The $38,000 Raise Nobody Has to Approve

Hamza Asumah, MD, MBA, MPH

No new patients. No fee increase. No begging insurance for better rates. On a typical $1M practice, there’s roughly $38,000 sitting in the overhead line — and you capture it by fixing systems, not cutting people.

There’s a raise hiding in most dental practices that requires no one’s approval. On a $1M practice, the gap between average staff compensation — around 33.8% of collections — and what high performers run, closer to 30%, is worth roughly $38,000 a year. And here’s the part that surprises every owner I explain it to: you don’t capture it by cutting people.

You capture it by fixing the system around the people you already have. And staff compensation is only the most visible line. Once you learn to see overhead as a system, similar gaps show up in scheduling, supplies, and vendor contracts — each one a raise you don’t have to ask anyone to approve.

The four places the raise is hiding

1. Right-size the schedule

Every empty operatory hour is production you’ve already paid the overhead for. Paying skilled clinicians to sit in unproductive gaps is one of the most expensive habits in the building. Scheduling in most offices happens reactively — patients request times, the team accommodates, and the result is a schedule that looks full but isn’t strategically built. The move: block-schedule your highest-value procedures into your most productive hours, and stop treating every open slot as equally valuable. If your daily production target is $8,000 and you routinely land at $7,000, that $1,000 gap across a year is nearly $200,000 in lost production.

2. Audit your waste

Expired materials, over-ordering, single-use items used inefficiently. A quarterly waste audit — physically reviewing what’s being discarded and why — routinely surfaces $5,000–$15,000 in annual savings in a mid-sized practice. The move: once a quarter, have someone physically inventory what expired unused and what’s over-stocked, then adjust ordering pars accordingly. This is among the fastest cash you’ll ever find.

3. Renegotiate supply and vendor contracts

With costs up around 5% and reimbursement flat, every dollar of overhead you claw back drops straight to the bottom line. The move: list your top ten vendors by annual spend and renegotiate the top three this quarter. Consolidating suppliers for volume pricing is exactly how DSOs achieve lower overhead — centralized purchasing power, not higher billings. You can borrow the tactic without joining a DSO.

4. Measure staffing as a percentage of production — monthly

The industry benchmark for total staff cost is roughly 22–28% of production. If yours is creeping above 30%, that’s your signal — not to fire, but to investigate why productivity and payroll have drifted apart. The move: run the calculation every month (total staff cost ÷ production × 100). Often the answer isn’t too many people; it’s too little production per person, which points back to scheduling and case acceptance — not layoffs.

The overhead scorecard

High-performing practices target these ranges as a share of collections. Use them to find your biggest gap:

Total overhead: 60–65%   ·   Staff cost: 22–28% of production

Supplies: 5–7%   ·   Lab: 8–10%   ·   Facility/rent: 5–8%

Find your worst gap versus these benchmarks, close that one first, then re-measure next quarter. One category at a time.

Why cutting heads is the wrong instinct

Under pressure, the reflex is to look at the payroll line and start trimming. But the raise isn’t in the payroll number — it’s in the discipline around it. Cutting a good team member to save a salary usually costs you more than it saves once you count lost production, the turnover bill, and the months the role sits empty in a market where nearly 40% of practices already can’t staff a full hygiene schedule. You save one line item and blow up three others.

Same team. Same chairs. $38,000 you were already leaving on the table.

The common mistake

The mistake is treating cost control as a one-time purge instead of an ongoing discipline. The practices that consistently beat their benchmarks aren’t the ones that made a single dramatic cut and moved on. They’re the ones who built overhead monitoring into the normal rhythm of the month — a standing review, a scorecard, one improvement per cycle — so the raise shows up every year, quietly, without anyone having to sign off on it.