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From Burnout to Breakthrough by Dr. Ashley Kisling

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Categories: Orthodontics;
From Burnout to Breakthrough 

Knowing when it’s time to hire a COO

by Dr. Ashley Kisling

Running an orthodontic practice today requires far more than clinical expertise. For many of us, ownership means juggling the dual responsibilities of delivering exceptional patient care while also managing the complexities of business operations. Early in your career, this balancing act may feel manageable, even energizing. But as practices expand, adding locations, larger teams, or more sophisticated services, the weight of operational leadership often begins to erode both efficiency and personal well-being. At this stage, many orthodontists begin to ask themselves an important question: Is it time to bring in a chief operating officer (COO)?


The first signs it may be time
The earliest signal that a COO may be needed is when your days are consumed less by patients and more by problems. Often, this shift happens quietly. Late nights become the norm, margins start to feel tighter, and the passion for orthodontics dims under the weight of operational fires. If you find yourself pulled into staffing conflicts, vendor negotiations, or scheduling dilemmas, you’re no longer working as a visionary; you’re functioning as a bottleneck.

When growth slows not because of demand, but because systems are too fragile to scale, a COO can be transformative. The role allows you, the doctor, to reclaim your position as the visionary, delegating execution to someone who can turn strategy into reality.


Defining the role of a COO
So, what exactly does a COO do in an orthodontic practice?

A chief operating officer is not just an elevated office manager. While an office manager typically oversees scheduling, staff supervision, and front-desk tasks, the COO takes a much broader, executive-level approach. They are responsible for:
  • Financial management, including budgeting, forecasting, and contract negotiations.
  • Developing systems and processes that support expansion.
  • Analyzing data and KPIs to identify growth opportunities.
  • Building organizational culture aligned with the practice’s mission and values.
In short, the office manager ensures the practice runs smoothly today, while the COO positions it to thrive tomorrow.


Attributes of a successful COO
The right COO blends operational expertise with people-centered leadership. They must be analytical thinkers who can interpret complex data, set measurable goals, and design systems for efficiency. At the same time, they must be adaptable, solutions-oriented leaders who thrive in the dynamic world of orthodontics.

Key attributes include:
  • Strong business insight and fiscal discipline.
  • An entrepreneurial mindset that identifies and acts on growth opportunities.
  • The ability to inspire teams, foster accountability, and maintain a culture of excellence.
  • Integrity, resilience, and urgency in execution.
But even the most skilled COO cannot succeed without a clear, compelling vision from the owner. Your role as the orthodontist is to define where the practice is headed: the patient experience you want to deliver, the reputation you want to hold in the community, and the innovations you want to champion. A COO is not a magic cure for a struggling practice; lasting success comes only when the owner puts in the work to define and communicate their vision and then delegates its execution.


Preparing to hire
Hiring a COO requires intentional planning, not just a job posting. Before bringing someone on board, define your three, five, and 10-year goals, your mission and core values, and the metrics that will measure success. Be clear about what decisions you want to delegate and where ultimate authority should remain.

Compensation should also be thoughtfully structured. Many practices combine a base salary with performance incentives tied to new case starts, staff retention, or profit margins. Some even explore profit-sharing or equity models to align incentives in the long term. The right structure ensures both the practice owner and the COO are invested in growth.


Finding the right fit
When I first sought to hire a COO two years ago, there were very few resources available. One that proved invaluable was The Scalable Practice by Luke Infinger, a book that gave me the framework I needed to hire with intention. Today, my COO, Melinda Bruns, and I have created a Facebook group called The COO Collective—a space for practice owners and COOs to connect, share ideas, and find support no matter where they are on their growth journey.

In terms of recruitment, LinkedIn remains one of the most effective platforms. Its professional network and advanced filters enable you to connect directly with candidates who already have experience in health care, operations, or practice management. Beyond job postings, LinkedIn allows you to proactively identify and approach talent who understand the nuances of health care operations.

Don’t overlook your own professional network either. Sales reps, dental consultants, and industry colleagues often know of qualified candidates who may not be actively searching but are open to the right opportunity. Because the COO role is highly relational and trust-based, these warm introductions can often yield the strongest matches.


Stepping out of burnout
Perhaps the most difficult part of this transition for orthodontists is letting go. We are trained to be perfectionists in clinical detail, and that instinct often carries over into business management. But no one can do everything indefinitely, not without sacrificing patient care or personal well-being. Empowering a COO allows you to reclaim your energy and redirect it toward higher-level strategy, innovation, and clinical excellence.

Of course, hiring a COO comes with risks. Bringing someone on too early may strain finances, while hiring someone misaligned with your culture can cause disruption. But when done with intention, the benefits far outweigh the risks. A capable COO allows the orthodontist to step out of constant burnout and step into the role of leader, mentor, and innovator.


The breakthrough
Outsourcing operations doesn’t mean relinquishing control of your practice; it means building a structure that amplifies your vision. For practices reaching the point of overwhelm, hiring a COO can be the breakthrough that unlocks sustainable growth and restores the joy of practicing.

As orthodontics evolves, with new technologies, AI, multi-specialty models, and rising patient expectations, the need for professionalized operations leadership will only grow. Recognizing the right moment to make this hire is not just about business metrics. It’s about designing the kind of practice and the kind of life that allows us to thrive as clinicians, leaders, partners, and parents.
Author Bio
Dr. Ashley Kisling Dr. Ashley Kisling is a board-certified orthodontist and the owner of a pediatric dentistry and orthodontic practice in Southern California. Kisling earned a bachelor’s degree in public health sciences at UC Irvine in 2011 and a DDS from UCLA in 2015, then completed her three-year orthodontic residency program in Georgia.
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