Episode: How Fishbein Orthodontics Keeps Growing When the Industry Is Down
Show: GrowOrtho Podcast
Host: Luke Infinger (HIP Creative) with co-host Harrison Bagdon (HIP Creative)
Guest: Amanda Floyd, operations leader at Fishbein Orthodontics and co-founder of Fishbein Fundamentals
Published: Dec 22, 2023 · Last updated: June 15, 2026

Summary: Amanda Floyd has spent 25 years in orthodontics and helped grow Fishbein Orthodontics from roughly $1 million and seven team members into a nine-office group with more than 100 people. In this episode she argues that practices comparing their numbers to 2021 are using the wrong baseline and should measure growth on a three-year CAGR instead. Her core position is that a slowdown is the time to spend more on marketing, not less, the same move that let Fishbein buy market share cheaply during the COVID closures. She breaks down the math of an empty chair, why most practices underproduce existing locations before opening new ones, how affordability and a premium experience coexist, how the practice hires almost entirely through internal referrals, and why same-day case acceptance comes down to a confident treatment coordinator and a doctor who stays out of the room.

Topics covered: measuring growth in a down market, marketing budgets during a slowdown, community and general-dentist referrals, the cost of an empty chair, location strategy, affordable orthodontics with a premium experience, sharing production goals with the team, internal-referral hiring, leader development, and treatment-coordinator-led case acceptance.

Key entities: Fishbein Orthodontics, Dr. Ben Fishbein, Amanda Floyd, Fishbein Fundamentals, HIP Creative, Luke Infinger, Harrison Bagdon, Miranda Riley, Pensacola, Niceville, Cantonment, Pace, Invisalign, treatment coordinator (TC), CAGR, Simon Sinek.

About the author

Luke Infinger is the founder of HIP Creative and co-creator of PracticeBeacon, where he has helped more than 500 dental and orthodontic practices nationwide grow, and is the bestselling author of The Scalable Practice, Front Desk Secrets, and The Ultimate Treatment Coordinator, Master Your Mindset. Connect with Luke on [https://www.linkedin.com/in/luke-infinger-b36a001b/].

Most practices are reading the market wrong

If your new-patient numbers are down this year, the first question to settle is what you are comparing them to. Sustained orthodontic practice growth almost never comes from one big year. It comes from doing the unglamorous work long enough that it compounds, and from refusing to cut the inputs the moment the market gets bumpy.

Amanda Floyd has watched that play out for 25 years. She runs operations for Fishbein Orthodontics, the Pensacola-based group that Dr. Ben Fishbein built from about a million dollars and seven people into nine offices and more than 100 team members. Her read on the current slowdown is blunt: most owners are panicking because they are measuring against 2021, which was never a real baseline.

This episode is the operating manual for what to do instead. It covers how to measure growth honestly, where to put marketing money when leads drop, how to think about the cost of an empty chair, and how Fishbein hires and develops the team that makes all of it possible.

Key takeaways

  • Stop measuring against 2021. Measure growth on a three-year CAGR (compound annual growth rate). On that basis most practices are still up, even though nearly everyone is down versus their pandemic-backlog peak.
  • A slowdown is the wrong time to cut marketing. Fishbein kept marketing spend flat or higher and added a fourth full-time marketing person during a down year specifically to get ahead of the dip.
  • Community marketing is the cheapest growth lever most practices ignore. At Fishbein, roughly 30% of referrals come from patients, 30% from the community, and 30% from online, so a practice doing no community outreach is leaving about a third of its potential referrals untouched.
  • An empty chair has a real, calculable cost. If a practice can run eight consults a day at a 70% conversion rate but only sees three or four, the open slots represent thousands of dollars in lost production every day.
  • Underproducing your current locations is a reason to fix them, not to open new ones. Fishbein has taken a single location to $10 million, and a practice with five to seven chairs running three clinical days a week can reasonably reach $3 to $4 million.
  • Affordability and a premium experience are not a trade-off. Fishbein produced around $7 million out of a half-renovated building, then kept the model: spend on countertops and floors, source furniture from Wayfair or Amazon, and let the team carry the experience.
  • Almost all hiring is internal referral. Fishbein starts inexperienced people at a low hourly rate, shows them a defined promotion path at 3, 6, 9, 12, 18, and 24 months, and pays a $250 bonus to team members who refer a hire.
  • Case acceptance is a treatment-coordinator job, not a doctor job. Fishbein’s TCs present fees above $7,000 and earn same-day starts by keeping the conversation simple and leading with an affordable option, while the doctor diagnoses and leaves the room.

How should an orthodontic practice measure growth when the whole industry is down?

Compare against the right baseline, not against your best pandemic month. Amanda’s first move with a worried client is to take 2021 off the table entirely. The seven-week COVID closure in 2020 created a backlog that every practice burned through, so 2020 and especially 2021 ran hot in a way that was never going to repeat. Measuring this year against that peak makes a healthy practice look like it is failing.

The honest measurement is a three-year CAGR (compound annual growth rate), which smooths out the pandemic distortion. On that basis, Amanda says most practices are still growing. Almost everyone is down versus 2021, with the exception of brand-new startups that only recently began marketing. That is a baseline problem, not a growth problem.

Fishbein’s own internal target is at least $25,000 in production per clinical day. In 2021 the practice averaged $28,000 to $30,000 a day. In 2022 it ran around $24,000, and this year the average sits closer to $22,000 to $23,000, which is the first time since 2016 it has not consistently hit $25,000. Amanda frames that as fluctuation around an upward trend, not decline, especially with a new provider and a brand-new location added in the same window.

Should you cut marketing when new patients drop?

No, and Amanda treats cutting marketing in a downturn as the single most common mistake she sees. Fishbein kept marketing spend flat or higher through the slowdown and hired a fourth full-time marketing person during a down year, on purpose, to get ahead of the dip rather than react to it. Her standing rule with the practice: if leads are down, the first call is to marketing about what to do next, not a budget cut.

The logic is the same one that made the COVID closures a growth opportunity for the practice. When competitors retreated, Fishbein stayed visible and ran community marketing events while the rest of the market went quiet, which Amanda and the HIP hosts compare to buying market share at a discount. Buy attention when it is cheap and everyone else has stopped competing for it.

She also pushes back on the budget excuse directly. Community marketing is inexpensive, and so is hiring a marketing person relative to the production they protect. When Fishbein had 25 employees it ran two marketing people, and at more than 100 it runs four. A practice with 25 employees and no dedicated marketer is, in her view, the one with the real problem.

What is the actual cost of an empty chair?

It is far higher than most owners calculate, and that number is the whole argument for not cutting marketing. Harrison walks the math: take an average practice converting around 70% of consults. If a doctor has eight consult slots in a day but only fills three or four, every empty slot is lost production. Depending on the practice, an orthodontist’s chair time can be worth a few thousand dollars an hour, and for a high-volume doctor much more.

Set against that, the cost of the activity that fills those chairs is trivial. Bringing lunch to a fire station, dropping neighborhood cards at local businesses, or hiring a marketing rep costs a fraction of the production a single recovered consult slot generates. Once you price the empty chair correctly, community marketing stops looking like an expense and starts looking like the cheapest production you can buy.

How do you get more referrals from the community and from general dentists?

Treat both as systems you work every week, not as things that happen on their own. Fishbein’s referral mix runs roughly 30% patient referrals, 30% community, and 30% online, so a practice doing zero community outreach is leaving close to a third of its potential referrals on the table. Amanda has seen strong practices with no full-time marketing person still leave that community third completely untouched.

The community tactic is direct and old-fashioned. When Fishbein opened its first de novo (ground-up) location in Pace in 2016, Amanda personally visited every local business, not just dental offices: hair salons, nail salons, tanning salons, and locally owned restaurants. They hand those businesses “neighborhood cards” with an offer like a treatment discount to pass to their own customers. The practice repeats it at every new office, and reps with open time spend it visiting nearby businesses.

Courting the general dentist still works, and Amanda argues the relationship has to run both ways with an actual acknowledgment loop. Harrison tells a story from a New York trip about a high-volume general dentist who stopped referring to an orthodontist he had chosen himself, not over gifts, but because he never once got an email or call acknowledging the patients he sent. The fix is a tracked, two-way referral process: confirm receipt, send patients back, and at minimum let the dentist know the patient arrived. Fishbein also runs an Invisalign event for general dentists, teaching them easy cases and positioning the practice as the place to send the complex ones, which is an abundance posture rather than a turf war.

Is it better to open a new location or grow the one you already have?

Grow the locations you have first, because most practices are badly underproducing them. Amanda is direct that she is a numbers person: Fishbein will not open another clinical day unless a location is producing at least $25,000 per day, because payroll runs about 23% to 25% of overhead and there is no reason to pay a team to be there twice when one day produces the same output. Opening a new location only makes sense once your brand is proven and you have genuinely run out of room to produce more where you are.

The ceiling owners imagine for a single location is usually far too low. Fishbein has taken one location to $10 million. A friend in Miami produced $7 to $8 million out of five chairs in 1,700 square feet before building a bigger space. A typical office with five to seven chairs running three clinical days a week can reasonably reach $3 to $4 million. When an owner says “if I could just get this location to $2 million,” Amanda’s response is that the target is too small, and the answer is rarely a second building that splits an already-thin team across more overhead, a burned-out doctor, and an associate who only shows up one day a week.

Do you need a beautiful office to grow, or can affordability and experience coexist?

They coexist, and Amanda has the receipts. Fishbein produced about $7 million out of its Pensacola location the year before it was renovated, while the building was falling apart with people coming through the ceiling mid-construction and patients signing on plywood. The lesson she draws is that the office does not need to be clean, modern, and simple. Patients signed up to start every day in the worst-looking version of that office because the experience the team delivered carried it.

When Dr. Ben bought the practice, no one in town was offering real affordability. The industry norm was a 15% minimum down payment, or 25% if a patient’s credit was weak, which priced most of the community out of treatment. His mission was access to care without finances standing in the way, but with a genuinely nice experience attached. The way to do both is to spend where it shows and save where it does not: real money on stone countertops and wood floors, clean and inexpensive furniture from Wayfair or Amazon. The piece that actually ties affordability and experience together is an incredible team, not a seven-figure remodel.

Should you share production goals and numbers with your team?

Yes, and Amanda treats secrecy around numbers as an outdated instinct. Her point is that the information is no longer hidden anyway: anyone on the team can look up typical orthodontic overhead, fees, and start volumes online, so the fear of talking about production is left over from a pre-Google era.

Fishbein shares goals every single day, but tailored to the level. The full team hears goals in starts (“goal in Cantonment is seven starts, goal in Niceville is five”). Daily operations managers hear daily production goals like $24,000 or $27,000 depending on where the month stands. Senior leaders work to quarterly targets such as $5.5 million, and only a small group discusses the full annual number, because the broad team does not parse a $24 million annual figure or understand overhead. Whether it is framed as starts, daily production, or quarterly goals, keeping the team centered on a shared target is part of the culture, and Amanda ties it to the broader reason small businesses fail: a team that does not know what it is working toward disengages and leaves.

How does Fishbein hire and keep people when everyone else says they can’t?

Fishbein hires almost entirely through internal referral and refuses to frame staffing as a hiring problem. Roughly 100% of the people the practice interviews come from someone who already knows the practice: a current team member, a family connection, a friend of a friend. Amanda traces it back to the original seven-person team, where the first hires were direct relationships, including a waitress they recruited from a Christmas party and a connection from Dr. Ben’s CrossFit gym. The model held as the practice grew across nine offices, so the size is a result of the culture, not the reason the model works.

The system has structure. Fishbein starts inexperienced, hand-picked referrals at a deliberately low hourly rate because it is investing heavily in training them, and it shows each new hire exactly where they will be at 3, 6, 9, 12, 18, and 24 months as long as they hit the stats for each level. When an early attempt at hiring through Indeed ads produced a bad fit Amanda had to let go on day three, she pulled the ads and instituted a $250 referral bonus for team members instead. A clear growth path plus a visible culture is what attracts talent, and Amanda’s posture when someone leaves is to wish them well rather than negotiate, partly because good people often come back. She recently rehired a former three-day-a-week standout directly into an assistant-manager track, the first time in ten years she has hired someone in at the manager level.

Why is the treatment coordinator the key to case acceptance, not the doctor?

Because case acceptance is a sales role, and the TC owns it. Amanda is unambiguous that selling, done with integrity, is a service: if you cannot help a patient say yes, you cannot help them at all. The job of the treatment coordinator (TC) is to present the plan with confidence, and she has watched TCs present fees above $7,000 and earn same-day starts in a row, with no discounts and no flinching, after going through Fishbein’s TC empowerment training.

The doctor’s job is to stay out of the way. The doctor should come in, greet the patient, review the records, lay out the treatment plan, and leave, because most doctors are not salespeople and a 30-minute doctor monologue overwhelms a patient into “let me think about it.” Amanda’s TCs run on the principle that less is more: they lead with an affordable option from the start, so a parent never has to admit in front of their child that they cannot pay in full. A representative offer at Fishbein is $300 down and $169 a month, which is simple enough that the patient can say yes the same day. The patient already clicked a link or called to book, so the intent is there, and the only thing that kills a same-day start is the TC creating roadblocks that were never necessary.

Frequently asked questions

Why shouldn’t I compare my practice’s numbers to 2021? 2021 was distorted by the backlog from the 2020 COVID closures, so it ran abnormally high and was never a sustainable baseline. Amanda Floyd recommends measuring on a three-year CAGR (compound annual growth rate) instead, which shows most practices are still growing even though nearly everyone is down versus their 2021 peak.

Should I cut my marketing budget when new patients are down? No. Fishbein Orthodontics kept marketing spend flat or higher through the slowdown and added a fourth full-time marketing person during a down year. The reasoning is that a slowdown lets you buy market share cheaply while competitors retreat, the same move that made the COVID closures a growth period for the practice.

How much of orthodontic referrals should come from the community? At Fishbein the referral mix is roughly 30% patient referrals, 30% community, and 30% online. A practice doing no community outreach is leaving close to a third of its potential referrals untouched, which is why Amanda treats community marketing as the cheapest growth lever most practices ignore.

Is it better to open a new location or grow my existing one? Grow the existing one first. Fishbein will not open an additional clinical day unless a location produces at least $25,000 per day, and a typical five-to-seven-chair office running three days a week can reach $3 to $4 million. Opening a new location only makes sense once the brand is proven and you have run out of room to produce more where you are.

How does Fishbein hire so consistently when other practices say they can’t find people? Almost all hiring is internal referral. Fishbein starts inexperienced, referred candidates at a low hourly rate, shows them a defined promotion path at 3, 6, 9, 12, 18, and 24 months, and pays a $250 bonus to team members who refer a hire. Amanda credits the culture, not the headcount, for making the model work.

Who should actually close the case, the doctor or the treatment coordinator? The treatment coordinator. The doctor diagnoses, presents the plan, and leaves the room, because most doctors are not salespeople. Fishbein’s TCs present fees above $7,000 and earn same-day starts by keeping the conversation simple and leading with an affordable option, such as $300 down and $169 a month.

Glossary

CAGR (compound annual growth rate): A way to measure average year-over-year growth across a multi-year span, used here to smooth out the pandemic distortion instead of comparing a single year to 2021.

TC (treatment coordinator): The team member who presents the treatment plan and fees to a patient and owns the case-acceptance conversation.

De novo location: A practice location built from the ground up rather than acquired from an existing owner.

Start: An accepted case where a patient begins treatment, used as a daily and per-location goal metric.

Same-day start: A patient who accepts treatment and begins it during the same visit as their consult.

Full episode transcript

Host: Luke Infinger (HIP Creative). Co-host: Harrison Bagdon (HIP Creative). Guest: Amanda Floyd, Fishbein Orthodontics.

[00:00] Catching up and intro

Luke: Amanda Floyd, thanks so much for being here today. I really appreciate it.

Amanda Floyd: My pleasure. I’m happy to be here. I can’t believe that after all these years we’ve worked together, this is my first time doing a podcast.

Luke: I know, it’s crazy. There’s one interview I leaked as a podcast, but I leaked it years after. Originally I chopped it up to post on social. So this is the first official one.

Amanda Floyd: You know what’s funny about that interview? I was thinking about it this morning during my personal development and reading time. It was about five years ago, and I was thinking back on the amount of growth both of us have had since then. If I looked at myself in that moment, and you, I think we both thought we were really doing well right then. Five years later I look back and it’s crazy.

Harrison: Come a long way.

Luke: I hope the next five years is like that. I always want to see myself as somebody who isn’t the most accomplished, who’s always looking for the opportunities. I hope we’re sitting down in five years thinking we could never have guessed we’d be here.

Amanda Floyd: The minute anybody thinks they’ve succeeded, their career starts to die. There’s never a day you’re not going to learn more and have to put in the work to learn more.

Luke: Give a brief intro of yourself. Most people watching or listening know you, but let’s say there’s one who doesn’t.

Amanda Floyd: I’ve been in the orthodontic industry for 25 years now. This is my 25th year. I started very young. I’ve worked in every role in the practice, and I’ve always had a major passion for it. I love this industry and the people aspect of it. Ben Fishbein bought the practice I was working at a little over ten years ago, and we clicked right from the start. We grew a very small practice, about a million dollars then with about seven team members, into what it is now. We have a little over 100 team members now. The best part of what we do is serving so many patients and providing an affordable smile with a quality experience. On my side, the best thing I do is provide career and leadership opportunities to people who wouldn’t have traditionally thought they could move in that direction.

[02:41] The state of orthodontics this year

Luke: Let’s talk about what you’re seeing. What does orthodontics look like this year? So many people are in freak-out mode, things are down, and you see people making rash decisions.

Amanda Floyd: Pretty much industry-wide we’re seeing a decrease. We came off a COVID year that was unprecedented, a seven-week closure, and coming back from that we were all killing it because there was so much backlog to get through. So we had a great year in 2020, and then 2021, which you almost have to take out. I tell my clients to pretend 2021 never happened and look at everything on a three-year CAGR. If you measure it that way, you’re most likely still growing. If you measure against 2021, everyone’s down. I don’t know anyone who’s not down, unless it was a brand-new startup that just started marketing. There are some outliers, people who never traditionally did marketing and are getting into it now, but the vast majority are down.

Luke: When you talk to people who are in freak-out mode, what do you tell them to calm them down and get them thinking about the future? Any business has highs and lows. Even orthodontics, which is supposed to grow like crazy, has down years.

Amanda Floyd: Right now is not the time to be decreasing budgets significantly. Luckily, that’s just not how Ben operates. We’re still putting as much into marketing, if not more. We actually hired a fourth full-time marketing person this past year, even though we’re down, because we need to get ahead of it. That’s our first go-to. If the numbers are down and we’re not getting the leads we got in the past, we reach out to marketing and ask what we need to do now. A lot of people are comparing where we are now to 2021, and you can’t. We look at things on a daily and annual basis rather than against where we were two years ago. We want to produce at least $25,000 a day every clinical day. We’re not there every month right now, and it’s our first time since 2016 not hitting those numbers. We’re still over $20,000. In 2021 we were averaging $28,000 to $30,000 a day. In 2022 we averaged about $24,000. This year our average is probably $22,000 to $23,000, and we did bring in another full-time provider and open a brand-new location. Things fluctuate, but don’t take your foot off the gas with marketing. That’s one of the biggest things I’m seeing people do, and it’s the opposite of what they should be doing.

[05:54] Spending more when everyone else retreats

Harrison: You said something interesting. We look at you and the Fishbein team, and some of our fast growers, and when things slow down or the economy gets bumpy, your mindset is that you need to spend more. You’re not letting the day dictate your decisions. So many people, when goals aren’t met or production is down, cut. I think about why some of you crushed it when we opened after COVID. When everyone was shut down, you were still marketing and doing everything you could. I remember you did something with the first responders.

Amanda Floyd: Yeah, we did a lot of marketing events.

Harrison: So when the world was shut down, the mindset was that this is a time to buy market share at a discount, because everyone else is retreating. It’s like the stock market: buy low, sell high.

Amanda Floyd: We also didn’t want to furlough our team, so we paid everyone their full salary the entire time we were shut down. At that point we had about 85 team members. There was nothing to do outside of assigning two people to answer phones each day. The first couple of weeks were busy because we had thousands of patients to reschedule, but the deal was we’d pay 100% of salary and ask salaried people, only seven or eight of them, to work one day a week on marketing events and team meetings. We redid all of our training materials, checklists, and the Google Drive, cleaning up everything that had been pending. But a lot of it was community events and marketing, because it’s cheap. People freak out about getting out in the community and say they don’t have the budget. It’s inexpensive to go to an event, and it’s inexpensive to hire someone for marketing.

Amanda Floyd: It’s one of the biggest battles I have with people I work with privately. They say they don’t have the need for a marketing person when they have 25 employees. When we had 25 employees, we had two marketing people. We’re at 100 now with four.

Harrison: It’s like Dr. Ben says: what’s the cost of an empty chair?

[08:50] The math of an empty chair

Harrison: What’s the cost of an empty new-patient consult? Not everybody does 20, 25, 30 exams a day like you do, but say an average office converts about 70% of consults. If I can do eight consults in a day but only see three or four, what’s an orthodontist’s time worth? Two grand an hour, three, five? Ben’s time might be much more. For every open slot, what does that cost the business, compared to bringing lunch to a firehouse?

Luke: Are people even thinking about that? We don’t see people thinking that way.

Harrison: It doesn’t make sense. You’ve got five open slots that could be producing five or six grand each.

Amanda Floyd: The rock stars do think about it. But even some rock stars, someone we both work with, doesn’t have a full-time marketing person. He’s crushing it, but he’s leaving so much on the table. He’s doing zero community marketing. I showed him our referral breakdown: about 30% patient referrals, 30% community, and 30% online. When I look at his practice, he’s leaving 30% out in the community without even trying.

[10:33] Community marketing and courting the dentist

Luke: When we go to offices, a lot of them are in business parks. The one we just visited was in New York City, thousands of businesses, and just on his direct block I saw 20 he should be talking to. I walk in and start rattling off the brands and ask how many he’s talked to.

Amanda Floyd: None of them. Traditionally in orthodontics that was never done. When we opened our first de novo in Pace in 2016, I was out there doing the marketing myself. I went into every local business, not just dental offices: hair salons, nail salons, tanning salons, locally owned restaurants. We bring in what we call neighborhood cards that they can hand out to their customers, something like $500 off treatment or whatever call to action you want. We’ve continued that. Every time we open a new office we visit every local dentist, and when our marketing reps have open time they’re visiting local businesses. Our Cantonment rep, Hannah, emailed this past week to say she had a free day so she visited all the local businesses around the office.

Harrison: Courting the dentist is not dead. It’s a gold mine. People say they don’t want to do it because the dentist is doing Invisalign now, but they’re doing what, three cases a month?

Amanda Floyd: We’ll take that. We actually do an Invisalign event for the general dentist. We tell them, let me teach you how to do some easy cases, just send us your hard ones.

Harrison: That was one of the more interesting things Dr. Ben said. Everyone’s shunning the dentist for doing this, and Dr. Ben says no, we’re going to be their biggest cheerleader. Teach them basic mechanics, help them get a couple extra cases a month, and when they can’t get the result the patient wants, they send the complex ones to you.

Amanda Floyd: It’s the difference between an abundance mindset and a scarcity mindset. It’s the same with whitening. So many offices won’t implement it. We’ve been doing whitening for four years.

Harrison: I’ve got a story from New York. A dentist we visited told me he used to refer all his ortho to a specific orthodontist. I asked why he chose them and why he stopped. He said he did his own research, found who was close, who had a nice office and good reviews, and started sending them all his patients. He didn’t need gifts, but over a year or two of referring he never got a single call, email, or drop-by, not even an acknowledgment that the patient arrived. So he stopped referring.

Amanda Floyd: What a loss, at a high-volume dental office.

Harrison: A lot of patients. And the orthodontist they were referring to is a client of ours.

Luke: When we turn on campaigns, you’ll get some dental-type leads, people who need dental work. There needs to be a referral system both ways.

Amanda Floyd: Exactly. With our size now, we’re a bigger referral source to a general dentist than they could ever be to us. The numbers speak for themselves. We were just in a call-center meeting Friday with our ten call-center employees. I still go to the team meetings. I want to hear what’s being said and throw in some motivation, give them podcast or book recommendations, because you never know who’s going to be your next rock star.

Amanda Floyd: We were role-playing. Someone calls to set up a new-patient appointment and at the end asks if we do crowns. A team member said we’d just tell them no and cancel the appointment. I stopped that. First, we don’t cancel anyone’s appointment. We still see them, because even if they’re not a patient now, eventually they or someone they know will need orthodontics, and a great experience matters. Second, it’s an opportunity to solidify relationships with the dentists we refer to. Don’t just hang up. Here are our top five people we want you to refer to.

Harrison: The amount of people we work with where the moment someone says on the phone they need a cleaning or a filling, they can’t get off the phone fast enough.

Amanda Floyd: They still have family, and you never know. To piggyback on that, we’ll ask what their referral process is. A lot of them don’t have one. If they do, I ask whether the dentist knows they sent the patient. Usually they don’t tell them.

Luke: You could make a spreadsheet, share it with them, sign a BAA, whatever you want, but you need to actually track it. Otherwise it’s out of sight, out of mind.

[17:58] Location strategy and underproduction

Luke: Shifting gears. Another false belief we see is that to scale you have to buy more locations, even though the four you have are underproducing. What do you tell someone with too many locations and all that empty chair time, buildings turned off two or three days a week?

Amanda Floyd: Ben and I have had differences of opinion on this over the years, but for me it’s numbers. If we’re not producing at least $25,000 per day, we’re not going to open another day. It doesn’t make sense. Your payroll costs are about 23% to 25% of overall. We’re not going to pay the team to be there another day when we could produce just as much in one day as in two. But if you’re doing well and you’ve created a brand that works, opening another location makes sense, even if you won’t hit that $25,000 per day. You don’t want to open another location just to open one. If you have room to produce another one or two million in the locations you’re in, why spread your resources?

Harrison: That’s what we see all the time.

Luke: The doc’s burned out, traveling with the team, with an associate who’s only there one day a week and doesn’t want to do as much as he does.

Luke: Typically people are underproducing the locations they have. We’ll hear, if I could just get my locations to $2 million. I say you’re thinking too small. We could get this location to $4 million.

Amanda Floyd: We’ve gotten one location to $10 million. That’s the limit, it’s a beast of a location.

Harrison: A typical office with five, six, seven chairs running three days a week could be producing what?

Amanda Floyd: Three or four million easy. That should be pretty simple.

Luke: People in highly populated areas tell us nobody’s doing that here. I say they are.

Amanda Floyd: We have a friend in Miami producing seven or eight million out of five chairs in 1,700 square feet. They were bursting, built a new location, and they’re crushing it. We produced about $7 million the year before we renovated Pensacola. You saw what it looked like. We had people falling through the ceiling mid-construction. The worst-looking office you could imagine, and people were still signing up every day to start.

[21:13] Affordability and experience

Harrison: I was doing a residency talk at West Virginia University, and a resident asked if a direct-to-consumer office has to be gorgeous. I told them the story about you and Dr. Ben producing orthodontics with people falling through the ceiling and exposed wiring.

Luke: Didn’t you have patients signing the plywood?

Amanda Floyd: Yeah. Honestly, do not say clean, modern, and simple.

Harrison: You don’t need gold chandeliers, champagne, and strawberries.

Amanda Floyd: When offices bring in seven-figure designers for incredible remodels, I love it, but does it produce? When Ben bought the practice, no one in town was offering affordability options, so the vast majority of patients in our community couldn’t get treatment. The minimum down payment was 15%, or 25% if you didn’t have great credit, with a credit check. His mission was to provide access to care to as many patients as possible without letting finances stand in the way, but he wanted it to be a nice experience, not a dumpy office. There are ways to make it clean and nice and spend money where you need to, like stone countertops or nice wood floors, but you can find clean, nice furniture on Wayfair or Amazon.

Harrison: So a top-notch experience and affordability can live together.

Amanda Floyd: Absolutely. And the key that ties it together is an incredible team.

Luke: It’s like Chick-fil-A, a low-ticket item where the experience is high.

[23:44] Vision and sharing goals with the team

Luke: You had a vision for where the business was going. We ask owners and doctors and they’re pulling it out of thin air, “I’d like to be at $2 million.” Where is this written down? How often do you rally your team around it?

Amanda Floyd: Most doctors are terrified to talk about their production or goals. I tell them Google is free. Everyone on your team knows how to look up your annual production, how many patients start each day, what you charge, the traditional overhead. It’s not rocket science. Being scared to talk about it is an archaic way of thinking. Pre-Google nobody knew, but the information at our fingertips now makes it easy to not worry about it.

Luke: So you talk about that to some level?

Amanda Floyd: We do, but we differentiate by department. To the full team we’ll say the goal today is five starts. By location, the goal in Cantonment is seven starts, in Niceville five. For our daily operations managers, we give daily production goals, $24,000 or $27,000 depending on where we are in the month. For senior leaders we talk quarterly goals, like $5.5 million. Only a couple of us talk full annual goals. We’re not throwing a $24 million annual goal at the whole team, because they don’t understand overhead.

Harrison: Regardless of how it’s positioned, being focused and centered on goals with the team is part of the culture.

Amanda Floyd: Every single day. We talk about it every single day.

Luke: It’s really any small business. It’s why so many small businesses fail over a decade. Good team members want to know what they’re part of and working toward. If they don’t, they get stuck, they’re a cog in the wheel, and they leave. That leads into my next question. You’re hearing from a lot of practices about attrition, that they can’t hire or keep people. What’s your philosophy?

[26:58] Hiring, attrition, and internal referrals

Amanda Floyd: I had three people quit last week, all going to other local orthodontic offices. I wish them the best. We’ve also had three people in the last few weeks come back from other local offices. When people leave, I’m never going to talk you into staying. That’s part of your journey, and I wish you all the joy and success there is. We had a well-loved team member quit this past week because she didn’t get promoted and someone else did. Ben asked if I wanted him to talk her into staying. I said no, I think it’s time for her to go. She thinks there’s something better out there, and maybe there is. I think she’ll probably be back in a couple of months, which is typical, but some people find a better fit, and that’s okay because none of us are for everyone.

Luke: But you’re never going to say you have a hiring problem.

Amanda Floyd: No, we don’t have a hiring problem. People are baffled because we don’t start people out high. We have a clear hiring structure. The vast majority of our team members come from direct referrals with zero experience. We train them on the job and start them at a low hourly rate because we’re devoting so much time, effort, and money to training them. We’re clear in the interview: here’s where you start, and here’s where you’ll be at three, six, nine, twelve, eighteen, and twenty-four months, as long as you’re hitting the stats for each level.

Luke: So you have a path you can show people. Almost everyone is attracted to that, because they can see where they can grow and a company that wants to grow them. They also see your culture and brand values, sometimes for five years before applying, which helps the interview process and attracts talent. So many businesses don’t think about marketing and selling to talent, not just customers. We didn’t until about 2020.

Amanda Floyd: There’s a time for both. We just did something we’ve never done in the history of the practice. We had a rock-star guy who worked for us a couple of years while going to school, pre-law, sharp, three days a week in the call center. When he put his notice in I almost cried. We’d told him we saw him as a manager, but we’d never have a manager who works three days a week, so when he could commit full time we’d love to provide that opportunity. He left, worked in sales a couple of years, then called about four or five weeks ago asking for an interview. We hired him in as an assistant manager during his 90-day period, after which he’ll be a full manager. I always said I’d never hire someone in as a manager, and I just did it for the first time in ten years. He did have two years with us before, and we knew what we wanted for him.

Amanda Floyd: 100% of the people we hire and interview come from someone who already knows us. My daughter Jenna worked for us six or seven years before leaving a few months ago to work for Glenn Krieger at one of his startups. One day I walked in and there was a big guy interviewing in Brittany’s office. It was Jenna’s husband’s best friend. We hired him as an assistant, a bodybuilder type, and he’s one of the best assistants we’ve hired. You never know where your next great person will come from, but with direct-referral interviews they know what they’re coming into. This guy knew he was coming in at a low hourly rate to get training in something he could make really good money in long term.

Harrison: People who come to Fishbein Fundamentals always say, “they can do that because they have 100 people.” But go back to when it was just you and Dr. Ben. Was it always internal referral?

Amanda Floyd: It was. People say it’s easy because we have 100 people. I remember being one of seven. There are only three of us still here from that original seven. The first two people we hired were direct referrals: my daughter Casey, and Nancy, who Dr. Ben had worked with at a previous practice. The third was Eliza, who was our waitress at a Christmas party. She had the best personality and almost got me to eat lamb, and I don’t even eat meat. I told her she needed to be a TC and hired her two weeks later. After that we hired Brittany, who Dr. Ben knew from CrossFit. We had a lot of relationships already, and we knew we were going to grow. When you’re producing under a million, there’s only one way to go.

Amanda Floyd: One year we went from $4 million to $11 million, a $7 million growth in one year. You can imagine how understaffed we were. I was the office manager, clinical manager, TC, and marketing coordinator. I wore every hat. We placed a couple of ads on Indeed, the first time we’d ever done it, and hired one person I had to let go on day three. She wasn’t friendly to our patients, and every person before her we had handpicked. The day I let her go I said we’re not doing this again, pull the ads. That’s when we started offering a referral bonus to team members. We told them we want people like you, so anyone you refer that we hire earns a $250 bonus. We’ve done it for years.

Harrison: So it’s not that having 100-plus team members is the reason you hire internally, because it happened that way from the start.

Amanda Floyd: It’s the culture you build. If you have a great culture and your team is happy, other people want to work there. People want a job they enjoy and to work for someone who’s built a brand and a reputation. Someone was talking about Dr. Ben yesterday and called him a pillar in the community. He is now. He wasn’t eight years ago, when he was a new guy who’d just moved here from up north. Back then people were taking a chance on us. Now we’ve built something safer for someone to come into.

[36:50] Compounding, the long game, and budgets

Luke: The takeaway is that it’s not magic. Pensacola isn’t a magical place. You did the work, and it’s like compounding interest. Good investors put money in every week and don’t touch it, and it grows. Ten years later the average market roughly doubles your money every seven years depending on the market. You did that in your business, but the ROI is far greater because you have all the control. Most people skip the foundational work and just try to jump ahead.

Amanda Floyd: It’s a lot of work. We’re ten and a half years into working together, and Ben works a couple of days a week now. We run a few businesses and aren’t in the orthodontics as much as we once were. But the people who’ve been here a long time remember. I had a shower in my office because I’d go to the gym at five, be at the office by 6:15, and leave most days at 5:30 in the evening, never taking lunch, Monday through Friday. It was years of hustle to get to the point where we could build leaders who run the day to day. It’s easy to look now and think they have it made.

Luke: If anybody will sit down, make a plan, set targets, and bring their team in on it.

Amanda Floyd: We have budgets for everything, which shocks people. We do a lot of team appreciation, and it makes me sad when offices remind their team to bring their own lunch. Ben never wanted to save money on team appreciation, even when he wasn’t bringing a paycheck home. We bring lunch in every Monday, have snacks and drinks every day, do coffee once or twice a week, and lots of little pop-ups. There’s a lot of money spent, but there’s a budget for it. At the end of every year I take collections and divide them by category. Our marketing budget is 7% of collections. There’s a budget for every little thing down to the day, per office, for snacks. There’s a math and a science to it.

Harrison: It’s calculated.

Amanda Floyd: You can’t afford for it not to be.

[40:35] Culture, the “why,” and developing leaders

Harrison: I know you’re a big Simon Sinek guy. The way I got introduced to him was his TED talk, the golden circle: people don’t buy what you do, they buy why you do it. Culture is such a buzzword now.

Amanda Floyd: It is a buzzword.

Harrison: It can turn into a woo-woo, feel-good thing, but it’s something you’ve internalized and live by. Our talent pool in Pensacola is very small.

Amanda Floyd: You have to develop it.

Harrison: People say they can’t find or keep people, and sometimes I think, have you considered you might be the problem? You and Dr. Ben were so intentional about how your people feel and how they’re treated.

Amanda Floyd: It’s a long game. So many private clients ask about Miranda Riley, our creative director, and say she’s a unicorn, where did you find her. I worked side by side with her for four and a half years to develop those characteristics. You can’t find someone who already knows how to do everything out the gate. You find someone with an incredible personality who shows signs of being a great leader and a self-starter, someone you don’t have to hold their hand. That’s what we saw in her. When I find someone like that I don’t want to stick them in one role. I want them to learn every aspect of the practice, and that becomes the best leader. Any client could call her and she could walk them through clinical issues, building a PowerPoint, managerial issues, or HR issues. But it’s a long game. You won’t develop someone like that in three months, and most people give up.

Luke: Think about a sports team. The exceptional players were developed and mentored before they ever got their shot, training and watching film, so when the moment came they were ready. We don’t think about those situations. If you bring in a stock trader, you don’t throw them in to make big trades on day one. They’re mentored and trained. As small business owners we miss that.

Amanda Floyd: Nobody has the patience or wants to invest the time and money. It’s a huge investment to take someone with zero experience and develop them like Brittany over the years, flying her around the country to trainings and seminars. You don’t just wake up with someone like that.

Harrison: She’s a rock star. Shout out, Brittany.

Amanda Floyd: Couldn’t make it through a day without her.

[45:11] Sales, the TC, and case acceptance

Harrison: Think about our relationship, Luke. I met you and Justin on a sales call when I was working at another agency.

Luke: The short version is the sales call was bad, but he still got the sale. The call was framed as a payment call. We had our card out thinking we were paying, and the whole dog-and-pony came out, write down three numbers, circle one. But we saw something in Harrison that a lot of people don’t have. A lot of people in high-ticket sales are afraid to make the ask or challenge you. He had that, so I thought we just needed to train him. How long have you been here now?

Harrison: Four and a half years.

Amanda Floyd: Sales is confidence, you can’t get around that. We were at a mutual client’s practice in Ohio recently. This guy has rock-star TCs and has grown tremendously this year. We sat in on consults, two, three, four in a row of over-$7,000 fee presentations, no one batting an eye, no discounts, same-day start after same-day start. When people say it’s impossible, I say come listen to this. They had just left our TC empowerment course and were doing the exact fee presentation we teach. It comes down to the TC’s confidence in what they’re offering and the doctor’s ability to get out of the way and let the TC do their job, because these doctors are not salesmen.

Amanda Floyd: The doctor should come in, say hi, look at the records, give a treatment plan, and get out. Let the TC do what they need to do. If your TC isn’t a salesman, you need a new TC, because that is the job. Nobody wants to say that because it’s a medical industry.

Harrison: If you can’t sell somebody, you can’t help them, as long as we’re operating from integrity and the product will make a positive impact. If those two things are in alignment, closing somebody is the highest form of service, because if I can’t close you, I can’t help you.

Amanda Floyd: Especially same-day. You save them the time of coming back. These people didn’t fall out of the sky into your consult room. They clicked a link or called and made an appointment. They reached out, so they want to be here. If they can start treatment and the doctor says let’s move forward, there’s no reason they shouldn’t start today.

Harrison: Unless the roadblocks are created.

Amanda Floyd: Unless the obstacles are thrown out there by the TC. I could tell you 100 recent stories of TCs throwing out roadblocks. That’s why we tell our TCs less is more.

Luke: How many doctors do we know who go in and try to run the show? Thirty minutes later they’re still explaining.

Luke: Did you see the patient’s eyes glaze over? It’s information overload.

Amanda Floyd: Now they’re leaving because they can’t make a decision, which is what I’d do in that situation too.

Harrison: This feels more serious than I thought. I thought I was coming in for braces and colors, why are we looking at x-rays?

Amanda Floyd: The way our TCs do it is so simple. We offer an affordable option from the gate. They don’t have to admit in front of their kid that they can’t afford the down payment or to pay in full. We’re not asking for that. We’re asking for $300 down, $169 a month. It’s pretty easy.

[49:54] Fishbein Fundamentals

Luke: Let’s wind down with Fishbein Fundamentals. What are you wanting to do with it, and what are you offering? So many people ask whether they should do a one-on-one or a course, and when the next one is.

Amanda Floyd: We started the course to streamline things. When you see an orthodontic practice with extreme growth, everybody wants to know the secret. There’s no secret, it’s probably a book we read. But nobody wants to read. I love order, and Dr. Ben is more easygoing, so people would just show up, two or three different groups in the same week, unannounced. So we started the course to make it less chaotic. We’ve had 18 fully sold-out courses at this point. We started it in 2017 or 2018. Then we started the one-on-one program because the courses fill up. We only offer three or four a year. The next available is August 24, with a few spots left, and then our HIP course in November. The one-on-one is similar to the course but more individualized. Someone spends a full clinical day with whatever department they want. About two years ago we started offering virtual options, which are very popular, a half day with me and Miranda and the director over whatever department they want. We also do private consulting, reserved for clients who’ve already been through the one-on-one training and the conference.

Amanda Floyd: We’re very selective about who we work with. We want people with an abundance mindset and a growth mentality. I don’t want to spend months working with someone who says “that would never work here.” I’m not for everyone, and I’m certainly not for anyone who writes off the possibilities before trying. I want to work with people willing to get out of their own way and let their team grow the practice, because you’re not going to do it by yourself.

Luke: Typically when people say that, it’s not that they believe it, it’s that it’s making them uncomfortable. But growth happens when you’re uncomfortable.

Amanda Floyd: We have a mutual client, Jesse Carmen in Ohio. He brought his whole team to fundamentals, came back a month later for the TC course with 15 people, a huge expense, and then four weeks later brought four more people for our TC-only event. They started working with you all and had massive growth, and we started working with him privately. He told me the reason it’s worked so well is that he told his team from day one, whatever Amanda and Miranda suggest, we’re going to try it, because worst case it doesn’t work and we change it back. We’re not doing brain surgery. So we made hard changes: switched people into different departments, changed their fees, changed their entire consult process, developed a call center. A lot of it was uncomfortable, but he got out of the way and saw the big picture, and it’s been tenfold for him.

Luke: How can somebody get a hold of you?

Amanda Floyd: Through Fishbein Fundamentals. https://amandafloydconsulting.com/fishbein-fundamentals/ People reach out with questions all the time, and we’re happy to answer what we can by email and to schedule calls.

Luke: Thanks for being here. I feel like we could talk all day. Thank you so much for your time.

Amanda Floyd: My pleasure. Thanks for inviting me.

Ready to grow your practice the way Fishbein did?

If this conversation mapped to where your practice is stuck, whether that’s under producing locations, a marketing budget you’re tempted to cut, or case acceptance that stalls at the fee presentation, HIP Creative can help you build the system behind it. Book a growth strategy call: https://hip.agency/landing/discovery/