Introducing Field Notes on Health Progress

Hello—I'm Josh Renken, a practicing dentist who has spent the last 24 years organically growing a group of general dental practices.

For context, we did not place a single Class II composite when I was in dental school. The unofficial pecking order was determined by who could carve the nicest wax pattern and cast the best gold onlay.

Dentistry has changed considerably since then.

We have moved from film to digital imaging, handwritten charts to practice-management systems, and traditional impressions to intraoral scanners. Implant dentistry has become commonplace. Artificial intelligence can now identify clinical findings, evaluate conversations, and help practices understand thousands of patients at once.

Many procedures once reserved for advanced specialists are now performed routinely in comprehensive "super GP" practices, giving far more patients access to care.

Yet for all of that progress, operating a dental practice feels harder than ever.

Costs have risen. Reimbursement has struggled to keep pace. Experienced administrators, dental assistants, and hygienists have become more difficult to find. The number of systems, vendors, regulations, messages, handoffs, and decisions required to care for one patient continues to grow.

Almost every dentist I know feels some version of the same pressure:

How do we continue providing great care, supporting our teams, and maintaining a healthy practice without simply asking everyone to work harder?

That question has shaped much of my work.

When Covid hit, we struggled to rebuild our onsite administrative teams. We had already democratized care presentation and checkout, allowing more members of the clinical team to help patients understand and take the next step in their care. We adapted by moving the remaining administrative work offsite, and we have continued operating without onsite administrative roles ever since.

That statement tends to get people's attention. It can also be easily misunderstood.

We did not conclude that administrators were the problem or that people should be replaced. We redesigned where and how administrative work happens. Our clinical practices are supported by a centralized remote team and technology that handle scheduling, phones, revenue-cycle work, human resources, marketing, and other essential responsibilities.

Inside the practice, every team member can remain focused on supporting and caring for patients, with the shared goal of helping each person move forward on their Path to Health.

This model has taught us a great deal about role clarity, technology, specialization, and unnecessary complexity. It has also created new challenges. Centralized support can become distant and impersonal if we are not intentional. A clinical team can feel unsupported even when many capable people are working hard behind the scenes.

We are still learning how to make remote support feel personal, responsive, and connected to the mission of the practice.

That is an important part of this story: we have not solved everything.

We have built a working laboratory.

Inside that laboratory, one idea has continued to become clearer.

The real unit of work is progress

Dental practices measure a lot of things: production, collections, new patients, case acceptance, hygiene reappointment, phone conversion, open chair time, outstanding claims, and accounts receivable.

Those numbers matter. A practice cannot fulfill its purpose if it is not economically healthy.

But most of those measures tell us what happened to the practice. They do not always tell us what happened to the patient.

A patient can have a diagnosis, a treatment plan, an insurance estimate, and even a future appointment—and still never become healthier.

Patients become stuck everywhere:

• They visit for an emergency but never return for a comprehensive examination.
• They complete an examination but do not fully understand or accept the plan.
• They accept care but never schedule the first appointment.
• They begin treatment but lose momentum before disease is controlled.
• They complete urgent care but never rebuild what was lost.
• They become healthy but gradually fall out of maintenance and prevention.

The practice may remain busy while hundreds or even thousands of patients quietly stop moving forward.

That led us to a different organizing question:

Where is each patient on the Path to Health, and what is the next right step?

We call this Health Progress.

Health Progress does not mean pushing more dentistry. It means helping a person understand their condition, make an informed decision, overcome resistance, and take the next appropriate step toward health.

Sometimes that step is treatment. Sometimes it is an examination, a conversation, prevention, financing, reassurance, or simply more time.

Our responsibility is not to force movement. It is to make healthy progress easier.

Patient health, team health, and practice health

I have also come to believe that sustainable progress requires three forms of health to exist together.

Patients need to understand where they are, where they are going, and what comes next.

Team members need clarity, support, useful systems, and the ability to see the meaning in their work.

Practices need the financial health and operating strength to continue serving people over time.

When we optimize one at the expense of the others, the system eventually breaks down.

A practice cannot create lasting patient health by exhausting its team. It cannot protect its team without sound economics. And it cannot build healthy economics while losing patients in a confusing, fragmented journey.

The opportunity is to align all three.

Why I'm writing now

Much of what we have built has been influenced by ideas outside traditional dentistry: behavioral economics, organizational design, technology, decision science, business, psychology, and healthcare innovation.

I love reading about how people make decisions, how systems create friction, why progress stalls, and what helps human beings move forward. I have spent years adapting those ideas inside our practices—sometimes successfully and sometimes not.

Until now, I have shared most of that work with our teams, other practice owners, and the dentists I coach.

I'm ready to open the lab notebook more widely.

Field Notes on Health Progress will explore what we are seeing, what we are trying, what is working, and where we are still struggling.

Some notes will examine patient progress: why diagnosed care stalls, why chairs sit open, and how we might help more patients take the next step.

Others will explore team and practice design: centralized support, role clarity, artificial intelligence, communication, leadership, margin pressure, and what we have learned from operating without onsite administrators.

I will also share the books, concepts, tools, experiments, and mistakes that continue to shape my thinking.

This is not a declaration that we have discovered the one right way to operate a dental practice. Dentistry has too many different patients, people, practices, and communities for that.

It is an invitation to explore a different question together:

What could dentistry become if we organized the practice around creating measurable progress in patient, team, and practice health?

There is enormous expertise across our profession. I also believe many of us are experimenting with pieces of the same future without yet having a shared language for it.

Perhaps we can learn faster by comparing notes.

If that question interests you, I hope you'll join me.

I would also love to hear from you:

Where do patients most often become stuck in your practice—and where does your team experience the most unnecessary friction?

—Josh