The Dental Truth Project

David Janash, Founder & CEO of Underbite Dental, built a 13-location DSO from the ground up in one of the most brutally competitive markets in the country: New York City. 
He's made every expensive mistake in the book — and turned those mistakes into a data-driven operation that actually tells him what's going to happen before it does.
David used to log into every single office manually, every single night, just to know how his business was doing. 
Then he spent hundreds of thousands of dollars building a custom data warehouse and hiring software engineers to solve the problem. 
He eventually scrapped all of it for a monthly software subscription that does it better.
The lesson isn't just about wasted money — it's about what happens to your strategy when you're operating without real insight. 
David coined it himself: "The map to that gap is your data"
Key Revelations:
The Gap Between Intention and Actuality
Most DSO leaders are obsessing over last month's report — the operators winning right now are looking at next week
Running multiple offices on different practice management softwares isn't flexibility — it's chaos disguised as convenience
Special contracts, different hours, outlier comp plans — when things go wrong, you'll wish you'd standardized your DSO sooner
 
💡 The "Ask Ken" Question: 
"Does my EBITDA look strong, but I still feel broke every month?"
Ken's answer: A few things hide from EBITDA that devour your cash — debt service, capital expenditures, and cash vs. accrual distortion. Strong EBITDA and empty pockets aren't a contradiction. They're a signal. Here's how to read it.
 
Top 3 Episodes of The Dental Truth Project. Listen Now!
(E.25) The PMS Data Gatekeeping Scandal in Dentistry: Jake Larsen & Clint Berry, Kolla
(E.20) Fake Codes, Hidden Fraud & The Accounting Nightmare: Paul Lowry, Dental Menu
(E.5) The DSO Valuation Crash No One Talks About: Gareth Petsch, pH Partners
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project

Tonya Christal and Danielle Powell of Lee Dental Centers in San Antonio don't have a fancy training platform, a DSO war chest, or a playbook they borrowed from a conference stage. What they do have is something far rarer — a 40-year family practice, a sister who's also their business partner, and the hard-won clarity to know exactly who they are and who they're not.
The hard truth? Most dentists are building their practice to look like someone else's. They're scaling because the seminar said to scale. They're chasing new locations because four feels small now when it used to feel big. And somewhere in that race, they stop asking the one question that actually matters — is this the life I actually want?
Key Revelations:
Designing Your Group on Purpose
At four locations, you're constantly asking: Are we good? Do we need to get to ten? Are we just keeping up with the Joneses?
Sacrificing EBITDA on purpose isn't a failure — sometimes it's the exact right move to protect your team, your time, and your sanity
The "sell your house" exercise: go under the hood as if you're preparing to sell — you'll either fall back in love or finally get clear on what has to change
 
💡 The "Ask Dallin" Segment:
"What AR data patterns signal a billing system problem before cash flow is affected?"
Dallin's answer: Two things to watch. First, your total AR balance — some is normal, but if it's climbing month over month, something is broken. Second, your aging buckets — any meaningful amount sitting at 90+ or 120+ days is a warning sign you can't afford to ignore. Catch these patterns early, before the cash flow feels it.
 
Top 3 Episodes of The Dental Truth Project. Listen Now!
(E.22)  The DSO Leaders' Imposter Syndrome Epidemic: Thomas Passalacqua,  Ascend Professional Pathways, LLC
(E.12) Niche Down or Burn Out: Why Top Dentists Do Less and Earn More: Alex Sharp, Shared Practices Group
(E.2) Why High-Multiple Exits Are Bankrupting Dental Practices: AJ Peak, Health Wealth Capital
 
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project 

Sean Hamel, Founder & CEO of Art of Dental Marketing, tears apart the broken cycle that's quietly draining dental practices dry — and most owners don't even know it's happening.
Every dentist has hired a marketing company. Most have hired several. And yet the phone still isn't ringing the way it should. Sean reveals why the problem was never your marketing budget — it was the message. When every practice looks the same, sounds the same, and posts the same stock photos of people in scrubs, the only way to stand out is discounts. And discounts attract the wrong patients. And the wrong patients feed a cycle that burns through marketing companies, money, and momentum — over and over again.
The hard truth? Patients aren't choosing you because you're clinically superior. They already assume you are. What they're actually buying is how you make them feel — and almost no one is marketing that.
Key Revelations:
What Patients Are Actually Buying
When every practice looks and sounds the same, discounts become the only differentiator — and that's exactly where the damage begins
The discount spiral: generic marketing → wrong patients → pressure on the practice → fire the marketing company → repeat
When your promise and the patient's experience sync, discounts become unnecessary — referrals and advocacy do the work instead
Patients aren't buying dentistry — they're buying the future version of themselves: more confident, better sleep, a better smile
 
💡 The "Ask Ken" Question:
"When should a practice stop thinking like a practice and start thinking like a DSO?"
Ken's answer: You never get to let go of the practices — they are everything. The DSO infrastructure means nothing without dental practices that run on repeatable, scalable processes. Get that right first. Then — and only then — think about buying more, doing de novos, and building a growth strategy around it.
Top 3 Episodes of The Dental Truth Project. Listen Now!
(E.26) You Keep Losing Dental Team. Have You Asked Yourself Why?: Bonnie Thompson, Forest Family Dentistry
(E.20) Fake Codes, Hidden Fraud & The Accounting Nightmare: Paul Lowry, Dental Menu
(E.15) We Pulled Insurance Duty From Our Front Desk - Revenue Jumped 30%: Francesca Pregano - Smile Makers Dental Center
 
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project 

A Czech-trained oral surgeon walks into Wisconsin dentistry — and quietly becomes the guy everyone calls about implants. Dr. Jan Bublik has spent nearly 30 years watching general dentists hold themselves back from a procedure they're more capable of than they've been led to believe. 
He pulls back the curtain on the unspoken rules that keep dentists small, and the community-first model that's changing how implant education actually works.
Key Revelations:The Cross-Training Effect
Sending a patient to a specialist without knowing what to ask for doesn't guarantee a better outcome — it just moves the responsibility
Long-term patient trust is a clinical asset. When you've earned it, expanding your scope becomes a natural conversation, not a hard sell
The dentists who grow aren't necessarily the most technically gifted — they're the ones who surrounded themselves with the right people and kept learning
💡 The "Ask Dallin" Question:"How do you objectively evaluate provider performance using data without relying on gut feelings?"Dallin's answer: Stop looking at raw production numbers — they're inflated UCR values that don't reflect what you'll actually collect. The metric that matters is net production per provider per day (or per working hour for even sharper insight). In group practices, benchmark providers against each other. Solo? Find peers in similar geographies and payer mixes and use them as your baseline.
Top 3 Episodes of The Dental Truth Project. Listen Now!(E.5) The DSO Valuation Crash No One Talks About: Gareth Petsch, pH Partnershttps://www.accrudent.com/podcast-the-dental-truth-project-the-dso-valuation-crash-no-one-talks-about-e5
(E.6) Are Dentists Selling Out Their Entire Industry?: Mike Baird, Accelerate Dentalhttps://www.accrudent.com/podcast-the-dental-truth-project-are-dentists-selling-out-their-entire-industry-e6
(E.15) We Pulled Insurance Duty From Our Front Desk - Revenue Jumped 30%: Francesca Pregano - Smile Makers Dental Centerhttps://www.accrudent.com/podcast-e15-the-dental-truth-project-we-pulled-insurance-duty-from-our-front-desk-revenue-jumped-30percent-e15
 
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project

Dr. Rehan Shahid, multi-practice owner, dental coach, and COVID-era graduate, reveals an uncomfortable truth about modern dentistry: dental school teaches clinicians how to drill and fill — but not how to run a business. 
As a result, many highly skilled dentists unknowingly build practices that struggle financially because they lack leadership systems, data-driven decision making, and business fundamentals.
Key Revelations:
The Business Education Gap in Dentistry
Many Dental Owners first see their financial statements from their CPA and don’t know how to interpret profitability, overhead, or where money is leaking.
Dental school teaches clinical dentistry, not how to run a business. Yet successful practices depend on systems, leadership, financial management, and operational structure.
Most dentists graduate with almost zero training in reading financial statements, running KPIs, or understanding business operations, even though many will eventually own a practice.
Execution beats perfection in business. Many dentists fall into “analysis paralysis,” waiting for the perfect plan instead of taking action, learning from mistakes, and improving systems along the way.
 
💡 The “Ask Ken” Question:
“Is EBITDA manipulation just part of the game when selling a dental group?”
 
Ken’s answer: Accuracy matters far more than appearance. Private equity firms will always run a quality-of-earnings review, and any attempt to manipulate EBITDA can destroy a deal immediately. Clean, transparent financial reporting is the only sustainable path when preparing a practice for a sale or partnership.
Top 3 Episodes of The Dental Truth Project. Listen Now!
(E.27) Hiring Entitled Dental Grad Nobody Talks About: Dr. Anushka Gaglani & Dr. Abhishek Nagaraj, Areo Dental Group
(E.24) Why Your Associate's Professional Insurance Won't Save Your DSO: Herb Ford, Risk Strategies Dental Practice
(E.18) Why Half Your DSO Budget Is Disappearing Into Toxic Culture: Gabriel Hofmann, The Dental Efficiency Guy
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project 

Sarah Ruberg, CEO & Founder of Our Thrive Tribe, delivers an uncomfortable wake-up call to every dental professional playing it safe on the sidelines: the industry is full of people with powerful stories, hard-won expertise, and genuine wisdom — and almost none of them are sharing it. In a world drowning in AI-generated noise, your most underutilized competitive advantage might be the most human thing about you: your voice.
Key Revelations:
The Personal Brand Blind Spot Nobody Talks About
Most dental leaders don't post because they believe "nobody cares what I have to say" — yet that silence is costing them relationships, opportunities, and revenue
You can say everything about yourself without saying anything about yourself — promoting others reveals your character, values, and mindset louder than any self-promotion ever could
Waiting for your marketing department to build your brand? Sarah's message to salespeople: you are the differentiator — not your product
In business, personal brand and relationships are the highest-value currency — more reliable than any job title or company badge
💡 The "Ask Dallin’ Question:
"What's the #1 metric you look at to understand the true health of a practice?"
Dallin's Answer: Net Production — and he'll debate anyone who disagrees. Everything in your practice — collections, RCM, expense control — means nothing if production isn't healthy. Most owners obsess over cutting costs, but real growth only comes from growing your top line. There's a floor to how low expenses can go. There's no ceiling on what you can produce.
Net production is the heartbeat. If it's weak, nothing else matters.
Top 3 Episodes of The Dental Truth Project. Listen Now!
(E.22) The DSO Leaders' Imposter Syndrome Epidemic: Thomas Passalacqua,  Ascend Professional Pathways, LLC
(E.6) Are Dentists Selling Out Their Entire Industry?: Mike Baird, Accelerate Dental
(E.3) How Associate Mismanagement Is Bankrupting Dental Groups: Eric Roman, Dental Associate Growth
 
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project 

Dr. Anushka Gaglani & Dr. Abhishek Nagaraj of Aero Dental Group exposes the uncomfortable truth about what's really breaking dental groups from the inside — and it starts the moment you make your first hire.
Two dentists who grew from a single struggling $200K practice to a multi-location group share what they've learned the hard way: the new associate entitlement crisis is real, it's wrecking your cash flow, and most DSOs are too afraid to say it out loud.
Key Revelations:Hiring Mistakes That Cost You Years
Most are walking into interviews asking about bonuses and guarantees before ever discussing how to get better clinically
Want to make $300K? You need to produce close to $900K–$1M — a number most new grads have never heard and aren't prepared for
Sign-on bonuses aren't gifts — if you don't perform, the group finds a way to get it back. Every time.
DSOs competing for D4 students with perks are creating a false sense of leverage before they've treated a single real patient
💡 " The "Ask Ken" Question:"Why do DSOs still run out of cash even when revenue is going up?"
Ken's answer: Growth is a cash killer before it's a cash creator. The moment you scale — more payroll, more supplies, more overhead — your working capital cycle goes negative before it recovers. Protect the cash first, celebrate the revenue later. Cash isn't just king. It's the whole kingdom.
Top 3 Episodes of The Dental Truth Project. Listen Now!(E.21) Why Your DSO Exit Strategy Is Probably Worthless: Vince Dilley, Platinum Dental Services(E.23) AI Is Killing Patient Loyalty in Dentistry: JW Oliver - SupportDDS(E.12) Niche Down or Burn Out: Why Top Dentists Do Less and Earn More: Alex Sharp - Shared Practices Group
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project

Bonnie Thompson, COO of Forest Family Dentistry and 37-year dental industry veteran, delivers an uncomfortable truth that no AI vendor wants you to hear: the biggest crisis in dentistry isn't technology — it's that leaders have forgotten how to lead people. While inboxes overflow with AI pitches promising to "fix" your practice, Bonnie exposes why practices keep burning through staff, why change management keeps failing, and why blaming "nobody wants to work anymore" is the laziest — and most dangerous — thing a dental leader can say.
Key Revelations:
The People Problem No Software Can Solve
Employees don't quit companies — they quit leaders who roll out changes without buy-in or training
Managing a Gen Z team member looks nothing like managing a Gen X or Boomer — and most leaders have no idea what to do differently
Turnover isn't a "them" problem. If your team keeps leaving, the first question a real leader asks is: what could I have done better?
The difference between ego and insecurity — and why confusing the two is costing you your best people
 
💡 The "Ask Dallin Question:
"Why does my profitability change so much each month on my financial statements?"
Dallin's answer: In dentistry, revenue and expenses almost never land in the same month. You might be paid before or after the work is done, and supplies and payroll hit before the production does. That mismatch is why your P&L looks like a roller coaster — and why what you think is a profitability problem might just be a timing problem. (Ask us about accrual accounting if you want the real fix.)
 
Top 3 Episodes of The Dental Truth Project. Listen Now!
(E.3) How Associate Mismanagement Is Bankrupting Dental Groups - Eric Roman, Dental Associate Growth
(E.9)  Dentist vs. Dentist - What I know, You Know! - Josey Sewell, Dental Associate Growth
(E.16)  Will AI allow me to fire my RCM team? - Jonas & Luis, Kaylie.ai
 
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project 

Jake Larsen and Clint Berry, Co-Founders of Kolla, exposed the dental industry's data hostage crisis: While Google made Gmail free to capture YOUR data and built an empire worth hundreds of billions, dental practice management systems are charging YOU to access YOUR OWN patient data - and in the age of AI, it's getting worse. The dirty secret? Some PMS providers are locking down data not because of costs, but because they've found a "clear path to revenue" by holding practices hostage.
 
Key Revelations:The Data Gatekeeping Scandal
Formerly open-source systems now charge third-parties for write access after closing their code
On-premise PMS providers actively lock doctors out of databases on hardware THEY OWN
Cloud-based systems charge up to $100/month PER LOCATION just to access your own data via API
PMS providers set arbitrary API prices with "no relation to actual costs" - it's pure profit extraction, not cost recovery
 
💡 The "Ask Ken" Question:"I'm afraid of my financial statements every month. I fear the worst. How can I overcome this?"
Ken's answer: You have Financial Disassociation - a diagnosable condition where you either avoid financials completely or obsess destructively. The cure? Force yourself into structured monthly/weekly reviews with a financial teammate. Create the pattern, follow the pattern, and the fear dissolves. This especially hits doctors transitioning from chairside clinician to practice leader.
 
Top 3 Episodes of The Dental Truth Project. Listen Now!(E.3) How Associate Mismanagement Is Bankrupting Dental Groups - Eric Roman, Dental Associate Growth(E.2) Why High-Multiple Exits Are Bankrupting Dental Practices - AJ Peak, Health Wealth Capital(E.7) Contaminated Water Lines Are Bleeding Your Practice Dry - Steve Craig,  Solmetex
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project

Herb Ford, VP at Risk Strategies Dental Practice (Brown & Brown Company) and longtime insurance industry insider, exposes the silent killer of emerging dental groups: catastrophic insurance gaps that owners don't discover until the lawsuit arrives. While multi-location practices celebrate growth and expansion, they're unknowingly operating with fractured liability coverage - associates control the protection for million-dollar corporations, general agents miss dental-specific risks, and one credit card decline can leave an entire DSO completely exposed to financial ruin.
Key Revelations:The Professional Liability Disaster Waiting to Happen
Thinking "my associate has their own coverage" means you've handed control of YOUR practice's protection to someone else
Group professional liability policies give you control over protection + group discounts, yet most multi-location owners don't even know they exist
70% of emerging DSOs keep using the same insurance structure from their single-location days - it doesn't scale and creates massive gaps
When lawsuits hit, attorneys don't sue the associate - they sue the corporation (the one with deep pockets: YOU)
 
💡 The "Ask Ken" Question:"Should I hire an in-house CFO or use a fractional one?"
Ken's answer: Timing is everything. Hire too early and they're bored; too late and you've already left millions on the table. Most DSOs need 10-20+ locations before a $250K-$300K strategic CFO makes sense. Until then? Fractional CFO who's hands-on coaching your team - not just showing up to meetings. Define the outcomes you need, then structure the role around that.
Top 3 Episodes of The Dental Truth Project. Listen Now!(E.15) We Pulled Insurance Duty From Our Front Desk - Revenue Jumped 30% - Francesca Pregano, Smile Makers Dental Center (E.1)  How Outsiders Invaded Dentistry and Destroyed Billions - Brian Colao, Dykema(E.19)  The Pay-to-Play Dental Conference Problem - Matthew McGaw, DSO Compass
Got a burning question about dental finance?Submit your question, and it could be featured in a future episode.Ask Ken Form: https://resources.accrudent.com/ask-ken-form-the-dental-truth-project