Every practice owner has had this moment. The profit and loss statement says the practice made money last month. Then you open the bank account and the number does not match. Not even close.
Neither number is lying. Profit answers whether the practice earned more than it spent. Your bank balance answers how much cash is sitting here right now. For an endodontic practice those move in opposite directions in the same month all the time.
Money earned but not collected: production booked as revenue arrives as cash weeks later. If accounts receivable grows while profit looks healthy, you are financing your patients and payers interest free.
Money spent that is not an expense: buy a $120,000 microscope and the bank drops it today, but the P&L spreads it across years of depreciation. Loan principal drains cash with no expense to show.
Owner draws and taxes: distributions and estimated tax payments do not appear on the P&L, but they come straight out of cash.
The fix is a monthly conversation between three numbers: what you earned, what you collected, and what you kept. Practices that review all three every month stop being surprised by their own bank account.