Dermatology Case Study
From Financial Leakage to a Stronger, More Profitable Practice
How Trent Wride helped a successful dermatopathologist recover revenue, reduce unnecessary spending, build an in-house laboratory, and create a stronger financial foundation.
Confidential. No cost. No obligation.
Advisor
Trent Wride
Senior Advisor, MTMG
32%
Increase in collections compared with the prior year
$88,000
Saved on a single equipment purchase
$2 Million
Invested in an in-house laboratory and supporting infrastructure
$1.2M to $22.8M
Reported growth in the practice owner's personal net worth over seven years
Results developed over several years and reflected a combination of improved collections, financial oversight, expense management, business investments, and additional revenue opportunities.
The Client
A Successful Dermatopathologist With a Weak Financial Foundation
Dr. Mike Peterson was a successful dermatopathologist with an established practice and strong clinical expertise.
From the outside, the practice appeared healthy. Patients were being treated, revenue was coming in, and the business continued to operate.
But beneath the surface, the financial foundation was broken.
Hundreds of thousands of dollars in outstanding balances were being written off. Work that could have been performed profitably inside the practice was being sent to outside laboratories. Vendor charges were leaving the bank account without meaningful oversight. Tax planning was treated as an administrative task rather than a financial strategy.
The practice was clinically successful, but it was losing money through unmanaged overhead, weak financial controls, and missed opportunities.
The Challenge
Profit Was Being Lost in Multiple Parts of the Practice
Collections Were Being Written Off
Large amounts of outstanding patient and insurance balances were being written off rather than actively pursued.
There was no structured process for determining what could still be collected, which accounts needed additional follow-up, or whether the existing collections process was working.
The losses had become accepted as a normal part of doing business.
Profitable Lab Work Was Being Outsourced
Although Dr. Peterson was a dermatopathologist, biopsy specimens were being sent to external laboratories for processing.
The practice was paying another organization to perform work Dr. Peterson was already qualified to complete.
This created a recurring expense while giving away a potentially valuable source of revenue.
Financial Oversight Was Reactive
Taxes were being prepared inexpensively through an informal family arrangement, but the practice lacked proactive tax planning and sophisticated financial guidance.
Important deductions and strategic opportunities were being missed.
At the same time, automatic vendor withdrawals were draining cash from the business without consistent review.
Spending Decisions Were Not Being Challenged
The practice lacked a disciplined process for reviewing proposed purchases, recurring expenses, and vendor relationships.
Financial decisions were often made reactively, without clearly evaluating the effect on the practice's bottom line.
The Strategy
Recover Revenue, Create New Income, and Professionalize the Business
Trent Wride focused on three priorities:
- Recover revenue the practice had already earned.
- Turn an existing expense into a new revenue stream.
- Build professional financial controls around the business.
“How does it affect the bottom line? That’s the only question that matters.”
Optimizing Collections
Recovering Revenue the Practice Had Already Earned
Trent brought in Boost, a professional collections company, for a six-month trial.
He was confident enough in the opportunity that he personally guaranteed the financial result. If the additional collections did not cover the company's fee plus 20%, Trent would pay the difference himself.
Instead of continuing to write off balances as uncollectible, the practice installed a more disciplined process for recovering revenue it had already earned.
Result:32% increase in collections compared with the previous year.
Vertical Integration
Turning an External Lab Expense Into an Internal Revenue Stream
Trent recognized that the practice was outsourcing biopsy processing even though Dr. Peterson had the credentials and expertise to perform the work himself.
He oversaw an approximately $2 million investment in equipment, infrastructure, and laboratory buildout to bring the work in-house.
The project required a significant upfront investment, but it fundamentally changed the economics of the practice.
External laboratory costs were eliminated, and a recurring expense became a high-margin internal revenue stream.
Rather than paying an outside laboratory, the practice captured more of the value created through its own clinical work.
Result:External lab costs were eliminated and replaced with a new internal revenue stream.
Financial Management
Building Professional Tax and Expense Oversight
Trent replaced the practice's informal tax arrangement with a professional CPA firm capable of providing proactive tax strategy.
The objective was not simply to file a return correctly. It was to help the practice and its owner make better decisions throughout the year, capture legitimate deductions, and structure finances more effectively.
Trent also reviewed recurring expenses, vendor contracts, automatic withdrawals, and proposed purchases.
In one instance, the practice was preparing to spend $125,000 on a new laser. Trent located the same model on the used market for approximately $37,000.
The practice received the equipment it needed without wasting an additional $88,000.
Result:Approximately $88,000 saved on a single equipment purchase.
Finding the Hidden Waste
The First Opportunity Was Already Inside the Practice
This process was part of what Trent calls financial scrubbing: reviewing where money is going, challenging unnecessary spending, and identifying expenses that have become invisible to the owner.
In many practices, Trent finds enough waste through this process to cover the cost of his engagement before any new revenue is generated.
Before creating new revenue, make sure the practice is not wasting the revenue it already has.
Implementation
Improving the Practice Without Alienating the Team
Operational and financial changes often create resistance, particularly when employees believe an outside advisor has been brought in to criticize their work or replace them.
Trent took a different approach.
He worked alongside the office manager and positioned her as a central part of the improvement process.
Instead of taking credit away from the internal team, he helped the office manager become the person responsible for implementing successful changes.
That approach turned a potentially resistant employee into a collaborative partner.
The practice gained stronger systems without damaging trust inside the organization.
The Outcome
Seven Years of Stronger Financial Decision-Making
Over the following seven years, Dr. Peterson’s reported personal net worth increased from approximately $1.2 million to $22.8 million.
That growth cannot be attributed to one change alone.
It reflected years of improved collections, disciplined expense management, stronger tax planning, successful investments, and the creation of additional revenue inside the practice.
The practice moved from reactive financial management to a structure built around visibility, accountability, and profitable decision-making.
- Increased collections by 32% compared with the previous year
- Eliminated external biopsy laboratory expenses
- Created a new in-house laboratory revenue stream
- Established more sophisticated tax planning and financial oversight
- Reduced unnecessary vendor spending
- Saved approximately $88,000 on one equipment purchase
- Increased the owner's reported personal net worth from approximately $1.2 million to $22.8 million over seven years
The Business Lesson
A Practice Does Not Need to Be Large to Contain Major Financial Opportunities
Even a solo practice with a small team can have substantial amounts of money buried inside uncollected balances, poorly managed expenses, inefficient workflows, and services that should be performed internally.
Trent approaches each practice like a mine.
The value is often already there.
The work is finding it, removing what is getting in the way, and building the systems required to capture it consistently.
For Dr. Peterson, the transformation did not come from working more hours or seeing more patients.
It came from running the business with the same level of discipline and expertise he brought to patient care.
The Advisor Behind the Work
Trent Wride
Senior Advisor, MTMG
Trent partners with physician owners on the business side of the practice, including operations, financial performance, team structure, expense management, and the growth decisions that shape the next five years.
He brings a builder’s mindset to multi-site groups and growing single-location practices, with a bias toward measurable outcomes, stronger financial discipline, and durable operating systems.
His work focuses on one central question:
How will this decision affect the owner’s bottom line?
How Much Profit Is Hidden Inside Your Practice?
MTMG helps physician-owned practices identify where profit is being lost, prioritize the highest-value opportunities, and implement the operational and financial changes needed to capture it.
The goal is not another report telling you what is wrong.
The goal is a more profitable, more organized, and more accountable practice.
Confidential. No cost. No obligation.
This case study reflects the reported experience of one practice and its owner over a seven-year period. Net-worth growth reflected multiple factors, including business performance, investments, tax planning, expense management, and personal financial decisions. Results vary based on practice size, specialty, payer mix, financial position, implementation speed, market conditions, team capacity, and owner involvement.