Insights from Female CFOs in Dentistry
In the dynamic world of DSOs, financial leadership has never been more critical. CFOs stand at the intersection of strategy, operations, and care, tasked with steering organizations through an intricate maze of challenges—rising costs, shifting patient demographics, and the pressure to innovate. As the financial stewards of their organizations, they manage budgets, navigate economic uncertainties, and champion long-term sustainability. But the role of a CFO extends far beyond crunching numbers. It demands a delicate balance between fiscal responsibility and strategic foresight.
Today’s CFOs are not only focused on financial health but also on fostering collaboration, driving innovation, and ensuring that financial strategies align seamlessly with clinical priorities. Their work shapes how care is delivered and how businesses grow.
To better understand the complexities of this role, we interviewed four accomplished CFOS — Crissy Fiscus from PepperPointe, Karen Friar from Benco Dental, Victoria Garcia from Dental Care Alliance and Marie-Claude Tardif from iFinance. We covered everything from navigating workforce challenges to the latest books of interest. Each perspective offers invaluable insights. Here’s what they had to say.
What are the most significant financial challenges facing DSOs in your region? How are you addressing them?
I believe the most significant financial challenge facing DSOs continues to be elevated interest rates. It is imperative to properly forecast cash flow and only invest in projects that generate positive cash flow after accounting for debt.
What approach do you use to balance cost management with maintaining high-quality patient care?
AT DCA patient care always comes first. We pride ourselves in delivering high quality care. We look for ways to create efficiencies using technology and process improvement to manage costs, while maintaining high quality care.
How do you collaborate with the clinical leadership to ensure financial decisions align with patient care priorities?
I see myself as a highly operations-focused CFO. I partner closely with the CCO and COO to gain clear understanding of clinical
and operational priorities before making any significant financial decisions. I get deeply involved in the operational strategy of the company to ensure financial strategy is aligned and complementary.
What trends are you observing in patient demographics and behavior? How are DSOs adapting to meet these trends?
Rising inflation and increasing cost of living have made access to care more challenging. We partner with organizations that help patients with their financing needs to be able to afford the care that they need.
What challenges do you face in communicating the financial story to investors and leaders in your company?
Investors and Leaders in the company have varying levels of financial expertise or depth of knowledge of our business and industry. Simplifying complex financial data and providing enough detail to instill confidence is key in communicating the financial story.
What advice can you offer to leaders on managing workforce challenges?
Managing workforce in DSOs is paramount, especially with today’s clinician shortages and wage pressures. It is important to invest resources in Strategic Workforce Planning that is multifaceted and focuses on employee development, communication and culture.
What key financial metrics do you prioritize to gauge health of an organization?
CFOs are responsible for managing a wide range of financial metrics. I would say the ones that I focus on the most in our current environment are Cash Flow and EBITDA growth.
What significant challenges do you face as a CFO?
The most significant challenge that I face as a CFO is finding a balance between communicating urgency and financial responsibility,
while still instilling confidence and excitement across varying stakeholders of the organization.
What’s a book, article, or podcast that has recently influenced or inspired you?
What challenges do you face in communicating the financial story to investors and leaders in your company?
One of the biggest challenges I face is ensuring that everyone, regardless of their background, understands not just the numbers, but the ‘why’ behind them. Financial data is often complex and filled with technical terms, so I focus on simplifying it, using clear visuals, and avoiding unnecessary jargon to ensure the message resonates with different audiences. I carefully tie every financial update back to our strategic goals, providing a clear view not only of our current performance but also of where we’re headed.
Additionally, I prioritize open, two-way conversations to address questions, clarify uncertainties, and build trust and alignment across all stakeholders. My ultimate goal is to make financial information easy to understand and directly connected to our broader strategic objectives. In the end, I want every stakeholder to feel informed, confident, and aligned with our financial direction.
What advice can you offer to leaders on managing workforce challenges?
One of the most important lessons I’ve learned in managing workforce challenges is the power of active listening and adaptability. Listening isn’t just about hearing words, it’s about truly understanding concerns, acknowledging unspoken challenges, and showing genuine
care for your team’s input. Leaders who listen create trust, foster transparency, and build a culture where employees feel valued and empowered to contribute. At the same time, adaptability has become non-negotiable. Whether it’s adjusting to remote work, embracing evolving technologies, or responding to shifting employee expectations, leaders must remain flexible and open to change. This balance of listening and adapting helps address challenges proactively rather than reactively.
Equally important is clear and transparent communication, especially when every suggestion or idea can’t be implemented. Explaining the why behind decisions helps employees feel respected and reduces feelings of dismissal, even if they disagree.
Beyond that, investing in employee well-being, offering growth opportunities, and fostering an environment of trust and accountability ensure teams remain engaged and aligned with the organization’s goals. At the end of the day, successful workforce management isn’t about having all the answers, it’s about creating a culture where people feel heard, valued, and motivated to contribute to a shared purpose.
What are the most significant financial challenges facing DSOs in your region? How are you addressing them?
Managing several different issues that can negatively impact profitability is our most significant financial challenge:
Managing and controlling overhead costs, which includes staff salaries, supplies, equipment costs, etc. The recent rise in inflation has resulted in an increase in all business costs. As with any other business, it is a challenge to manage costs in this environment and maintain our profit margin. There are two specific areas that have impacted our business costs the most – staff salaries and interest.
Staff salaries have increased significantly in the past 3-4 years. The increase in salaries is also coupled with a labor shortage. This
has created a perfect storm of staffing in the dental industry. We are investing in technology to assist our current administrative staff with their duties. By investing in technology and training our people to use these technologies, we are seeing increased efficiency with our teams. Investments in technology will be a continued focus for us.
Rising interest rates impact so many different areas of our business, our cost of capital has increased, and our suppliers’ costs have also increased, which then gets passed on to us. Again, everyone in business is feeling the impact of rising interest rates. We are not as impacted as a lot of businesses, but it still definitely has an impact.
Rising inflation impacts our patients’ discretionary income, which impacts their ability to accept treatment. If patients cannot pay for treatment, that is a problem on many levels. Therefore, we are working to offer more ways to break down financial barriers for patients to accept treatment – offering more financing options, etc.
What approach do you use to balance cost management with maintaining high-quality patient care?
Staff Training – We are putting additional emphasis on staff training, which includes clinical and nonclinical staff in all our practices, as well as staff at the PepperPointe office. Highly trained staff create a better patient experience and a more efficient practice. The same goes for the team at PepperPointe, if the PepperPointe team is highly trained we can provide better, more efficient support for our practices.
Data Analytics – The PepperPointe data analytics team is focused on providing data that can be used by the PepperPointe team, our doctors and our practice level staff to provide insights into their business. We have recently implemented several different dashboards to assist our staff in effectively managing their practices. Using data to monitor financial performance, practice efficiency, and patient outcomes allows us to make real time adjustments to create better outcomes for our patients and the financial performance of our practices.
Patient Payment Options – To improve patient access to care while managing our cash flow, we are utilizing more payment options for our patients. These options include various third-party financing options. We are also using technology such as text to pay to make it as easy as possible for patients to pay.
Staying competitive: Evaluating UCR and Fee Negotiations in Dental Practices – We regularly evaluate our practice’s usual, customary and reasonable fees, as that is crucial to ensure alignment with industry standards and competitiveness within our local market. This strikes a balance between offering a competitive rate that attracts patients and maintaining profitability, which is a vital aspect of practice management.
Fee negotiations with third-party payers are equally important. We focus these discussions on optimizing contracts to benefit both the
practice and the payer. Building and maintaining strong relationships with key third-party payers can open opportunities to reduce administrative burdens and create mutually beneficial solutions.
How do you collaborate with the clinical leadership to ensure financial decisions align with patient care priorities?
Collaborative Budgeting and Planning – The PepperPointe team works closely with the clinical leadership to develop the budget and operational plan for the upcoming year. The financial budget is coupled with a business development roadmap (BDR) developed for each practice. The key performance indicators (KPIs) are outlined in the BDR. The KPIs are both financial and operational. Through this collaborative effort a plan that addresses patient care and financial success is developed.
Shared Data – The financial and nonfinancial KPIs are developed and shared with the clinical leadership. They contributed to the development of the BDR and they also share in the performance against the goals of the BDR throughout the year.
Financial Training for Clinical Leadership – We also invest in financial training for the clinical leadership. The BDR and budgeting process provides the opportunity for clinical leadership to develop their financial skills as well.
What trends are you observing in patient demographics and behavior? How are DSOs adapting to meet these trends?
Digital Health Engagement – Patients are looking for more digital options – online scheduling, text communications, etc. More importantly, they are excited about digital treatment options, especially in orthodontics, where the physical patient visits can be reduced by using technology to send pictures to the orthodontist for review.
Flexible payment options – patients want and need various ways to pay to allow them to get the treatment that they need, this includes payment plans and third-party financing options.
What key financial metrics do you prioritize to gauge the health of an organization?
- This varies based on specialty, but these are some of the metrics that we are looking at daily for all specialties:
- Days sales outstanding
- Over the counter collections
- Staffing costs as a percentage of revenue
- Supply costs as a percentage of revenue
What’s a book, article, or podcast that has recently influenced or inspired you?
What key financial metrics do you prioritize to gauge health of an organization?
When assessing the financial health of an organization, I prioritize a balanced set of key financial and non-financial metrics that provide both a snapshot of current performance and insight into long-term sustainability. While we consider many metrics, we emphasize revenue growth, market share, EBITDA margins, free cash flow, and customer and associate satisfaction scores. Each of these metrics is important individually, but their full value is realized when analyzed together as part of a broader performance perspective.
Financial health isn’t just about numbers, it’s also about building trust and loyalty with customers and associates. High satisfaction scores indicate repeat business, brand advocacy, and long-term customer retention. Likewise, engaged and satisfied employees are the driving force behind operational excellence and innovation, offering insights into organizational culture and long-term productivity.
What is a significant challenge you faced as a CFO and the lessons it taught you?
One of the most significant challenges I faced was of course navigating the CV19 pandemic. Practically overnight, we were faced with disruptions in operations, supply chains, and customer demand. During those moments, two key lessons stood out: the importance of resilience and the power of proactive communication. We focused on optimizing cash flow without compromising long-term goals and supporting our teams with clarity and transparency. At the same time, we doubled down on serving our customers, ensuring they had the resources needed to weather the crisis.
Perhaps the most important takeaway was that during times of uncertainty, financial leadership isn’t just about spreadsheets and forecasts, it’s about trust, adaptability, and courage. By staying focused on our core strengths and maintaining open communication across all levels, we emerged from the pandemic not just stable but in a position to grow and invest in the businesses. CV19 reinforced that true financial health isn’t established during periods of stability, it’s revealed and tested by how you navigate the most challenging moments.
What’s a book, article, or podcast that has influenced or inspired you?
A book that shaped how we hold our organization accountable ‘Measure What Matters: How Google, Bono, and the Gates Foundation Rock the World with OKRs’.
A classic book that has influenced me early in my executive career is ‘Lean In: Women, Work, and the Will to Lead’.
My go-to podcast is ‘CFO Thought Leader’ because it shares real-world stories from finance leaders, offering valuable insights on resilience, strategic decision-making, and driving meaningful change within organizations. I love listening and learning from many amazing leaders, gaining fresh perspectives, and finding inspiration to enhance my own approach.
What challenges do you face in communicating the financial story to investors and leaders in your company?
Simplification without oversimplifying! One of the main challenges is translating complex financial data into clear, concise, and accessible narratives. Financial topics often involve intricate details—such as the underperformance of a project or deteriorating relationships with external partners—that require careful explanation. However, investors and leaders typically seek a high-level understanding rather than a deep dive into every detail. Striking the right balance between clarity and comprehensiveness is crucial and a daily challenge for CFOs. Another challenge is prioritizing key insights, by determining which elements are most critical to highlight. Investors and executives are primarily interested in the facts that impact the organization’s overall performance and long-term strategy. For example, when explaining why a project underperformed, it’s essential to not only share the contributing factors but also connect these to the broader financial impact and lessons learned. In other words: audience adaptation is key: tailoring the message to the audience’s role and perspective. Leaders focus on strategic decisions, while finance teams handle day-to-day operational details. Recognizing this distinction and adapting the narrative to ensure that messages are both impactful and aligned with the audience’s strategic priorities.
What advice can you offer to leaders on managing workforce challenges?
Listen actively: The first and most essential piece of advice is to truly listen to your employees. Make time to understand their concerns, ideas, and feedback. Active listening fosters trust, encourages open communication, and helps leaders stay connected to the pulse of their workforce. After, balance employee needs with organizational goals. A key challenge in leadership is finding the right balance between prioritizing the well-being of employees and achieving the company’s objectives. These two priorities can sometimes feel at odds, but they are not mutually exclusive. A great leader listens to and values their team while making decisions that align with both the team’s needs and the organization’s strategic goals, and they are also skilled at clearly communicating the bigger picture to their team, ensuring everyone is aligned and onboard. To achieve this, make sure to foster a shared vision. A leader must clearly communicate the company’s vision and how individual and team efforts contribute to achieving it. This alignment helps employees understand the bigger picture and the rationale behind decisions, especially when those decisions are difficult. A leader who can inspire their team while staying transparent about challenges is more likely to maintain morale and engagement.
What key financial metrics do you prioritize to gauge health of an organization?
The metrics I prioritize depend on the nature of the business, as every organization has unique key performance indicators (KPIs). However, there are three broad areas I consistently focus on:
- Liquidity and financial stability : The ability to quickly access funds, whether through cash reserves or credit lines, is essential for responding to unexpected challenges or seizing opportunities, but most importantly, I also evaluate relationships with financial partners: strong relationships with lenders and investors provide not only access to capital but also insights into how the organization’s financial health is perceived externally. Financial partners are often well-informed, and their perspectives can serve as a valuable indicator of overall stability.
- Employee retention and organizational culture: Employees are a company’s most valuable asset, and their retention is a strong indicator of internal health. High turnover rates can reflect deeper cultural or operational issues, while stable retention suggests a positive work environment. Employee satisfaction and engagement also serve as a barometer of organizational culture, which is directly tied to long-term success.
- Strategic vision and alignment: A company’s strategic vision and its execution are key to its long-term viability. To assess this, I look at:
- Clarity of Vision: Is there a well-defined strategic direction?
- Resource Allocation: Are resources being deployed effectively to achieve this vision?
- ashboards and Metrics: How well does leadership track progress toward strategic goals? Dashboards that monitor KPIs aligned with the vision are critical for ensuring accountability and adjusting courses when necessary.
What is a significant challenge you faced as a CFO and the lessons it taught you?
One significant challenge faced as a CFO was effectively sharing the enthusiasm of the management team with external financial partners—particularly when presenting a new project or expansion plan. While the benefits of such initiatives might seem obvious to those deeply involved, communicating this vision in a way that resonates with external stakeholders requires a different skill set. As CFOs, we are often more accustomed to analyzing and presenting data than crafting narratives. However, I learned that storytelling is just as crucial as the numbers themselves. It’s not enough to simply present financial projections; you must create a compelling narrative that explains the broader impact of the project on the organization—both financially and strategically. This experience taught me three key lessons: master the art of communication, focusing on tailored messaging and bridge passion with data! Enthusiasm alone isn’t enough; it needs to be backed by solid numbers.
What’s a book, article, or podcast that has recently influenced or inspired you?
