There Are Only Three Ways to Grow a Practice by Mike Alan Gusching

by Mike Alan Gusching

One of my favorite stories begins with a man walking down Wall Street. He finds himself surrounded by investors and bankers, all of them boasting about the immense value they provide, the clients they’ve helped, and the families they’ve supported. And to prove their point, they direct the man to the fruits of their labor: their yachts parked along the waterfront.

The man looks around, takes it all in, and asks one of the most famous questions in the history of personal finance:

“So where are your customers’ yachts?”

The finance industry is a masterclass in manufactured complexity. Every year, thousands of brilliant graduates flood investment firms armed with jargon, frameworks, and products designed to make the simple sound sophisticated. For the average person today, personal finance can feel like a realm reserved for Ivy League MBAs.

And yet the best financial advice fits on an index card. That’s not a metaphor. The best-selling book The Index Card: Why Personal Finance Doesn’t Have to Be Complicated, by Helaine Olen and Harold Pollack, exists precisely because it does something incredibly valuable: It cuts through the noise and gives you only what matters. It’s the spirit of Richard Feynman’s teaching philosophy: If you can’t explain something to a 5-year-old, you don’t really understand it. For those curious, Fig. 1 shows the personal finance index card.

Fig. 1

Fig. 2

But if a multibillion-dollar personal finance industry can be reduced to an index card, I figured it was worth asking the same question about orthodontic practice growth. Every year, thousands of podcasts, social media ads, YouTube shorts, marketing companies, consultants, vendors, and now AI gurus pitch orthodontists a new path to growth. But could these ideas be boiled down to an index card? And if so, could any of them pass this “index card test” if there was one?

Here’s what I found (Fig. 2). Strip away every strategy, tool, and trend, and every method of revenue growth comes down to moving the needle on one of these three pillars:

1. Increase the number of patients who call in.

2. Increase the number who convert.

3. Increase pricing.

That’s it.

Every consultant, every software platform, and every marketing campaign, if it’s legitimate, should tie explicitly to an outcome in one or more of these three pillars. If it doesn’t, you’re helping them with their pillars.

But here’s where most go wrong: They treat these in isolation. You can spend a fortune driving thousands of new leads to your practice, but if they don’t convert, those calls are worthless. Most intuitively understand this. What’s less understood is the trap of focusing only on higher conversion rates.

“Our treatment coordinator closes at 50% and the industry standard is 75%! Help!”

That sounds like a loss. But conversion rate without context is meaningless. The practice winning on conversion rate may actually be trailing on what matters: profit, as determined by pricing. High acceptance rates built on discounted fees and heavy insurance dependency can quietly erode a practice’s margins, and they may eventually burn out the team under the guise that “more starts” must mean “a better practice.”

The index card test says don’t blindly focus on just your conversion rate. It forces you to ask, “How does this impact our pricing and profits, too?”

Considering new practice management software? Run it through the index card: How will it generate more calls, improve conversion, or support better pricing or profits? Evaluating a treatment coordinator against a benchmark? Bust out the index card: Were pricing, case mix, and lead quality constant, or are we comparing apples to oranges?

As a sales professional who has worked across multiple specialties, I’ve seen brilliant clinicians get drawn in by complexity dressed up as “innovative strategy”—a compelling demo, a slick dashboard, an edgy social media guru touting growth—all while the fundamentals get buried. I’ve seen it often enough that I believe every orthodontist, especially those just starting out, should have this index card in their pocket and pull it out before purchasing anything, then revisit it six months later.

I recently had the opportunity to interview Hansen, CEO of LeadSigma and former director of operations at Hansen Orthodontic Specialists. Scott is one of the top business thought leaders in the industry today, and what he told me brings this home:

“The best strategy for orthodontic growth isn’t chasing new trends. It’s mastering the fundamentals. Get back to the basics. Build a rock-solid foundation that can thrive in good times and bad. It’s never the flashiest practices that grow exponentially. It’s the ones that are built to last.”

The next time someone pitches you on an expensive growth proposition, pull out your index card. Quietly ask yourself, “Where, exactly, does this move the needle? How does this method impact each point, and specifically by how much?”

Your yacht is waiting.

Mike Alan Gusching is an orthodontic sales professional, speaker, and author of The Peak Orthodontic Practice: 20 Lessons and Interviews from Over 1,000 Practice Visits. As the son of an orthodontist, he brings a unique perspective to the industry. His latest book became a category No. 1 best-seller in early 2026.