Practice Management Companies: Profits Over People
If you feel like your local doctor is more of a salesman than a physician, you might have a problem. They might be practicing more than their craft—they may have bought into a practice management company or healthcare franchisor. These are large conglomerates that provide business infrastructure, branding, and aggressive sales systems.
Most likely, you have a local dentist, chiropractor, or even a pediatrician. You trust these healthcare professionals, and rightfully so. They have earned a doctorate in their area of specialty, and you’ve hired them to care for you and your family.
But here’s the question: Do they see you as a patient—or as a way to build and grow their profits? It’s a fine line between care and greed. Everyone chooses their profession to earn an honest living. But do practice management companies or healthcare franchisor groups take it too far?
Recently, our daughter went to a new chiropractor. He did the routine initial exam, which included X-rays, and his staff took our insurance information. But after looking at her X-rays, he told our 22-year-old daughter that she had a significant amount of arthritis in her neck, that it would only get worse, and that in 20 years the pain would be unbearable if she didn’t take action right away. He informed her that he was one of only a few chiropractors in the state who could treat her issue and that he could fix the problem—but only if she came in for daily treatments and bought a special pillow he sold.
When she hesitated to book her next appointment, he asked her—right in front of everyone in the lobby—“What time will I see you tomorrow?” After she felt pressured to schedule, he texted her that evening to remind her he would “fix the problem” and see her the next day.
Needless to say, she felt pressured, uncomfortable, and reluctant to trust this new chiropractor.
I’ve noticed similar tactics at a local dentist’s office, which I later learned is also part of a practice management company. These are just a few things our family has experienced:
The $40 “co-pay” that wasn’t. After a routine cleaning and X-rays, the hygienist would end our appointments by saying, “You owe us $40 for today.” That didn’t seem unreasonable—it’s a typical co-pay—so we paid it. Only after the payment was processed would they say, “Now it’s time for your fluoride.” Turns out, the $40 was not a co-pay at all—it was for a fluoride treatment none of us wanted. This was a nonchalant way of getting paid for an unnecessary service without asking first.
Double X-rays. After bite wings (average cost $40–$120), the dentist would request a panoramic X-ray as well (average cost $100–$250). Insurance typically covers only one type per visit, so the pano would be out-of-pocket. When we asked if it was necessary, the dentist said, “We do panoramic X-rays every five years—it’s common here.” In reality, this was simply an upsell. Sure enough, we received a bill in the mail.
Insurance wordplay. When our dental insurance changed and the dentist became out-of-network, I called to see if they’d still take it. The receptionist assured me they “worked with” our new provider. What she didn’t say was that “working with” meant the insurance would pay only part of the bill—leaving us with a surprise $450 charge.
This is how these companies train doctors and staff to wordsmith conversations to bring in more money—often for services that are not truly necessary. Healthy adults at low risk may only need X-rays every 2–3 years. That’s me: I’ve never had a cavity, and my teeth and gums haven’t changed in 30 years. Even if insurance pays, someone is still footing the bill, which drives up overall healthcare costs.
Dental X-rays are truly only necessary in the following cases:
Children/teens: Teeth and jaws are still developing.
High-risk patients: History of frequent cavities or gum disease.
New patients: To get a baseline view.
A good dentist will tailor the schedule to your needs—not force a one-size-fits-all policy.
Even our family optometrist ends appointments with, “It looks like your insurance covers eyeglasses, so someone will help you pick out a pair in the lobby.” What he doesn’t mention is that our insurance covers only a small portion of the cost, and the frames sold in his office are 10 times more expensive than online options. I can buy prescription glasses online for $50—far cheaper than using insurance on a $400 pair from his display case.
The main goal of practice management companies is to maximize profitability through upselling services and products, creating repeatable sales models, and blending wellness ideals with corporate business systems. They offer tools and training in sales, marketing, operations, and growth—skills that often work against the patient’s best interests.
And it’s not just chiropractors, dentists, and optometrists. Podiatrists, physical therapists, and even veterinarians are also known to buy into these systems.
So if your “local” doctor doesn’t feel so local anymore—if they start sounding like a smooth-talking salesperson or withhold important information about costs and insurance coverage—it might be time to ask questions and consider finding a new provider.
