Operational Consistency

The Headline

+25 percentage-point growth gap

between the steadiest 10% of practices and the most chaotic 10%, over the last 12 months.

Steadiest 10% (YoY growth)

+8.9%

Daily production stays close to its weekday average.

Middle of the pack

~+5%

Average growth, average day-to-day swing.

Most volatile 10%

−16.8%

Packed Tuesdays, empty Fridays. Big swings = shrinkage.

What it means — in plain English

Two practices can produce the same amount of money in a year — but one does it steadily, day after day, and the other has wild swings.

The steady ones grow. The wild-swing ones shrink. Volatility itself is a warning sign — even when the total looks fine.

Key adjustment: every Monday has 3 doctors, every Tuesday might have 1. We compare Mondays to Mondays — not Monday to Tuesday.

Methodology — Robust DOW-Normalized CV

How we measure 'steadiness' net of staffing structure

1. Group

Take each practice's last 365 days of net production. Group by day-of-week (Mon, Tue, …, Fri).

2. Normalize

Divide every day by its own weekday average (Monday ÷ avgMonday). Centers each weekday at 1.0 — strips out staffing structure.

3. Trim

Drop the extreme 10% on each tail to neutralize outlier days (storms, holidays, comp days).

4. Measure

Coefficient of variation (std ÷ mean) of what remains. Lower = steadier.

5. Filter

Analyze organic general-practice only. Exclude specialty (perio, oral surgery) and DeNovo / acquired / partial-year (prior < 180 days OR |YoY| > 80%) — by rule, before analysis.

Evidence — Clean Organic GP, n=208

Decile gap + statistical signals

Tier	CV (lower=steadier)	YoY growth
Steadiest 10%	0.29	+8.9%
Middle 80%	~0.45	~+5.0%
Most volatile 10%	0.79	−16.8%

Gap between tiers: +25.7 pp

Statistical Signal

Pearson r

−0.299 (p<0.0001)

Spearman ρ

−0.224 (p≈0.001)

Bootstrap 95% CI

[−0.36, −0.08]

Size-controlled partial r

−0.298 (not a size artifact)

Variance explained (R²)

~5–9% of YoY growth

Adversarial review (Codex): direction confirmed; tail-gap magnitude exploratory pending holdout replication.