How to Go From £85 an Hour to £1,000 an Hour

Most of us know our monthly numbers. We know what came in last month, roughly what came in the month before, and we have a general sense of whether things are trending up or down. Fewer of us know what a single hour in the chair is actually worth once the overheads are stripped out.

Dr Pav Khaira worked his out. The average practice costs around £85 an hour just to keep the surgery running, whether or not there's a patient in the chair. That means an empty room isn't neutral. It's a cost you're paying whether you notice it or not. His own target is £1,000 an hour, and he won't get out of bed for less.

He gets there through four things he calls his levers: capability, efficiency, volume, and sedation. None of them mean longer days. Each one is a decision you're already making, just made with the hourly number in mind instead of the monthly one.

The Four Levers of Profitability Capability

The more advanced your skill, the more you can charge, and the less competition you face. That's the first lever, and it sounds obvious until you actually apply it. Pav has placed over 12,000 implants and completed more than a thousand full arches. His stated favourite, though, isn't the complex case. It's multiple single implants on the same patient. As Pav explains it, they're surgically less risky than a full arch, and the hourly rate reflects that too, per hour, nothing else comes close.

The reasoning is straightforward. If you can do something other dentists in your area can't, patients will travel to get it done. Distance stops being the deciding factor once skill becomes the differentiator. That's also the argument he makes for training in depth rather than dabbling: understanding the biomechanics behind a technique, not just the steps of it, is what lets you skip stages safely.

Efficiency

Time saved is money earned, but only if you're actually looking for the time to save. Two examples do a lot of the work here.

The first is follow-up appointments. If a patient needs stitches removed after a procedure, that's a booked slot, chair time, staff time, all for something that resorbable sutures can handle without the patient coming back in. The second is scanning. Rather than booking a separate appointment to scan for a restoration, some cases allow you to scan at the same time as placing the implant. That's chair time saved without cutting anything from the patient's care.

Efficiency also shows up in how appointments are protected. A structured follow-up call the day after surgery, run through a checklist with clear red flag criteria, means the practice can make an informed decision about whether a patient actually needs to come in, rather than defaulting to "better safe than sorry" for every case. Done properly, that's not corner-cutting. It's a documented, defensible process that respects both the patient's time and the practice's.

Volume

This is the lever most likely to raise an eyebrow, so it's worth explaining properly. The idea is simple: quote a fair, honest price for treating one implant, and offer a genuine saving when a patient has several done in the same sitting.

Here's how the numbers actually work. If a patient needs four implants and has them done individually, the fee might be £4,000 each. If they have all four done together, the price drops to £2,500 each. The patient sees a real reduction, £1,500 off per implant, and they're not wrong to feel like they've got a good deal, because they have. What changes for the practice is the hourly rate. The overhead for that hour doesn't move. The amount of treatment delivered in it does. That's how a genuine saving for the patient and a higher hourly rate for the practice sit in the same transaction without either side losing out.

The starting price matters here too. If a patient is told the discounted price first, and only finds out afterwards what they would have paid individually, the saving doesn't land the same way. Presenting the fair price first, then the saving for treating more at once, is what makes the value visible to the patient rather than assumed.

Sedation

Nervous patients will often pay for comfort, and sedation is where that shows up most clearly. A standard procedure like an impacted wisdom tooth extraction, something that might otherwise sit on an NHS waiting list for years, becomes a same-day option under sedation. Pav charges £2,000 for that extraction done this way. Patients who are anxious about treatment aren't being upsold. They're being offered a genuinely different experience, and for many of them, that's worth paying for.

The same principle extends beyond implant work. Once a practice is confident offering sedation, there's no reason to limit it to surgical cases. General dentistry, for patients who'd otherwise avoid the chair altogether, is fair game too.

Why the Hour Matters More Than the Month

None of these four levers require a longer day. What they require is knowing your own number before you try to move it. Pav's own story makes the case for why that matters. He ran a failing practice for nine years before it went under. He lost his house. He went through bankruptcy. When he rebuilt, the change wasn't in his clinical skill. It was in the question he asked about the business. Not "how much came in this month," but "what did this hour actually make me."

That's the shift underneath all four levers. Capability, efficiency, volume, and sedation aren't separate strategies. They're four different ways of answering the same question, once you've actually started asking it.

If you worked out your true hourly rate this week, what would you find?

Source: Dr Pav Khaira, Founder of The Academy of Implant Excellence.