Most expansion decisions in this industry are made on a feeling. The practice feels slammed, the schedule feels full, the owner is tired of saying "our next opening is three weeks out," and so they add a room, finance a new device, or sign a lease on a second location. Sometimes that feeling is right. Often it's the most expensive feeling in the business — because the number that should actually drive the decision is utilization, and the practices that expand are frequently running it lower than the vibe suggests. Adding capacity to a practice that isn't using the capacity it already has doesn't multiply revenue. It multiplies overhead, and whatever problem was making the place feel busy comes right along with it.

What utilization actually measures