A recent episode of The Art of Dental Finance and Management centered around a simple idea about how a dental practice should be run:
“The doctor is still the CEO, and the office manager is the COO.”
That framing makes a lot of sense. The dentist should set the direction, make the major decisions and stay connected to the business. But a strong office manager should have enough visibility and authority to keep the day-to-day operation moving without everything constantly coming back to the doctor.
The bigger question is how you get there.
You cannot simply give someone the office manager title, hand them more responsibility and expect them to start thinking like a COO. As the dentist, you have to create the structure that helps them understand the business, build confidence and gradually take more ownership.
That is where we would add our two cents to the conversation.
We think the progression looks something like this:
Structured Meetings → Dashboards → Checklists → Ownership → Recommendations
Start With a Regular Meeting
Before you build another report, start with a recurring meeting. Weekly or biweekly is usually enough, as long as it happens consistently.
Keep the agenda simple:
- What changed since the last meeting?
- What numbers are off track?
- What needs attention?
- What can the office manager handle?
- What still needs the dentist?
This gives your office manager context they cannot get from a spreadsheet alone. They start learning what matters to you, which problems deserve attention and how you think through decisions.
Another important part of that CEO/COO relationship is knowing where each person’s lane begins and ends. Your regular meeting is a good place to work through that. If your office manager does not know what they can own and what still belongs with you, delegation gets messy fast.
Give Them a Simple Dashboard
Once the meeting rhythm is in place, give your office manager a short list of numbers to watch. Not every report your software can generate. Just the numbers that give a useful picture of the practice.
A good starting dashboard might include:
- Gross and net production
- Gross and net collections
- New patients
- Total overhead
- Overhead percentage
The goal is not to turn your office manager into an accountant. It is to help them learn what normal looks like.
If collections start slipping behind production, they should notice. If new patients are up but production is flat, that should raise a question. If overhead starts climbing, it should not be a surprise three months later.
At first, they may simply report the numbers. That is fine. They are building familiarity.
Turn the Numbers Into Checklists
A dashboard tells you what happened. A checklist helps your office manager know what to do next.
As the episode moved into collections, the conversation got much more specific. A/R over 90 days should be watched closely, with anything above 10% called out as a red flag. Unresolved insurance claims should also be getting attention around day 31, not sitting untouched until they are 60 or 90 days old.
Turn that into a repeatable process:
- Review total A/R
- Check the percentage over 90 days
- Review insurance claims over 30 days
- Assign follow-up
- Flag anything unusual
Now your office manager is not just reading a report. They are managing a process.
The same approach works elsewhere. For scheduling, they might monitor production goals, open chair time and protected blocks. For marketing, they might track spend, patient sources and treatment generated. For staffing, they might monitor open roles, onboarding and performance issues.
Keep the checklist simple enough that it actually gets used.
Then Give Them Ownership
This is where the dentist has to give up a little control.
The conversation put it plainly:
“In order for me to grow as a leader, I have to give up some of that control.”
That does not mean handing over the practice. It means deciding what your office manager can own without checking with you every time.
A simple way to divide it is:
- Office manager decides: routine scheduling adjustments, standard follow-up processes and smaller operational issues.
- Office manager recommends: staffing changes, vendor changes, larger marketing shifts and process improvements.
- Dentist decides: major financial commitments, clinical decisions and overall practice direction.
The clearer that line is, the easier it is for your office manager to act with confidence instead of constantly wondering whether they are overstepping.
Move From Reporting to Recommending
This is where all of that structure should eventually lead.
At first, your office manager might say, “Collections were $145,000 this month.” Later, they might say, “Collections were below target and our 90-day A/R increased.”
Eventually, you want to hear something like: “Collections were below target because several insurance claims sat too long. I think we should start reviewing them at 30 days and track it weekly.”
That is a much more valuable conversation. They are no longer just bringing you information. They are using what they know about the practice to help decide what should happen next.
The episode makes a similar point when the discussion moves into marketing. Instead of telling the dentist that marketing seems to be working, the office manager should be able to look at spend, ROI, referral sources and the treatment generated, then come back with a recommendation.
That is the shift you are trying to create.
Give It Time
Your office manager is not going to understand every number or confidently recommend a solution after two meetings.
They learn by seeing the same numbers and working through the same problems repeatedly. Over time, they start spotting patterns. They know when A/R looks wrong, when the schedule is full but not productive or when a marketing channel is not pulling its weight.
That experience builds confidence. More importantly, it builds judgment.
Start With One Area
You do not need to build a giant management system all at once. Pick one area that regularly causes headaches, whether that is collections, scheduling, staffing or marketing.
Then work through the formula:
Meeting → Dashboard → Checklist → Ownership → Recommendation
When your office manager brings something to you, ask one simple question: “What do you recommend?”
You may get “I’m not sure” at first. That’s okay. You are giving them the opportunity to start thinking beyond the report.
As a matter of fact, this is also part of the work we do with dentists at Engage Advisors. Practice management and financial performance tend to meet in the same place. How you schedule, collect, monitor overhead and manage the team eventually shows up in your numbers.
You do not need your office manager to think exactly like you. Give them the structure and visibility to develop their own judgment.
That’s when the CEO/COO relationship described in the episode starts becoming more than a good idea. It starts becoming the way you actually run the practice.