ON THE PREVIOUS EPISODE:
When Dr. Mark Pugliese told a patient with generalized 6mm bleeding pockets that he couldn’t keep seeing them if they refused the scaling and root planing, his staff was shocked.
Six months later, the same staff was thanking him. Because the patients they had spent years dreading? Replaced. By patients who showed up, paid, said yes, and didn’t argue about radiographs.
If you have not listened to Part 1, you missed the path: Boston University dental grad, ASDA national trustee, Aspen Dental associate in rural Maine, then practice owner at 29 in Concord, New Hampshire. This is Part 2. The one where Mark stops talking about how he got the practice and tells you exactly what year one of running it actually looked like.
DR. MARK PUGLIESE’S STANDARD
Mark inherited a practice built across 70 years of family dentistry. Two generations. Same town. The previous owner was beloved. He was also old school. So old school that the office still placed amalgams as the default posterior restoration. Hygienists had never seen an AAP perio staging chart. There was no caller ID on the phones. Emergencies were scheduled a week out. And the philosophy was simple: keep every patient happy, no matter what they refused.
Mark walked in with a different standard. He typed up a written perio protocol from scratch. He held weekly staff meetings to roll out changes one at a time, sometimes backpedaling on one that did not work. He hired a hygienist straight out of school he did not technically need yet — because she would learn his way, not the old way. He fired a 13-year veteran assistant who could not place the right anesthetic on the tray. And he started having the hardest conversation in dentistry: “If you do not want the standard of care, I am sorry, I cannot continue to see you.”
Twelve months in, the metrics tell the story. 90% patient acceptance. 50% treatment plan acceptance. Zero voluntary turnover. One full year of compounding small decisions. Here is what he actually did.
7 TAKEAWAYS FROM THIS EPISODE:
1. The New Patient Experience Is the Whole Game
Mark spent a week at Aspen headquarters in his first six months, role playing new patient interactions. He calls it the most valuable thing he got from his entire DSO career. The system: do not talk dentistry for the first five minutes. Ask about the jersey. Ask why they switched dentists. Ask what they are actually looking for. By the time you look in their mouth, the patient already trusts you. That trust is what closes cases. Not the x-ray.
2. Photos Beat X-Rays at the Close
Mark put an intraoral camera in every operatory the day he took over. When he sees a fracture line, he photographs it and shows the patient on the screen. His script: “It might last 10 years. It might break tonight. Do it on your terms, because it always breaks at the worst time.” Patients see what you see. The case closes itself.
3. A $17 Book Saved Him $50,000 in Sleep
How to Win Friends and Influence People by Dale Carnegie. Mark read it, took notes, and revisits them every few months. The result: zero voluntary employee turnover in his entire first year of ownership. His framing: if you can motivate people for free — the way he did running ASDA and his college fraternity — motivating people you are paying becomes easy. Wipe down rooms. Help with sterilization. Lead by doing. Most dentists lean on “I am paying you to do this, so do it.” That is how you lose your team in 18 months.
4. Hire for Teachability, Not Experience
Hot take: Mark prefers brand new dental assistants over 13-year veterans. The veteran he inherited could not get a consistent x-ray and set out the wrong anesthetics every time. New hires learn HIS systems, follow HIS protocols, and cost less. Same with his hygienist hire — fresh out of school, full time before the demand fully justified it. He bet on teachability and won.
5. Dismiss the Patients Your Team Dreads
When Mark stopped seeing patients who refused SRPs against standard of care, his staff was initially uncomfortable. Six months in, they were relieved. Those were the same patients showing up late, denying radiographs, and arguing every filling. Less liability. Less headache. More chair time for patients who actually wanted treatment. The math is brutal and obvious: a patient who fights you on a $300 SRP is going to fight you on a $1,800 crown.
6. Patient Acceptance > Treatment Plan Acceptance
Mark tracks both numbers in Practice by Numbers. His patient acceptance rate is 90%. His treatment plan acceptance — the dollar percentage — is around 50%. He cares far more about the first number. His reasoning: patients are not buying your treatment plan. They are buying YOU. If they buy into you, the crown gets done eventually. Maybe not today. But when that tooth breaks in six months, you are the one they call. Not a different office.
7. The Arrival Fallacy Will Eat You Alive
Mark’s first three months of ownership: 7 AM arrivals, 8 PM departures, gray hairs, no gym, no hobbies. His fiancee carried the relationship while he transferred utilities, talked to lawyers, and figured out a DBA. He calls it a “season.” The wrong move would have been waiting for the day everything is fixed. There is no such day. There is only the next thing to improve. Owners who chase “things will be better when I get there” never enjoy any of it. Owners who enjoy the journey end up doing this for 30 years.
LISTEN:
CONTRACT REVIEW:
Mark prepared for ownership for two years. He talked to brokers. He toured practices he was not going to buy. He built a relationship with a banker before he needed one. By the time he signed, he knew exactly what he was buying.
Most associates do not get that runway. They get a contract dropped on their desk, a 48-hour pressure window, and a promise that “this is our standard agreement, everyone signs it.” We have read enough of those “standard agreements” to know what is actually in them. Termination clauses that let the office fire you for any reason with 30 days’ notice while you owe them 90. Non-competes that swallow your entire metro area. Production thresholds set so high you would need to be booked solid for 10 hours a day to ever see a bonus check.
We are not lawyers. We are two practicing dentists who read associate contracts every single week. We know what to negotiate, what to walk away from, and what is actually enforceable. If you are about to sign — or you already signed and something feels off — send it over. We will read it. Dentist to dentist.
Submit: theeducatedassociate.com
Or DM: @the_educated_associate on Instagram
CONNECT:
Guest: Dr. Mark Pugliese (@pugliese_dmd) | Wall Street Dental Group (@wallstreetdentalgroup) — Concord, NH
Podcast: @the_educated_associate
Alex: @dr.besmer
Newsletter: theeducatedassociate.substack.com
SHARE:
Share this with one classmate or colleague. That’s how we grow. That’s how we reach more dentists before they sign the wrong contract.
