The Production You’re Overlooking by Stacey Bybee

Four opportunities to finish 2026 strong

by Stacey Bybee

What if I told you that your practice could uncover additional treatment starts before the end of the year without spending another dollar on marketing?

As we near year-end, many orthodontic practices are reviewing their numbers and asking the same question: What can we do to finish the year strong and reach our production goals? For some, it’s about maintaining the momentum they’ve built throughout the year. For others, it’s finding opportunities to make up ground before Dec. 31.

When we talk about increasing production, the conversation often turns to getting more new patients through the door. But what if some of the best opportunities to increase production aren’t new patients at all? What if they’re patients who have already walked through your doors, expressed interest in treatment, or established a relationship with your practice?

After 26 years in orthodontics, including 23 years working directly in a practice before becoming a full-time consultant, I’ve seen how easily these opportunities can be overlooked. Pending patients, observation patients, missed new patient exams, and leads that never converted into appointments can all represent potential treatment starts.

The patients may already be there. The question is whether your practice has the systems in place to identify those opportunities and follow through.

Pending patients
Let’s start with one of the easiest responsibilities for a treatment coordinator to put on the back burner, yet one that could be costing your practice significant production.

Every practice has patients who come in for a consultation but don’t commit to treatment that day. Some need to discuss finances, others are comparing treatment options, and some may be struggling to make a decision after being presented with multiple treatment plans.

But not starting treatment on the day of the exam doesn’t mean they’ve decided against treatment. The challenge is what happens after they leave.

In many practices, pending follow-up is one of the first responsibilities pushed aside when the day gets busy. But the concern isn’t simply whether the treatment coordinator has time to make another call. It’s whether the practice has established a protocol, provided the tools to manage it, and created accountability to ensure those patients aren’t forgotten.

Another reason I frequently see pending follow-up pushed aside is that some treatment coordinators simply fear hearing “no” and aren’t confident in how to respond. Without the proper training and support, those conversations are often avoided, leaving potential treatment starts sitting on the pending list.

Pending follow-up shouldn’t be about repeatedly asking patients if they’re ready to start. It should be about continuing the relationship, understanding what’s holding them back, and helping them feel comfortable taking the next step.

A patient with financial concerns may need to revisit payment options. A parent trying to coordinate multiple schedules may just need help finding an appointment that works. Those are two very different conversations, and your follow-up should reflect that.

Consistent follow-up starts with understanding why the patient didn’t move forward. Your treatment coordinator should have a clear plan for when and how to reconnect with each patient.

Having a pending list is one thing, but having a system in place with clear expectations, assigned responsibilities, proper training, and accountability is what turns those opportunities into treatment starts.

You may find that some of your greatest opportunities for additional production are patients who simply need someone to reconnect with them.

Observation patients
An observation program is one of the most valuable growth opportunities an orthodontic practice has, yet it’s often one of the easiest areas to fall behind on. These are patients and families who already know your practice, have met your team, and have trusted your doctor to monitor their orthodontic development.

An effective observation program takes more than placing a patient in an OBS status and assigning a future return date. There needs to be a process for managing that patient from one visit to the next, ensuring appointments are scheduled appropriately and patients don’t fall through the cracks.

My first recommendation is to schedule the patient’s next observation appointment before they ever walk out the door, starting with their initial exam. When patients leave without their next appointment scheduled, you’re already creating additional follow-up work for your team and increasing the possibility of patients becoming overdue.

For patients who leave without scheduling, I recommend beginning outreach approximately eight weeks before their recommended return date. Don’t wait until the month they’re due to begin contacting them. By then, appointment availability may already be limited, and the patient can quickly become overdue.

Without consistent oversight, an observation program can become a growing list of patients who are overdue for appointments, some of whom may already be ready to begin treatment, leaving valuable production opportunities sitting untouched.

When managed effectively, your observation program becomes a steady source of future treatment starts while ensuring patients continue receiving the care and attention they need.

Missed exams
Here’s an area that often gets overlooked. What happens when a new patient schedules a consultation but cancels and never reschedules? Or when someone simply doesn’t show up?

In many practices, these patients remain somewhere in the practice management system, but no one is tracking them or making an effort to reconnect.

I encourage practices to establish a specific status and workflow to identify patients whose new patient exams were missed, canceled, or never rescheduled.

Having a status alone isn’t enough. There should be a defined process for following up with these patients, documenting communication, and ensuring someone is responsible for moving those opportunities forward.

Consider what it took to get that patient to schedule their initial consultation. Whether they came from a referral, your website, or a marketing campaign, they were interested enough in your practice to take that first step. Yet without a follow-up process, that opportunity can easily be lost.

A missed appointment doesn’t necessarily mean that interest is gone. But without a process to reconnect, the opportunity may be.

Lead follow-up
Practices spend considerable time and money generating leads through websites, social media, referrals, and other marketing efforts. But generating a lead doesn’t automatically mean that lead becomes a scheduled exam.

One of the challenges I frequently see when working with practices is that leads are coming in, but no one is actually responsible for managing them. In some cases, there’s no defined process for tracking incoming inquiries, following up with potential patients, or determining whether those leads ever become scheduled appointments.

Consider the person who submits a website inquiry but doesn’t answer when your team calls. Without a follow-up system and someone responsible for managing it, that opportunity can easily be forgotten.

Too often, practices focus on how many leads they’re generating without paying enough attention to how many are actually converting into completed new patient exams.

Lead follow-up needs to be an intentional part of your new patient process. There should be clear ownership, a process for tracking every inquiry, expectations for timely follow-up, and accountability for ensuring those opportunities aren’t overlooked.

More leads won’t necessarily produce more treatment starts if the systems to manage them aren’t working.

Systems that work
Identifying opportunities for additional production is only the beginning. Turning those opportunities into treatment starts requires defined processes, clear expectations, and accountability.

In my work with practices, the problem often isn’t that the team doesn’t have time to manage these responsibilities. It’s that there isn’t a system in place outlining how the work should be done, who is responsible for doing it, and how the results will be monitored.

The good news is that many practices already have technology available to help manage these responsibilities more efficiently. Before investing in another software platform, take a closer look at what you already have.

Many practice management systems and patient communication platforms offer features that allow you to automate portions of your pending, observation, missed exam, and lead follow-up. Implementing these workflows can help ensure patients receive timely communication without requiring a team member to manually initiate every contact.

However, there’s something I cannot stress enough when it comes to automated communication: Just because a message is automated doesn’t mean it should sound automated.

Your messages should feel personal, thoughtful, and relevant to the patient’s relationship with your practice. Patients should feel that someone genuinely wants to reconnect with them, not that they’re receiving another generic message.

And perhaps even more importantly, someone must be responsible for monitoring the responses. I frequently see practices that have automated communication in place, yet no one is managing the messages coming back in. Patients respond with questions, express interest in scheduling, or indicate they’re ready to move forward, but those responses aren’t being addressed. If no one is monitoring those conversations, the practice is missing the very opportunities the automation was designed to capture.

Technology can help initiate and organize communication, but it doesn’t eliminate the need for team accountability.

And if your practice doesn’t have the technology available to automate these processes, that doesn’t mean the responsibilities should go unmanaged. Establish manual workflows and written protocols that clearly outline when patients should be contacted, how follow-up should be documented, and who is responsible for each step.

Every one of these areas, whether pending, observation, missed exams, or leads, needs an assigned owner. Expectations should be clearly communicated, and leadership should regularly review results to ensure the processes are being followed.

Your year-end challenge
As we approach the final weeks of the year, I encourage you to take a closer look at four areas of your practice: pending patients, observation patients, missed exam opportunities, and leads that never converted into scheduled appointments.

Start by pulling your reports and identifying where potential treatment starts may be sitting untouched. You may be surprised by the number of opportunities already within your practice that could contribute to reaching your year-end production goals.

But identifying those opportunities is just the first step. Take a closer look at the systems and protocols you have in place to manage each of these areas. Ensure someone is responsible for each process, expectations are clearly defined, and accountability measures are in place so the work gets done. Don’t overlook the technology you already have available to help your team manage these responsibilities more efficiently.

You don’t have to overhaul every system at once. Start with the area that presents the greatest opportunity for your practice, establish a process your team can consistently follow, and monitor the results.

While the immediate opportunity may be additional treatment starts and production before the end of the year, the real value comes from building systems that continue to produce results well beyond 2026.

Continue focusing on attracting new patients, but before investing additional time and money into bringing more patients through your doors, make sure you’re maximizing the opportunities already within your practice.

Sometimes the growth you’re looking for isn’t about finding more patients. It’s about having the systems, follow-through, and accountability to make the most of the opportunities you already have.

Stacey Bybee, co-founder of Rootwell Consulting Group, brings 26 years of orthodontic experience, including 23 years working directly in an orthodontic practice before transitioning into full-time consulting. With a background in clinical care, treatment coordination, and practice management, Bybee specializes in helping orthodontic practices identify growth opportunities, strengthen their new-patient process, and implement systems that improve efficiency and accountability. She is passionate about helping doctors and their teams turn strategies into sustainable results.