Episode summary

Show: GrowOrtho Podcast Hosts: Luke Infinger (HIP Creative) and Dr. Kyle Fagala (Saddle Creek Orthodontics, Neon Canvas) Recorded: [06/09/2025] Last updated: [06/04/2026]

Meta ads and Google ads do two different jobs for an orthodontic practice, and most practices pick the wrong mix for who they actually are. Meta (Facebook and Instagram) is the only digital paid channel that reliably drives fast, high-volume growth, and one practice generated roughly $3.8 million in new production in 15 months from meta alone. Google ads capture high-intent searchers at the moment they decide they need treatment, but that volume is capped by local search demand and competition. The bigger lesson in this episode is that most “bad lead” complaints are really follow-up and systems problems, that the lifetime value of an orthodontic patient (around $4,500 in profit) justifies aggressive lead spend, and that whether to run discounts comes down to the kind of practice you want to build, not a universal right answer.

Topics covered: meta ads versus Google ads, the zero moment of truth, speed to lead, lead follow-up systems, patient lifetime value, staffing by role, discount and promo strategy, in-network insurance as a discount.

Key entities: HIP Creative, Neon Canvas, Saddle Creek Orthodontics, Meta (Facebook, Instagram), Google Ads, Practice Beacon, Predictive Index, Kolbe A Index, the book Misbehaving by Richard Thaler, J.C. Penney.

About the hosts

Luke Infinger is the founder of HIP Creative, an orthodontic and dental practice growth agency that has worked with more than 600 practices and has run paid social campaigns in the orthodontic space since 2016.

Dr. Kyle Fagala is a practicing orthodontist at Saddle Creek Orthodontics, a two-location practice in suburban Memphis, and a co-founder of the marketing agency Neon Canvas, which began inside his own practice.

Intro

Most orthodontists treat paid advertising like a hammer looking for a nail. They pick a channel, run some ads, and judge the whole strategy on whether the leads feel “good.” This episode of the GrowOrtho Podcast takes that apart. Luke Infinger of HIP Creative and Dr. Kyle of Saddle Creek Orthodontics and Neon Canvas come at paid ads from opposite directions, one from an agency that built its name on aggressive Facebook campaigns, the other from a practice that grew on Google and long-term SEO, and they agree on something most practice owners miss.

There is no single correct paid ads strategy. The right mix of meta, Google, and SEO depends on the practice you want to run, the market you are in, and whether your team can actually work the leads you generate. The conversation is candid about where both of their companies have gotten it wrong, and it lands on a practical framework any practice owner can use to decide where to put their ad budget.

Key takeaways

Meta ads are the only digital paid channel that reliably drives fast, high-volume growth. One practice generated about $3.8 million in new production in 15 months from meta ads, a result that would be very hard to match with Google or organic SEO alone.

Google ads capture searchers at the “zero moment,” the point where someone has already decided they need an orthodontist and is actively looking. That intent is valuable but capped by local search volume and competition. In dense, competitive markets, practices can spend $20,000 to $30,000 a month on Google.

Most “bad lead” complaints are follow-up problems, not lead problems. Practices that contact a lead once or twice and give up are leaving production on the table. Speed and persistence matter, and one agency follow-up team moved practices from scheduling roughly 5 to 10 percent of their leads to around 20 percent.

The lifetime value of an orthodontic patient is roughly $4,500 in profit, most of it realized in the first two years. Against that number, a lead cost of $50 to $200 is small, which is what justifies building real follow-up systems.

Staffing by role rather than by person raises conversion. In one practice, two treatment coordinators splitting roles converted at 80 percent and 50 percent. Aligning each person to the seat that fits them (using tools like Predictive Index or the Kolbe A Index) lifted results and made the team happier.

Discounts and promos work because people respond to offers, even people who claim to dislike them. Whether to use them is a brand and persona decision. A practice that wants a lower-volume, higher-fee lifestyle model can grow without them, and a practice that wants aggressive volume usually needs to be comfortable with them.

Should orthodontists run Meta ads or Google ads?

The two platforms are not interchangeable, because people use them at different moments. Nobody opens Facebook or Instagram to search for an orthodontist. They go to Google for that. Dr. Kyle framed it around what marketers call the zero moment of truth, the point where a parent thinks “my dentist said my kid needs braces” or “it’s probably time for Invisalign” and starts actively looking. Google ads put you in front of that person at exactly that moment, which is why the intent is so high.

The catch is that the zero moment only happens so often, and you cannot manufacture more of it. Google volume is capped by how many people in your area are searching, and in a smaller market that ceiling is low. In a large, competitive metro the limit becomes budget instead, with practices spending $20,000 to $30,000 a month and still bidding against three or four other orthodontists for the same clicks.

Meta works earlier on the timeline, before the zero moment. You are reaching people while they are scrolling, not searching, so a smaller percentage will convert. The advantage is scale. Meta can reach far more people than local search volume allows, which is why it is the only digital channel that supports aggressive growth. As Luke put it, one practice’s account showed about $3.8 million in new production over 15 months driven by meta ads, a number that would be very difficult to hit through Google or SEO alone.

That scale is also the trap. Meta generates more leads, and more leads that need nurturing, which can overwhelm a team that is set up to work only warm, high-intent inquiries. Both hosts admitted their own companies have leaned too hard in one direction, HIP toward an even meta-and-Google split that diluted focus, and Neon Canvas toward Google and SEO without ever pushing meta hard for many clients. The better approach is to treat channel selection the way an orthodontist treats a case. You do not treatment-plan a Class II the same as a Class III. You look at where the practice is, where it wants to go, and how fast, and then you build the mix. That can also be a stair-step. Start with web and SEO, bolt on Google ads, dial in the referral network, and only move aggressively into meta once you have decided you actually want that kind of volume.

Why “bad leads” are usually a follow-up problem

When a practice says its leads are bad, the leads are often fine and the follow-up is broken. Luke’s point was about empathy for how people actually behave. He described opening his own phone to five unsaved numbers in red and two voicemails he deleted without listening, then asked why a practice would expect a prospective patient to behave any differently. Someone can opt in to an ad with real intent and still ignore a call an hour later, because that is how everyone treats their phone now.

He pointed to the well-circulated research on shrinking attention spans (the Time magazine piece on the Microsoft study, and Nicholas Carr’s work on what the internet does to focus) to make the case that practices need to meet people where their attention actually is. The practical version of that is speed to lead and persistence. Harvard Business Review research on contacting leads within five minutes versus ten, and on the number of attempts it takes, shows how fast a lead goes cold. Yet HIP’s secret shopping of practices regularly finds offices that reach out once or twice, get no response, and mark the lead dead.

Luke told a story about working a lead himself, a person who filled out a form during a webinar. It took about a dozen contacts over a week with no luck, until he switched from the practice software to a plain text from his iPhone that just said the person’s first name and “yes?” That started a conversation, and after several more messages and a short discovery call, the person became a buyer. His honest read was that very few clients would go that far. Dr. Kyle matched it with his own story of being a “bad lead” for a medical procedure, ignoring five days of calls and never listening to a voicemail, until the office found his work number and called his wife, who put it on his calendar. He would have gotten around to it eventually, but only a good follow-up system actually captured him.

The fix is partly persistence and partly giving people options other than the phone. Dr. Kyle was blunt that he will not take a call in the middle of the day but will text all day long, and that an online scheduling portal would have closed him instantly. Phone, text, email, and self-scheduling are not redundant. They are different doors for different people. When HIP started its own follow-up and scheduling team to test this, practices that were scheduling almost none of their leads moved to around 20 percent, which is the difference between calling the leads bad and calling them revenue.

Why lifetime value changes the math on lead spend

The reason these follow-up systems are worth building comes down to one number. Dr. Kyle put the lifetime value of an orthodontic patient at roughly $4,500 in profit, counting not just the initial start but referrals, replacement retainers, possible retreatment, and add-ons like whitening or retainer plans. Most of that value lands in the first two years.

Dr. Kyle once put it this way:

Whatever it costs to capture a lead, even if it’s $200, you have to weigh that against the lifetime value. About $4,500 is sitting on the ground every time someone calls in or requests an appointment. How would you treat that? I’d jump on the ground and pick it up.

That image reframes the whole follow-up conversation. A lead cost of $50, $100, or even $200 is trivial against $4,500, which means the expensive mistake is not the ad spend, it is the lead you stopped calling after two tries. It also means the systems and staffing that capture more of those leads pay for themselves quickly, because each additional start carries years of value behind it.

Build your team around seats, not people

Most practices Luke walks into have split roles, with team members jumping between jobs like musical chairs. His fix is to ignore the people first. He removes everyone’s name, parks them in a roster, and builds an org chart of seats only, the roles the practice actually needs. Then he plugs names back in based on where each person fits, often using interviews and a tool like Predictive Index to see whether someone is naturally suited to, say, talking to leads on the phone all day or doing focused research.

The payoff shows up in conversion. In one Tennessee practice, two treatment coordinators were splitting time between the front and the clinic. One converted close to 80 percent and the other around 50. The 50 percent coordinator actually wanted to work full time in the clinic, and the 80 percent one wanted to be the treatment coordinator full time and could be incentivized further. Separating the roles raised results and made both people happier. Dr. Kyle connected this to the Kolbe A Index, which describes how people approach work, matching a “quick start” to fast-turnaround tasks like lead follow-up and a “fact finder” to research-heavy projects.

Both hosts were realistic about the limits. A practice with 15 employees cannot specialize the way one with 200 can, and people are not chess pieces with fixed roles. Someone strong in a role last year may struggle this year because of what is happening in their life, which calls for the same empathy you extend to a lead. Dr. Kyle’s bottom line was that the biggest block to fixing any of this is not the size of the team or the difficulty of the change. It is the leader deciding it is worth an hour of attention and actually acting on it.

Do discounts hurt your brand?

This is the most polarizing topic in orthodontic marketing, and the hosts disagreed in a useful way. Dr. Kyle does not like discounts, and he is honest that it is partly a personal bias rooted in seeing healthcare as something that should not be marked down. Luke’s experience is that offers work, because people respond to them, and that an offer presented in the first few seconds after someone opts in is when they are most ready to be scheduled.

Luke pointed to the book Misbehaving by Richard Thaler and the J.C. Penney example. When the company moved away from constant coupons and rebates to simple everyday low prices under Ron Johnson around 2012, sales fell sharply, because customers had been trained to value the feeling of getting a deal. The same psychology is why Mercedes runs rebates and why electric vehicle tax credits move buyers. Practical version for a practice: marketing a $10,000 fee with $1,000 off outperforms marketing the same treatment at $9,000 with no offer, even though the patient pays the same.

Dr. Kyle’s strongest point cut against his own bias. He noted that many orthodontists who criticize discount advertising are themselves in-network with insurance:

In-network insurance is you discounting your fee to be on a published list of providers. How is that not the same thing? And that discount usually equals more than $750.

Both hosts were careful about ethics. They are not attorneys and are not advising practices to raise fees artificially just to mark them down, and they flagged that anything genuinely dishonest catches up with you, especially in a small community. There are ethical ways to create room for an offer, like revisiting fees that have not moved in five years against real inflation, or building value-adds like retainer plans or whitening into the treatment fee. The honest conclusion was that there is no universally right answer. A practice built on a lower-volume, higher-fee, lifestyle model can thrive without ever running a promo, and a practice chasing aggressive volume usually needs to be comfortable with one. Pick the model that fits who you are, then commit to it through the good and the bad.

Frequently asked questions

Should an orthodontist use Meta ads or Google ads? Both, but in a mix that fits the practice. Google ads capture high-intent searchers at the moment they decide they need treatment, but volume is capped by local search demand and competition. Meta ads reach people earlier and at far greater scale, which makes meta the better choice for practices that want fast, high-volume growth.

Why do my leads from Facebook ads seem like bad leads? Meta reaches people before they are actively searching, so a smaller percentage convert and more of them need nurturing. The leads are often fine. The common failure is a follow-up process that contacts a lead once or twice and gives up. Practices with strong follow-up systems schedule a much higher share of the same leads.

How quickly should you follow up with a new orthodontic lead? As fast as possible, and through more than one channel. Research on speed to lead shows a sharp drop in contact rates between five and ten minutes, and it usually takes many attempts to reach someone. Offering text and online self-scheduling alongside phone calls meaningfully increases the odds of booking.

What is the lifetime value of an orthodontic patient? Roughly $4,500 in profit, including referrals, replacement retainers, possible retreatment, and add-ons, with most of it realized in the first two years. That number is what justifies spending on leads and building follow-up systems, since a $50 to $200 lead cost is small against it.

Do discounts hurt an orthodontic practice’s brand? Not necessarily. People respond to offers, which is why retailers and car brands use them. Whether to run promos is a brand and persona decision. A higher-fee lifestyle practice can grow without them, while a high-volume practice usually needs them. Notably, being in-network with insurance is itself a form of discounting your fee.

Glossary

Zero moment of truth: The point when a person has decided they need a product or service and starts actively looking for it. For orthodontics, this is usually a Google search.

Speed to lead: How fast a practice makes first contact after someone submits an inquiry. Faster contact sharply increases the chance of reaching and booking the lead.

Treatment coordinator (TC): The team member who guides a prospective patient from consultation to starting treatment. TC conversion rate measures how often consultations become starts.

Lifetime value (LTV): The total profit a single patient generates over the full relationship, including referrals and follow-on services, not just the initial treatment fee.

Predictive Index and Kolbe A Index: Workplace assessments that measure how people are wired to work, used here to match team members to the roles that fit them.

Meta ads: Paid advertising on Facebook and Instagram, both owned by Meta.

Watch or listen to the full episode

This is a condensed write-up. For the full conversation, including the on-screen account data and ROI comparisons the hosts walked through, watch or listen to the full episode of the GrowOrtho Podcast here: https://youtu.be/tbkva-9pVDU

Full episode transcript

[The following transcript has been lightly cleaned for readability. Filler and false starts have been removed and obvious transcription errors corrected. Meaning has not been changed.]

[00:00] Introduction

Luke Infinger: All right, Dr. Kyle.

Dr. Kyle: Excited to be here, Mr. Luke.

Luke Infinger: What are you doing in town?

Dr. Kyle: I’m here for the Fishbein Fundamentals course, somewhere in the middle of May. Days run together, and who knows when the person listening to or watching this will see it. But we’re here for the course, and we thought it was a good opportunity to come to this beautiful podcast studio and shoot an episode. In the spirit of HIP and Neon Canvas coming together, we thought we’d look at the things HIP has been good at and maybe not so good at, and the same for Neon Canvas, and talk about it openly.

Luke Infinger: Be open and real, show actual results. I’m excited to talk about paid ads, what works and what doesn’t. I think everyone will be a little surprised. As we move forward with HIP and Neon partnering under a new brand and identity, we’ll be curating the GrowOrtho Podcast together, bringing more perspective to the topics and guests.

Dr. Kyle: This was one of our reasons for combining companies. We had three big pillar reasons, and one was to combine around education and podcasting, because we think we can do more, do it better, and do it more efficiently for the benefit of the orthodontic profession and healthcare in general. We don’t have the same perspectives on everything, which is good, but we have similar enough perspectives that it has already borne fruit. Today we’re talking about media buying.

Luke Infinger: Paid ads. That’s the term people understand. We’ll mostly talk about digital, but we could get into offline strategies too. Fundamentally, we’ve approached paid ads differently, so let’s start there.

[02:30] Two different philosophies on paid ads

Dr. Kyle: The kind of marketing agency Neon Canvas is reflects the persona of our own practice, Saddle Creek Orthodontics. Neon Canvas literally started in our back office, and we were its first client. Our practice is a lifestyle practice, two locations with one associate, doing around four and a half to five million. It’s a big practice, but we’re not trying to grow to seven locations or ten million. We’re in two affluent suburbs of Memphis.

Luke Infinger: And why did you build it that way?

Dr. Kyle: We built it from scratch. There was an earlier time when I was a startup practice and the first SEO client of a company where Alex, a co-founder of Neon Canvas, worked. We were evolving those systems on the go. The fact that Neon Canvas has focused on Google ad strategies and long-term SEO reflects the practice we started it with. My perception of HIP has always been that they run a lot of Facebook ads, sometimes built around discounts or offers that grab attention. For a practice like ours, too many leads that aren’t a good fit wears the team out. So talk about HIP and why it does more Facebook.

Luke Infinger: The thing that gave us our brand and prominence in ortho has also been our Achilles heel. We started in healthcare, in orthopedics. An orthodontist most people know, Ben Fishbein, heard about us, and we started running Facebook ads in early 2016. Back then Facebook was different. You could target very specifically. It was like the wild west.

Dr. Kyle: The targeting, if people only knew, was something. It was effective from a productivity standpoint.

Luke Infinger: From a business standpoint, pinpointing a specific avatar, it was incredible. The algorithm has changed since, but we saw massive success. I’d get texts at 9pm about all the leads pouring in. When you find that kind of success, you project it onto everyone, and largely it worked. But as we grew, we learned there are plenty of practices where that volume turns them off. If the team and systems aren’t set up to nurture leads, they would rather just have buyers. For practices that do want to grow aggressively in the right market, meta ads, Facebook and Instagram, are the only digital paid strategy that hits those growth numbers. One practice’s account showed about $3.8 million in new production within 15 months, just from meta ads. That would be very hard to do with organic SEO or even Google. Google and meta are wildly different. You don’t search for an orthodontist on meta. You do that on Google. But search volume can be limited, and in a competitive area it’s limited by budget, not just searches.

[08:19] Search volume, competition, and the zero moment

Luke Infinger: In a small, low-population area, imagine how few people are searching those keywords. If there are three or four orthodontists, you’re all bidding. In Miami, people spend twenty or thirty thousand a month with a heavy Google focus. So if you want to grow fast and be a volume practice, meta is the way. A lot of the people who praise us are what we call easy growers. They have a growth mindset.

Dr. Kyle: The big idea you and I and our teams landed on is that an orthodontist doesn’t treatment-plan every case the same way. You don’t treat a Class II like a Class III. We should look at where a practice is, where it wants to go, and base the strategy on that. It sounds obvious, but it took time to converge on it from different directions. Sometimes a practice just wants to maintain. Clients come in saying they were producing two and a half million, then 2.1, then 1.4, heading for 900,000. That’s not a trajectory anyone wants. Digital marketing can get them back, but it has to be the right mix, and it depends on how fast they want to get there.

Dr. Kyle: Where we’ve both missed the boat in different ways: Neon Canvas has done meta ads, we just haven’t pushed the gas at a hundred miles per hour for many clients.

Luke Infinger: Same with HIP and Google. We have a search and paid media team, but we created an even split of meta and Google, and that diluted focus. To fix it, you might run a heavy Google focus with only a small retargeting budget on Facebook, retargeting the people hitting your website and landing pages rather than cold traffic.

Dr. Kyle: No one searches on meta. An interesting side note is that younger generations are searching on TikTok, and people are using AI more, and Reddit is huge.

Luke Infinger: We were pulling Reddit data that surprised me when Zach showed me.

Dr. Kyle: The point is the zero moment, the moment someone decides they need something, like “my kid needs braces” or “I need Invisalign,” and goes looking. That only happens so often, and it’s a very targeted, important moment. The moment before that is when they’re just on the internet, on YouTube or Facebook or Instagram. There are opportunities to capture them there, and with the right market and strategy you can actually inform that zero moment and move it forward in their schedule. If you capture someone at a non-commerce moment like Facebook, they’re less likely to follow through, but a certain percentage will, and it’s not a bad percentage. Then you have to look at what it cost to capture them and whether you have the systems to support them. A lead from meta takes more calls and more effort than someone referred by a dentist. Our teams and TCs get used to the easy referral leads, and I like those more too. If a practice is happy maintaining with dentist relationships and community work, great, there’s no need for digital marketing.

Luke Infinger: It can also be a stair-step approach. If you have patience and you’re in it for the long game, you don’t have to start with everything. Start with web and SEO, bolt on Google ads, dial in your referral network, then decide whether you want to grow more aggressively and get serious about meta. You don’t have to decide all of it today.

Dr. Kyle: It’s a more strategic and sophisticated way to approach it, instead of treating it like a hammer and a nail.

[16:00] Attention spans and lead follow-up

Luke Infinger: I want to talk about the linear belief that you spend on meta, get leads, and they just come in, or you spend on Google and people show up. There’s a Time magazine article about a Microsoft study claiming people now have shorter attention spans than a goldfish, and Nicholas Carr’s work on what the internet does to our brains. Carr was the first author I read on this, and he spoke at my school, SCAD in Savannah. The internet short-circuits our focus. I catch myself starting a project, getting a notification, chasing it, and losing an hour. We don’t have enough empathy for how people behave. Someone can have the best intention opting in on a meta ad and still go quiet.

Luke Infinger: If I pull up my own phone right now, I’ve got five unsaved numbers in red, and I deleted two voicemails this morning without listening. I’m not calling those back. We behave the same way as the leads we call bad. If your goal is to help as many people as possible, you need real empathy for that.

Dr. Kyle: My attention span has always been shorter than a goldfish’s, probably two and a half seconds. We have the capacity to be more intelligent now, but we underpace our potential because we’re distracted.

Luke Infinger: It’s patterns and behaviors. In the early 1900s it was easier to stay focused because there were fewer distractions. Reels and Stories function the same way. How long before you scroll to the next one? Half a second. So how much time do you have before a lead goes cold? Look at the first minute, even the first couple of seconds. This is from Harvard Business Review, contacting someone within five minutes versus ten, and the number of attempts. We secret shop offices, and they reach out once or twice, then move the lead to bad because there was no response to a voicemail or text.

Luke Infinger: Every now and then I work leads myself because I like the game. We had a lead fill out a form during a webinar asking to set up a time. That’s a warm lead. We reached out about twelve times over a week with zero luck. So I took it off our software and just texted from my iPhone, “Kyle, yes?” That started a dialogue. Eight or ten messages in, it’s “who is this and how can you help me?” I said, here’s who I am, here’s what you were doing, here’s what you clicked on, do you still want to chat? We set up a discovery call and she became a buyer. I don’t know that many clients would go that distance.

Dr. Kyle: I have a personal story about being a bad shopper. I went to a doctor for a procedure and they called every day for five days. Did I answer? No, my phone’s on do not disturb. Did I listen to the voicemail? No, I read the transcript. Did I call back? No. How did they schedule me? They found my work number and called my wife, who scheduled me, and it showed up on my calendar. It wasn’t a great experience, lots of waiting, but I did schedule the procedure because they had a good follow-up system and people who cared. I would have gotten around to it eventually.

[24:15] Give people options other than the phone

Dr. Kyle: They also texted me, which let me connect asynchronously instead of over the phone. If they’d had an online portal, I would have scheduled myself. Phone, text, email, give people different options. I hate being on the phone, it’s hard to do in the middle of the day, but I’ll text all day long.

Luke Infinger: I have similar stories. When someone opts in to a “$500 off braces” offer, that first couple of seconds is when they’re primed to be reached and scheduled. If a text comes instantly, it bumps the likelihood. But the other day I opened my phone to 25 texts, and a couple were from a chiropractor or something, and I never responded because I was inundated. To write Dr. Kyle off as a bad lead, if his wife and work number didn’t exist, how long would it have taken? Months, maybe. The same happens with most consumers. We’re not perfect, and we’ve made some bad investments too. I’m not trying to talk bad about Neon.

Dr. Kyle: It’s good. Reflecting on what we could have done better is the whole point of HIP and Neon coming together. If we didn’t do that, what was the point?

Luke Infinger: Through the bad investments we learned. We started our own scheduling team. It’s small right now, a percentage of our practices are on it, and we work their leads. When someone says all their leads are bad, we’ll offer free follow-up for a couple months to prove it may not be the leads. Nothing is 100 percent, but we’ll usually schedule people at much higher rates than they were, going from maybe 5 or 10 percent up to 20 percent. This just happened with a doctor we met at a conference booth. He couldn’t get anyone scheduled, our team started scheduling them, then another orthodontist who’s a client started coaching him right there at the booth. I love when another orthodontist validates what I’ve been saying for a decade. Our schedulers know they’ll call a lot of people, get hang-ups and no’s, but the new patients they get are worth it.

[28:40] Lifetime value justifies the systems

Dr. Kyle: Lifetime value is a big deal to me and it’s relevant here. The relative value of what we sell as orthodontists is so high that these systems are easily justified. Whatever it costs to capture a lead, fifty, a hundred, a hundred and fifty, even two hundred dollars, weigh it against lifetime value. The start carries value, but so do referrals, replacement retainers, retreatment, retainer plans, whitening, oral surgery. The number I land on is about $4,500 in profit, realized over the patient’s lifetime, though most of it in the first two years. If that’s sitting on the ground, how would you treat it? I’d jump on the ground and pick it up. People dive for dollar bills at concerts. We’ve got $4,500 every time someone calls or requests an appointment. Maybe we should throw a stack of hundreds on the ground and see if the team picks it up. We also have team members doing too much at once, who aren’t set up from a training or systems perspective to handle these leads well.

[30:17] Build the team around seats, not people

Luke Infinger: Most practices I walk into have split roles, like musical chairs. I did this yesterday with a practice: I remove everyone’s name into a roster and build an org chart of seats only, the roles the practice actually needs. Then we plug names back in, and responsibilities always change, especially if I interview the team and use something like Predictive Index to see where a person shines. Are they extroverted, introverted, resilient on the phone, or sick of talking by lunch? In a practice in Tennessee, one TC was converting close to 80 percent and another around 50 while they split roles. The one at 50 wanted to work full time in the clinic, and the one at 80 wanted to be the TC full time and could be incentivized further. Now the people in the seats are happier. The same is true anywhere. If Harrison is closing deals, the last thing I want is to break his flow state with filing. Find where someone shines and put them there. Now, speak to how that isn’t realistic early on.

Dr. Kyle: Honestly, it’s partly not realistic because as business owners we work in the business, not on it, and most of us never took courses in business or team dynamics. An orthodontist without an office manager doesn’t know what to do, and one with an office manager may have someone who rose through the ranks without that training. It’s not that we’re bad at what we do, we’re just not always equipped to know what to fix. That’s where an outside consultant helps, because they have a clean, unbiased view. A lot of how a practice is organized just happened organically, like an amoeba stretching to fill a position, rather than strategically. Rebuilding the foundation makes sense. It can be hard because people are used to what they do and resist change, but it begins and ends with the leader, the bus driver.

Dr. Kyle: The bus driver decides what happens on the bus. Sometimes a podcast like this sparks someone to think, I should do that, it’s not that hard. The Kolbe A Index shows how people approach work. If you find a quick start who likes to move fast, give them quick-turnaround work like following up on leads. If you find a fact finder who loves research, put them on projects. Maybe they’re in opposite roles now, so you reverse them and they’re cognitively more aligned. Running a practice you have a limited sample size, though. With 200 employees you could place everyone perfectly. With 15 it’s harder, and people aren’t chess pieces with one fixed role. Relationships also expire, and someone great last year may struggle now because of life circumstances, so you need empathy for your team the same way you do for a lead. The biggest block to fixing any of this is the leader deciding it’s worth an hour and acting on it.

Luke Infinger: Let’s bring it back to persona and paid ad strategy. It’s important to identify who you are and what kind of practice you’ll thrive in.

Dr. Kyle: You should enjoy it. The same way we align people to the right work, your practice should align with what you want. Someone who doesn’t thrive seeing a hundred patients a day can limit it to sixty. One way to do that is to not go in-network and carry a slightly higher fee. Digital marketing can fuel that, because the best way to get someone to pay full fee on an elective procedure is to get more new patients in. You may have a lower conversion rate, but if your production per patient is higher, you can still hit your goals seeing fewer patients. High lead volume doesn’t necessarily mean low fee. Conversion rate is a heralded stat, but what matters most from a business standpoint is how much you get paid for each case you start and finish.

[37:38] Do discounts and promos hurt your brand?

Luke Infinger: Let’s talk about the promo. A lot of people who haven’t enjoyed working with HIP point back to the promo. I get it, you don’t want to be seen as a discount shop. There’s a low-fee strategy that works well for the right persona, and we’ve worked with low-fee practices that did really well. But most orthodontists worked hard to get where they are and don’t want to be seen as the discount shop. There’s a story from the book Misbehaving by Richard Thaler about J.C. Penney. They had always done discounts and rebates and were thriving. Then a new CEO, Ron Johnson, around 2012, decided to set everyday low prices instead of running promos. Sales fell sharply, because customers valued the feeling of getting a deal. The book backs this with studies. People like an offer. It’s why Mercedes runs rebates and why EV tax credits drive sales. Justin was going to buy a gas Porsche until they pointed out a $7,500 rebate on the electric model. We work with practices that have some of the highest fees, seven, eight and a half, close to ten thousand on the West coast. Marketing $10,000 with $1,000 off beats marketing $9,000 with no offer. The argument becomes, what does it do to my brand?

Dr. Kyle: That’s a good question. Honestly, I’m not a fan of discounts, and that’s my personal bias, that healthcare shouldn’t be discounted. But the patient or parent may not think about it that deeply. I’m a walking contradiction, because I search for a promo code on everything I buy online, and they never work, but I still search. Sales make me buy. Yet I feel discounting is bad for my practice, so I have to remedy that. Here’s the thing, though: many orthodontists who criticize discount-based advertising are in-network with insurance. In-network insurance is you discounting your fee to be on a published list of providers. How is that not the same thing? And that discount usually equals more than $750. Maybe people just think a sale looks desperate, and maybe it does. We should research this in an evidence-based way.

Luke Infinger: For people who embrace it, it goes back to who you are, your mindset, and whether your team is bought into your vision. Depending on your vision, you may need to be okay with a promo. You’ve built a practice you enjoy without doing that, and that works too. The beautiful thing about the podcast and the work ahead is that it’s not about being right or wrong, which has become the whole argument on this topic. There could be five or ten different ways to do it. What’s the model, who are you, and will you see it through and be okay with the good and the bad?

Dr. Kyle: In fairness, this applies to me. We don’t like promos, but what happens at the practice when it’s the end of the month and we’re not hitting goals? Someone says, tell them it’s $500 off, same-day start. So I think some of this is an unwillingness to step back and revisit your foundations and biases. People also think it’s dishonest to raise a fee and then give a discount, but every business does that. Look at Black Friday prices.

Luke Infinger: I’m not saying to do that. People ask if they should raise their fee, and I say let’s talk about it ethically. When did you last raise your fees? Five years ago by 5 percent? Have you looked at housing, eggs, toilet paper? It might be time. Another way to capture revenue is your retainer plan or whitening. Bake it into the treatment, add eleven or nine hundred to eleven hundred dollars to the fee, take $500 off, and on the back end you’re still making $600 more. There are ethical ways to do this. We’re not attorneys, by the way.

Dr. Kyle: That’s how you know you’re talking about good stuff on a podcast, when that line comes out. Do your own research. If you’re unethical in business, it catches up with you, especially in a small community. So don’t do anything unethical. We want to do things that work, that grow the practice if we want growth or maintain it if we want to maintain. None of us want to shrink.

Luke Infinger: Let’s show on screen the difference between a meta-focused practice and a Google-focused practice, the ROI we’ve tracked in Practice Beacon for each. Both can work. This is why I love us working together, because we’ll be more intentional about discovering who you are and what playbook fits where you are now and where you want to be. Start with the end in mind and work backwards. We’ve always done that, but we’ll do it better.

Dr. Kyle: We’ve always done it, but we haven’t communicated it well enough, and that needs to be a top-down thing the whole team understands and communicates to clients. Doctors need to understand they’re empowered to dictate the direction of these things, not take a one-size-fits-all approach. It was never intended to be that way, but without tight systems and good communication it reduces to that, in the agency and in the orthodontic practice too.

Luke Infinger: If you liked this episode, find us on Instagram, send us a DM, or go to the website and subscribe, because there’s a lot more value coming.