Joel Idelson
CEO, Image Specialty Partners
Let’s be honest—most DSO leaders aren’t losing sleep over patient satisfaction surveys or whether Janice at the front desk smiled enough today.
They’re losing sleep over EBITDA.
And nothing quietly strangles your EBITDA faster than the one problem nobody ever brags about fixing on stage at a dental conference:
Overhead Creep.
What Is It?
It’s not a crisis. It’s not a disaster. It’s worse…it’s subtle.
Overhead creep is that slow, almost imperceptible climb in costs that starts out as “necessary support” and ends up as “how the hell did payroll go up $400K this quarter?”
It’s adding a new regional manager because the last one “had too much on their plate.”
It’s signing five software contracts to solve one problem.
It’s handing out corporate titles like participation trophies because “we need more structure.”
All of it feels reasonable in the moment. And all of it will gut your margin if you’re not paying attention.
Where Does It Show Up?
- Corporate Headcount Bloat: You needed a team, not an army.
- Vendor Sprawl: Why do we have three contracts for whitening kits, and none of them are even discounted
- Inefficient Processes: Six people manually doing what one AI-enabled system could do overnight, because “this is how we’ve always done it.”
Why It Happens
Because growth is exciting. And overhead? Well, it’s boring. Until it’s not.
When you’re in growth mode, it’s easy to justify everything. The revenue’s coming in, locations are opening, and your board is happy. So you start spending like a tech startup in 2012 and hope no one notices.
Spoiler alert: They will.
How to Kill It Before It Kills You
1. Track Your SG&A Like It’s Your Personal AmEx
If you wouldn’t personally spend $20K on a vendor doing… whatever it is they do, why are you doing it at the corporate level?
2. Build Systems, Not Silos
Standardize processes. Automate what you can. Integrate systems. You don’t need more people…you need better operations.
3. Audit Every Damn Thing
Run a ruthless vendor audit. Do a zero-based budget review. Ask “why?” five times. If no one can explain the expense, it’s probably not necessary.
4. Stop Confusing Headcount with Progress
You don’t scale by hiring your way out of inefficiency. You scale by solving the underlying inefficiency.
Final Thought
Overhead creep doesn’t come in screaming. It shows up politely. Quietly. Like a house guest who never leaves.
And if you let it stick around long enough, it will eat your margins, flatten your story, and leave you explaining to investors why your impressive topline revenue somehow leads to… almost nothing at the bottom.
So yeah, invest in growth. But don’t let bloat masquerade as scale.
In the DSO world, valuation is margin x scale. Lose the margin, and all you’ve built is a very expensive group chat.