand still while their peers compound.

Patient retention averages 70% at solo practices (top 10% 94%) and 58% at 8+ location groups (top 10% 90%). Henry Schein One states directly that retention and reappointment rates are higher in practices with 1–7 locations than in those with 8 or more. The industry-wide average fell to 64% from 72% year over year.

Henry Schein One, 2026 Catalyst Index (retention blog and press release)

NOT THIS IF — Per-site retention, measured on one definition, sits within a few points across the group.
05
The group's own size band — the middle of the market is the weak spot

At a certain office count the group is too large to run informally and not yet built to run systematically, and every site inherits the same drag.

Average growth by DSO size: 2–5 offices 9.0% (62.1% of offices growing, 166 DSOs); 6–10 offices 6.9% (66.1%, 55 DSOs); 11–25 offices 8.8% (68.0%, 45 DSOs); 26–50 offices 2.8% (55.3%, 20 DSOs); 51–100 offices 7.4% (64.9%, 22 DSOs); 100+ offices 7.1% (61.6%, 14 DSOs). The worst band is the middle, not the top.

Planet DDS, 2026 Deep Dive, groups of 2+ locations

NOT THIS IF — The group is under 25 offices, or individual sites vary widely inside it — then the cause is per-site, not structural. Note the small denominators in the larger bands: 20 DSOs in the 26–50 band and 14 above 100.

HOW TO TELL THEM APART

How to tell these apart in your own numbers

Each of these is a measurement you can run yourself, without us.

01 · The spread is the industry base rate — variance between sites is normal, not an anomaly

Rank every location on new patients per location per month and place each one against the published distribution rather than against your own group average — in groups of six to twelve locations the group average is almost always the number hiding the answer.

CONFIRMS IF

Your worst site is under 20 and your best is over 60 — that is precisely the published shape, where 38.8% of practices are under 20 and 17.7% are at 80 or more. The variance is normal; the question becomes which sites are movable.

EXCLUDES IF

Every site clusters within one band and production still diverges — then run the collections and fee-schedule tests instead.

02 · Chair count and chair efficiency, not market

Trailing 12 months collections divided by operatories actually in use, per site. Plot each site on the chair count and per-chair output grid.

CONFIRMS IF

Per-chair output varies more across sites than the per-site new-patient count does. That is a capacity and utilisation problem, not a demand problem. The reference point is a $156,741 DSO-segment median per chair, and Planet DDS's efficiency threshold of $118K per chair.

EXCLUDES IF

Per-chair output is even across sites while new patients are not.

03 · Day-of-week scheduling, not demand

Production by day of week, per site, trailing 12 months, with provider coverage overlaid.

CONFIRMS IF

The lagging site carries a heavier share of low-production days or thinner doctor coverage on the high-production ones. The published Friday-to-Tuesday spread is 27%.

EXCLUDES IF

The day mix and coverage pattern are identical across sites.

04 · Retention degrades with group size, and it degrades unevenly by site

Retention per site on one definition — percentage of active patients returning for care within an 18-month window against the total active base — plus hygiene reappointment within 12 months per site.

CONFIRMS IF

The lagging sites sit 10 or more points below the leading ones on either metric.

EXCLUDES IF

Retention and reappointment are uniform across sites, in which case the group has a demand or capacity problem rather than a retention one.

05 · The group's own size band — the middle of the market is the weak spot

Plot the whole group's average growth and the share of offices growing against Planet DDS's published size bands.

CONFIRMS IF

The group sits in the 26–50 office range and the whole group is at or near 2.8% growth with roughly half the offices growing — that is a structural band effect, and no per-site intervention will resolve it.

EXCLUDES IF

Sites inside the group vary widely — then the cause is local and the band comparison is a distraction.

WHAT RESOLVES EACH

What resolves this, and how you will know it resolved

The spread is the industry base rate — variance between sites is normal, not an anomaly	Rx 04 · marketing attribution →	Per-location readout, monthly, with each site placed against the published distribution rather than against the group mean. The first deliverable is usually the discovery that the group has been managing to an average no site actually occupies.
Chair count and chair efficiency, not market	Rx 03 · patient conversion →	Same-day capacity matching and routing, so the chairs that exist run harder before more are built. Planet DDS's Small and Efficient quadrant grows at 7.58% against 6.27% for Big but Inefficient — added chairs are not the lever.
Day-of-week scheduling, not demand	Rx 03 · patient conversion →	The cheapest fix in this document. Change the days and the coverage; do not buy media against a 27% structural gap between Friday and Tuesday.
Retention degrades with group size, and it degrades unevenly by site	Rx 03 · patient conversion →	Recall and reappointment instrumented per site with one definition. A national campaign cannot fix a site-level retention gap, and running one across a group with a fourfold demand spread wastes most of the budget on the sites least able to absorb it.
The group's own size band — the middle of the market is the weak spot	Rx 04 · marketing attribution →	Reporting sizes the problem honestly; the fix is an operating-model change, not a marketing one, and we would say so before quoting. It also matters for Rx 05 · pre-exit — the 26–50 office band is where a platform's same-store story tends to break, and diligence will find it.

WHAT "RESOLVED" LOOKS LIKE — The spread between best and worst location on new patients per location per month, and same-store production growth per site

MEDIAN

39 new patients per location per month (Henry Schein One); 46 per practice per month (Planet DDS). Same-store production growth: weighted average 4.0%, trimmed mean 4.9%, simple average 6.6% across 3,294 practice locations, with 63% of practices growing (Planet DDS, 2026 Deep Dive).

TOP DECILE

82 new patients per location per month is Henry Schein One's top 10%; 17.7% of practices see 80 or more (Planet DDS). 33.5% of practices grew more than 10% in production.

TARGET

Every location above the 39–45 "within average" floor, with the group's laggards moved into the 45–65 "strong" band, and same-store production growth of 6–10% per site. Not every site at 82 — the published distribution does not support a group in which every location is top-decile, and a plan that promises it is describing something other than this industry.

Planet DDS, 2026 Dental Industry Outlook Deep Dive; Henry Schein One, 2026 Catalyst Index new-patient performance tiers

HOW THIS DIFFERS BY SCALE

How this differs by scale

Single site	The presentation does not occur across sites, but the same tests work across providers and across days of the week inside one office. Run production and acceptance per provider and per weekday — the Friday-to-Tuesday spread of 27% exists inside a single practice too.
Group	At 2–25 locations this is the most fixable version of the problem, and the published growth rates support that: 2–5 offices average 9.0% growth, 6–10 offices 6.9%, 11–25 offices 8.8%. The work is per-site measurement first — pooled reporting is the reason the variance persisted long enough to become a complaint.
Platform	At 26+ locations the variance shows up in collections before it shows up in production: Henry Schein One puts 8+ location groups at 72% collection rate against 97% for the top 10%, and retention at 58% against 70% for solos. Planet DDS's 26–50 office band grows 2.8% with 55.3% of offices growing — worse than the 100+ band at 7.1%, which means size alone is not the excuse.

OTHER PRESENTATIONS — DSO & GENERAL DENTISTRY

A differential narrows the field. It does not replace the examination — that is what the six weeks are for. Every figure above is an industry reference range, not a client's numbers; those stay sealed. Sources are set out at /sources.

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