Practice: Fishbein Orthodontics. Starting point: $2.4M annual production from one office. Result: $26M+ in annual revenue across 8 locations. Time elapsed: 7 years.
The Starting Point
When I met Dr. Ben Fishbein, his practice was a strong single-location office producing roughly $2.4 million in annual production. From the outside, it looked like a great practice. From the inside, Ben was running close to capacity and feeling the limits of what one office could do.
He had a choice that every successful single-location owner eventually faces. Stay where he was and optimize for lifestyle. Sell to someone who'd take the practice over. Or commit to building something much bigger.
He chose the third option. The decision wasn't about money. It was about what he wanted his career and his life to look like at age 50, 55, and 60. Once that picture was clear, the work followed.
What We Did First
The early work was marketing. Ben tripled his marketing budget. Most owners would have cut spend at that point, not increased it. The bet was that if we could push the existing practice to its limit fast, we'd have the cash flow and the team to fund expansion.
It worked. Online conversions climbed by 500 percent. ROI on marketing spend hit 10X. Production at the original location grew significantly inside the first 18 months. By the time we opened the second office, the parent practice was strong enough to absorb the cost of standing up a new site.
The first lesson here: never expand from a position of weakness. Expand from a position of overflow.
Where the Real Compounding Happened
The marketing got us moving. The compounding came from everything underneath it. Three things, in particular, made the difference between a two-location practice and an eight-location group:
1. A Repeatable Operating System
We built and documented every system that mattered. New patient flow, consult flow, financial agreement architecture, scheduling templates, team training cadence. Each new location opened with a playbook, not a fresh start. By the time office number five was opening, the time-to-profitability was a fraction of what it had been at office number two.
2. A Real Leadership Team
Ben moved from being the operator of one office to being the CEO of a multi-location group. That meant hiring leaders who could run individual locations and a regional leadership layer that could manage across them. The biggest single decision was the day Ben decided he no longer needed to personally make every operational call. That decision is what made eight locations possible.
3. Location-Level Discipline
Every location had its own weekly KPI dashboard. Leads, exam show rate, case acceptance, same-day starts, production per chair hour, overhead percentage. We compared sites against each other, found the variance, and fixed the underperformers fast. That discipline kept any single location from drifting away from the brand standard.
The Numbers
- Starting point: $2.4M from 1 location
- Current state: $26M+ across 8 locations
- Multiple: More than 10x revenue growth
- Marketing: Tripled budget, 10X ROI, 500% boost in online conversions
- Time elapsed: 7 years
- Locations opened: 7 additional sites at increasing speed-to-profitability
What This Took From Ben
The number that gets the headlines is the revenue growth. The story that doesn't get told often enough is what changed inside Ben.
He had to give up the identity of being the smartest clinician in the room and accept the identity of being the leader most responsible for the team. He had to delegate decisions he was used to making personally. He had to invest in talent he'd never have hired at the single-location stage. He had to develop a relationship with cash flow, debt, and risk that single-location owners rarely have to think about.
All of that was harder than any tactical change. It was also the work that made everything else possible.
What This Means for Your Practice
Most owners reading this will not become Ben Fishbein, and that's fine. The story is not a script for everyone. The story is proof of what's possible when an owner commits to a real long-game vision and surrounds themselves with the team and systems to execute it.
If you're a single-location practice owner sitting somewhere between $1.5M and $5M, the same principles apply at your scale. Build the operating system. Build the leadership depth. Build the marketing-to-conversion engine. Then choose what you want the next decade to look like, knowing you have real options on the table.
The single most important moment in this entire story was the decision to stop running the practice as a clinician and start running it as a CEO. Every other change followed that one.