Why monthly goals built on assumption tend to be wrong
A few years ago I was sitting with a practice owner going over their end-of-year projections. I mentioned, fairly casually, that I thought the fourth quarter was going to come up short. The response was confident: December is always strong, people rally.
I come from a background where miscounting a single day moves the price of a bond. Counting days carefully is just how I see the world. It's super annoying, I get it.
October had been a genuinely good month — they'd beaten their target. But November had softened, and when I looked at what December would need to do, something felt off. So I went back to the goals themselves.
Each month had a target. The targets were different, which seemed reasonable. But when I compared them against the actual number of open days each month, they didn't hold up. The goals assumed a version of December that doesn't really exist.
Using 2026 as an example, a practice with standard holiday closures might see something like this:
| Month | Open days |
|---|---|
| October | 21 |
| November | 19 |
| December | 17 |
That's a 19% difference between October and December — nearly one day in five. Even the difference between October and November, just two days, is worth paying attention to. All else equal, you should expect December to produce proportionally less. Not because anything went wrong. Because there's less time to work.
And December isn't the only month that runs short. Many practices lose days in November around Thanksgiving, in the summer for team outings or training days, and scattered throughout the year for holidays and office events. This isn't a one-month anomaly — it's a pattern that repeats, and goals that don't account for it will be quietly wrong all year. In some months, your team may comfortably hit their goals while actually leaving production on the table. In others, they may fall short while genuinely performing well. The goal, not the team, is doing the misleading.
What follows from that is worth sitting with: if the quarter is going to get made, October needs to carry more of it. And if you don't know that going in, you'll spend November and December wondering what happened.
How the Hygiene/Doctor Team split changes the math
It goes further than that.
The instinct when you see a 19% gap is to think you need 19% more production — spread across the whole practice, everyone pulls a little harder. But Hygiene Team and Doctor Team production don't flex the same way.
The Hygiene Team is often more than half the schedule. A hygienist has a booked appointment and does the work in front of them — there's not much that can happen to change the outcome. The Doctor Team is presenting options, and has real agency over whether a patient understands the value of acting sooner or more completely.
When you need to close a production gap, the Hygiene Team can't close it. You're asking the portion of the schedule that has any flexibility — which might be somewhere between half and a third of your provider hours — to make up the difference for the whole practice.
Why a 19% gap can mean a 30% ask
That's when a 19% problem stops being a 19% problem.
To generate the same production in 19% fewer days, the Doctor Team needs to produce 30% more per hour.
So 19% fewer days requires a 23% higher production rate for the practice — which actually requires a 30% increase from the Doctor Team.
Days are a proxy. Provider hours are the real unit.
We've been talking about days because that's the most intuitive starting point. But days are actually just a proxy, and not a perfect one. Some days have fewer hours than others. The real unit is provider hours, which is what Pareto actually focuses on for production goals. Provider hours are what changes for sick days, snow delays, tornado days, lunch hours, and early Friday close.
This was the foundation of Pareto — understanding exactly what resources a practice has available, and using those resources to guide the goal-setting process so that targets are anchored to reality rather than assumption. Days are one resource. So are provider hours, chair capacity, and the mix of who is scheduled to work them. Once Pareto is set up, it just runs, automatically tallying days and hours (among other things). Other benefits — team buy-in, enhanced accountability, a clearer path to growth, and ultimately a practice that delivers a better experience for every patient — tend to follow when the foundation is right.