by Rob Thorup, DDS – President, My Practice My Business
When a dentist invests millions of dollars into a practice, who should that office be designed for? The patient, the clinical team, or the dental equipment sales quota? For decades, the dental industry has largely answered that question the same way by telling dentists to build more operatories because they will grow into them, eventually hire associates, perhaps add specialists, or regret not building more. Somewhere along the way, dentistry adopted another assumption that more operatories equal more production, and more production equals more collections. At first glance, that sounds logical, but logic without capacity is a dangerous business model.
Let’s ask an uncomfortable question about who benefits financially when five operatories become eight or twelve. The equipment manufacturer sells more equipment, the supplier sells more cabinetry, delivery systems, and chairs, and there is more plumbing, electrical, installation, technology infrastructure, and commission, while the dentist assumes the debt. That does not automatically mean suppliers are acting improperly, as many provide valuable guidance and have helped dentists build excellent practices, but dentists still need to understand the incentives involved. A supplier makes money by selling equipment, whereas a dentist makes money by operating a sustainable dental business, and those are not always the same objective.
Here is the flaw in the idea that more operatories automatically create more production: every clinician and hygienist has a carrying capacity, meaning there is a limit to how many patients one clinician can competently, comfortably, and efficiently treat in a day. Additional square footage does not change that biological reality, and you cannot solve a human-capacity problem by adding more operatories. Once the clinical team exceeds its comfortable capacity, the results are predictable because the schedule falls behind, patients wait longer, stress increases, communication gets rushed, the team becomes exhausted, treatment presentations become shorter, mistakes become more likely, and eventually, the patient experience suffers. Ironically, the strategy intended to increase production can undermine one of the most important drivers of long-term practice growth, which is a remarkable patient experience.
Over the years, Tracy and I have walked through hundreds of dental practices, and one thing shows up again and again: empty operatories, unused chairs, unused cabinetry, unused equipment, and unused square footage. The dentist eventually discovers a simple truth that there are only so many patients one doctor and one hygiene team can comfortably care for in a day, meaning the extra rooms often do not create the additional production everyone predicted. Instead, they create additional debt, and now the dentist is making payments on operatories that generate little or no return, which is not growth but carrying cost. An unused operatory is not free simply because no patient is sitting in it, since it already cost you money in construction, cabinetry, dental equipment, plumbing, electrical, utilities, maintenance, financing costs, and perhaps most importantly, opportunity cost. Every square foot devoted to an unused treatment room is space that could have been used to improve some other part of the patient or team experience, such as a larger operatory, a better consultation space, a more comfortable reception area, better staff facilities, additional storage, future technology, or simply a less cramped clinical environment.
One of the design trends we continue seeing is smaller and smaller treatment rooms, some approximately eight feet by twelve feet, which might look efficient on a floor plan. But once cabinetry, rear delivery systems, equipment, seating, and storage begin occupying the room, the usable clinical space shrinks quickly, forcing you to ask whether this is really the ideal environment for modern dentistry. At Thorup Dental, our operatories are just over thirteen feet by thirteen feet, and that difference matters because patients do not feel boxed in, the team has room to move, technology can be integrated without turning the room into an obstacle course, and the operatory feels less clinical and more comfortable. Patients have told us they feel less claustrophobic and less anxious while receiving treatment, which matters more to me than squeezing another operatory into a floor plan.
Dentistry continues to evolve with CAD/CAM, hard-tissue lasers, microscopes, digital scanning, AI-supported imaging, advanced monitors, new delivery systems, and future technologies we have not even seen yet. Yet many brand-new dental offices are designed so tightly that integrating additional equipment becomes difficult almost immediately, meaning the room may work beautifully for the exact technology purchased on opening day, but what happens five or ten years later? If your practice is successful, you will likely add technology, change equipment, or modify workflows, and a well-designed operatory should allow for evolution so that the office of tomorrow is designed for the technology of tomorrow rather than merely the equipment being sold today.
Perhaps the biggest flaw in many dental operatories has nothing to do with technology, but rather with psychology, particularly the position of the dental chair. In many offices, the patient faces away from the doorway, meaning an anxious patient sitting in an unfamiliar clinical environment cannot see the person entering the room as the assistant, hygienist, and doctor all approach from behind. For an anxious patient, that matters immensely because patient experience is built from small decisions, and if the room is supposedly designed around the patient, intentionally placing them where they cannot see who is approaching is not patient-centered design, but rather equipment-centered design.
Years ago, Tracy and I began asking a different question instead of figuring out how many operatories we could fit into a space, asking instead how we could create the best patient experience possible. Once the patient became the starting point, our design priorities changed to make bigger rooms, chair orientation, technology placement, lighting, visual clutter, entertainment, plants, and traffic flow matter so that the operatory stopped being just a room where dentistry happens and instead became part of the overall experience. At Thorup Dental, we intentionally designed larger treatment rooms around the patient by placing our dental chairs sideways to the entrance so the patient can immediately see everyone entering the room without anyone appearing unexpectedly from behind. We eliminated the traditional hanging overhead dental light and wall-mounted X-ray units, minimized visual clutter, added large plants, and positioned large televisions both in front of the patient while upright and overhead when reclined so they can actually watch while I work rather than staring at the back of my head. Patients have multiple programming choices because if we can help them temporarily forget they are sitting in a dental chair, we have improved their experience, resulting in an environment that feels genuinely different.
When we talk about creating a Disney experience, we are not talking about cartoon characters or turning a dental office into a theme park, but rather about intentional design where every detail—from signage and lighting to cleanliness and staff interaction—communicates that the patient is the most important person there. Patients and families notice that, talk about it, and refer others, creating the kind of marketing no advertising budget can buy. This connects to perhaps the most important business point in the entire discussion: more operatories do not automatically create more profit. Profitability comes from understanding the economics of the procedures performed inside those operatories, including knowing your direct operating cost per patient-care hour to reflect payroll, benefits, supplies, facility expenses, technology, compliance, debt service, and appropriate compensation for the dentist and team. Dentists should not be embarrassed to discuss that your employees deserve more than merely surviving, and the dentist deserves an appropriate return for the education, debt, risk, and responsibility required to own a practice. Furthermore, through concepts like procedural profitability, you must evaluate what a procedure costs to perform, the time required, material and lab costs, and your reimbursement to see what is actually left over.
Dentists frequently try to solve financial problems by increasing volume—adding another chair, a hygienist, or a patient column, seeing more patients, working faster, and keeping rooms full—but if the procedures performed in those rooms are not profitable, adding volume can actually make the problem worse by making you incredibly efficient at losing money. At MPMB, our goal is to help dentists understand how to make the procedures they perform financially sustainable, including care delivered to PPO patients where contracts and applicable law permit, which requires business literacy, insurance contract literacy, and knowledge of applicable state dental laws. Imagine if every dental office design meeting began by asking what design will create the greatest patient experience ten years from now instead of how many operatories can fit into the floor plan, because the building should serve the business, the business should serve the patient, and the patient should not be forced to adapt to a floor plan created around equipment density.
Dental supply companies have tremendous influence over the physical design of our profession by helping design thousands of dental practices, but that influence carries responsibility where the goal should not simply be maximizing equipment sales, but helping dentists create environments that support exceptional patient experiences, clinical efficiency, team comfort, future technology, practice flexibility, and financial sustainability. Suppliers who think this way will create stronger long-term relationships because when the patient wins, the practice wins, and when the practice wins, the supplier wins, which is a far healthier business model than simply asking how many chairs can we sell. Therefore, before you build another operatory, ask why by evaluating your clinical capacity, staffing, patient demand, economics, and whether the room will generate a measurable return rather than just building it because someone told you that you would grow into it.
The greatest dental offices are not remembered because they had twelve operatories instead of eight, and patients do not leave talking about an impressive operatory-to-square-foot ratio, but rather they remember how they were treated, whether they felt rushed or comfortable, whether they were anxious, whether the team listened, and whether the environment felt modern, calm, organized, and intentional. Perhaps it is time dentistry stopped asking how many operatories we can fit into a building and started asking how many extraordinary patient experiences we can create inside it, which is both the better design question and the better business question.
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