When trying to monitor progress with PPO involvement, there are a couple of hidden contributors to practice growth and insurance participation that often no one talks about. Consider two identical start-up practices, same location, same equipment, same patient flow. Practice number one appears to be thriving while practice number two seems to be just surviving. Why the difference? Although business skills, clinical excellence and strong leadership are all factors, often debt is the unnamed source. If the owner of practice 1 came out of undergraduate and dental school with no student loans while the owner of practice 2 paid for his/her entire education, there is easily a debt difference of $300,000. The tens, and often hundreds, of thousands of dollars of educational debt that are common today can contribute to the options a practice has in terms of insurance participation. I believe that someone who is set on having a strictly fee-for-service office can do it with the right marketing plan in place in spite of high debt, but debt levels add an additional burden because there is usually less room for mistakes. The pressure of having a full schedule is more heightened the higher the debt level, which is one reason why some practices choose to take more PPOs than others in the beginning. Another contributor to the amount of PPO participation can have nothing to do with the practice itself, but rather the dentist’s spouse. If the dentist’s spouse has a career which can support or significantly contribute to the household expenses, there is less pressure for the dental practice to become profitable immediately whereas if the spouse is at home, perhaps caring for children, the dental practice must instead recognize a profit fast. The discounted income of PPOs is better than empty chairs when bills are piling up with no other income source. Both practices will become successful, there are simply additional factors that need to be recognized when it comes to the pace of growth. I advise you not to get caught up on thinking your process may not be working if it seems slower than the dentists you are surrounded by. Be sure you have a plan in place for your practice based on your own circumstances and don’t get side-tracked!