What I Wish I Knew Before I Opened My Own Practice

PATHDOC / STOCK.ADOBE.COM

Whether you decide to build a practice from scratch or buy an existing office, there’s a lot that goes into opening a dental office. Although it is an exciting time in a dentist’s career, it also can be pretty stressful. Many critical decisions must be made, from practice location to the type of equipment to invest in to how to attract patients to your new practice.

It can seem a bit overwhelming but remember you’re not the first to go through this process. Many successful dentists once had the same concerns and challenges. Here, we talk to Drs Sarah Jebreil, Jennifer Sanders, John Flucke, Ankur Gupta, and Chad Duplantis about their journeys, what they wish they knew before they opened their practices, and what advice they have for dentists who are ready to take that leap and become practice owners.

Sarah Jebreil, DDS, AAACD

When Sarah Jebreil, DDS, AAACD, was ready to open her dental office, everybody told her to buy an existing practice rather than start from scratch. They warned her about the competitive landscape in Southern California and advised that the goodwill from an existing practice was the foundation she needed for success.

But Dr Jebreil wasn’t deterred. She had a clear vision of what she wanted her practice to be, and it was important for her to start with a clean slate. She wanted to choose the equipment and hire team members who understood and shared her philosophy of care. To her, building a new practice was the only option, so she began what became a yearlong process and opened her new office in 2015.

“I didn’t want to inherit somebody else’s way of doing things. I wanted to do things my way. I wanted my practice to reflect my personality,” she says. “Starting a practice from scratch is scary but it’s the greatest feeling in the world. You get to build what you want instead of buying someone else’s goodwill. You don’t know how much of that goodwill will stay with you.”

She was determined but also a little worried that it would take a long time to grow her practice. She didn’t want to overextend herself financially, so she opted to keep her practice relatively small. But her patient base expanded much faster than she expected, and she’s since outgrown the space. If she could go back, Dr Jebreil would have put a plan in place to allow for more growth; she realized she’s capable of more than she imagined.

Unexpected Challenges

One of the challenges Dr Jebreil encountered during the building process was obtaining the necessary city and county permits. She had issues with the number of practice parking spots, and she had to go to the city to petition for more. Had she known the issues she would face, she might have selected a different location for her boutique practice, she says. She at least would have been more prepared, making the process less stressful.

Selecting her equipment is another area she wishes she had known more about. Her sales representative talked her into investing in top-of-the-line products for her office because, he said, they last longer.

“In reality, with wear and tear all equipment ends up failing,” she says. “So pick and choose what’s important to you but don’t feel like everything has to be high end because at some point it’s going to break down.”

A lot also goes into the human resources side of a dental practice, and she spent a great deal of time dealing with documentation in the beginning. She has since invested in HR for Health, which streamlines the process and allows her to put her focus elsewhere. She recommends HR for Health to anyone starting out and wishes she would had something like it in those early days.

Her Advice

If you’re thinking of starting from scratch, look at the competition and determine a niche you can make for yourself, she says. Not everybody will be an ideal patient for your practice, so focus on attracting those who are. Get creative with your advertising and take advantage of free opportunities. She offered deals from Groupon, for example, to get more patients in the chair. She also enlisted her social circle to get the word out and asked happy patients to post reviews on Yelp.

And although advice from peers is valuable, take it with a grain of salt, she says. Don’t let it keep you from pursuing your dream dental career.

“After you work as an associate, you see how you want to do things,” says Dr Jebreil, who worked under the mentorship of her father right after she graduated. “It’s hard to go and buy somebody else’s practice when you know exactly what you want to do.”

Jennifer Sanders, DMD

Jennifer Sanders, DMD, knew the practice she decided to purchase in 2014 needed a little work, but there were a few surprises along the way she wishes she had been better prepared for.

The 900-square-f oot practice had 2 chairs, with just 1 dentist and an assistant seeing patients. The dentist was ready to retire and essentially was practicing part time, so things were pretty slow. But it seemed that there was a decent number of active patients, and production numbers weren’t too bad, considering how little he was working. The practice was also the only one in town, which was a big plus. She decided to take the leap and make the practice her own.

So what were the surprises? Turns out, only about one-third of the active patients were actually active, so she wasn’t nearly as busy as she expected. She also soon discovered that one of the delivery units didn’t work and the other was pretty broken down. Within the first few months of buying the practice, she replaced both chairs and added a third, an expense she wasn’t expecting. She also hired a hygienist, because she knew that would be important to growing her practice.

“It was a bit of an adventure,” she says. “But even if I had known all of that, I probably still would have bought the practice. I knew it was a fixer-upper, but it would have been less stressful to go into the situation with eyes open and to have a plan, to know what I needed to replace right away. I knew I wanted a hygienist and a third chair and a panoramic [x-ray] machine, but I didn’t understand the full scope of it.”

Learning On the Fly

The previous dentist handled everything, including payroll, tracking everything with a spreadsheet and taking deposits to the bank himself. After he left, no one in the practice knew how to do any of those things, so Dr Sanders had to figure it out as she went along. Things would have gone a little smoother had she known more about the business side of dentistry and what questions to ask before purchasing the practice.

The biggest challenge, she says, was learning how to run a business on the fly. The business side is much easier to handle today, even though she opened a new 4000-square-foot practice with 8 operatories and 2 associate dentists in 2020 in Frenchtown, Montana.

“I put a lot more time in running the business than I do now even though it’s bigger and busier,” she says. “It runs better because I have systems in place.”

She implemented those systems over time and trained her team members so they could run them with her oversight, freeing her up to focus on the dentistry and her role as practice CEO.

Her Advice

If you’re ready to open your own practice, it’s important to think about what you actually want, Dr Sanders says. She was OK with buying a practice she saw potential in even though it needed work, but other dentists might prefer to walk into a fully functional practice. You have to think about what kind of business owner you want to be and then find the practice that best suits you.

And know you don’t have to do it all on your own. Although there isn’t much focus on business in dental school, there are plenty of experienced dentists you can reach out to, whether you find a mentor near you or turn to an online forum for advice, Dr Sanders says.

She knows just how valuable it would have been to build a dental-focused team to guide her during the practice purchase, to have a financial planner and an accountant with experience in the industry. Yes, it would have been an extra expense, but it’s one that likely would have saved her money in the long run, not to mention reduce her stress.

It’s also important to realize you can still be successful even if you don’t own your practice, Sanders says. Not everyone wants to be a business owner, and that’s OK. Don’t make yourself miserable; determine the right path for you and then take it.

“Realize that if you’re going to buy a practice, you are an entrepreneur,” she says. “You’re not just a dentist. You’re not going to spend all your time seeing patients, you’re going to spend time being an entrepreneur. You must have that mindset shift and ask yourself if this is something you really want to do.”

John Flucke, DDS

Even though John Flucke, DDS,bought an existing practice, he basically had to build his patient base from scratch. The practice’s previous doctor, a retired military dentist, realized he hated private practice and walked away after only a year. The office was closed for a few months before Dr Flucke took over, and he didn’t have much to work with when he did. There was no existing recall, just a list of patients seen in the office who might want to come back, and only 1 treatment room.

It was a different situation, and Dr Flucke wishes he would have known more about practice marketing and business operations. Although he felt his clinical skills were good, he didn’t know much about how to manage a team or how to grow his patient base.

“It would have been nice to know things like real estate values,” Dr Fluckesays. “I didn’t know how to negotiate a lease. I basically took over the lease from the previous dentist, but it expired about 2 years after I became the owner. I didn’t even know what rent was going for in my area. That was overwhelming.”

The Right Team Makes a Difference

Approximately 15 years ago, Dr Flucke left that location to build a new practice in Lee’s Summit, Missouri. Unlike the horror stories you sometimes hear, the process was pretty seamless—and he attributes that to the team he assembled around him.

Dr Flucke knew a local architect who had designed medical and dental practices, so he reached out to him when he was ready to get started. Because he had done this type of job before, the architect already had a team that could handle different aspects of the project. They all worked well together, and that resulted in a low-stress office build-out. So although this can be a challenging, stressful process, working with the right team makes it a lot easier.

His Advice

Buying an existing practice and building one from scratch are expensive endeavors, and it’s OK if you’re not ready to jump in right after school, Dr Flucke says. There’s no shame in working as an associate for a few years and saving up so you can start your dream career. Determine how much you need to save and how long it will take, and then set a budget to ensure you get there. Avoid unnecessary splurges that will take you off track.

Once you’re ready to open your practice, don’t go overboard buying expensive new equipment, Dr Flucke says. A lot of dentists end up taking on more debt than they can handle because they think they need to buy their scanner, mill, cone beam and 3D printer at once. Instead, plan on buying 1 piece of technology to start and adding more as you grow.

Because they’re in so much debt and eager to start earning, many dentists concentrate too much on the money and selling dentistry once they start treating patients, he says. Patients can sense that, and it makes them more likely to question your treatment recommendations.

“If you focus on doing what’s right, you’ll make a terrific living,” Dr Flucke says. “If you focus on making a terrific living, you probably won’t.”

Once you do start making money, don’t spend it all. Think about putting some away for your retirement so you can have the lifestyle you want once you decide it’s time to step away from dentistry.

“It’s important but hard to realize that when you’re 30, when what you really want to do is celebrate yourself,” he says. “Celebrate a little but don’t spend everything you make.”

Ankur Gupta, DDS

When Ankur Gupta, DDS,and his wife Nisha opened their practice in Ohio in the early 2000s, the advice they received was pretty simple: Be nice, be good dentists and patients will flock to your office. That’s exactly what they did, taking continuing education (CE) to improve their skills and building rapports with patients. The problem was, after 5 years, they weren’t nearly as successful as they expected.

A Different Mindset

After reading a few business books, it became clear they needed to make some changes. The biggest? Stop behaving the way they thought a dentist should behave. Instead of accepting they were going to be in debt, they stopped buying expensive things just because the bank told them they could. With student loans, car and house payments, and credit card bills, they were paying a significant amount per month to take care of their debt, thinking it was normal and that the only way out was having more success as business owners. He wishes he had realized sooner that wasn’t the case at all.

“We realized we needed to change the way we lived a little and pay more every month to get out of debt,” Dr Gupta says. “And once we did that, we’d have more freedom to upgrade things in the practice and spend more money on marketing. So we began living a lifestyle that was still happy and fruitful and full of great memories, but much more intentional when it came to spending on luxury items that didn’t bring that much fulfillment.”

They also realized they needed to tap into the “incredible power of the internet” to start marketing their practice, something Dr Gupta wishes he had done sooner. Until that point they’d relied solely on word of mouth, and that wasn’t enough. Whenever the team did something remarkable or funny, they’d post a video to YouTube, their website, and Facebook. It didn’t cost anything, and it got people’s attention. The effort resulted in a reservoir of new patients who liked the practice’s fun, happy feel.

Many of these patients work at schools or day cares, creating another opportunity. The team began asking if they could come to the school to teach children about dentistry in a fun way. After every presentation, a few more families would call the office to make new patient appointments. They still do those presentations, expanding to community groups such as the Rotary Club and senior centers.

His Advice

It’s important for dentists to set a realistic budget for both their home and their practice, Dr Gupta says. Be realistic about the money that is going out and use that as a template to determine what your collections goal should be each month. And it’s not the more the better. That mindset puts you in a “state of financial desperation,” he says, making you likely to take on cases you should be referring out.

Dr Gupta also recommends getting several quotes from distributors rather than going with just 1 when designing and equipping your practice, taking care of your physical health as part of your daily routine, and resisting the urge to lecture to patients about their dental health issues.

“I’ve learned that the more compassionate I am, the more I put myself in their shoes when I make treatment recommendations, the more people actually say yes,” he says. “I take a photo of their teeth, put it on a TV screen, magnify it, look at the screen with them side by side, and ask them what they see. I let the patient talk about their situation and long-term goals.”

Chad Duplantis, DDS

After working as an associate for several years, Chad Duplantis, DDS,decided he wanted to be a practice owner. He hired a broker and began looking for the perfect office, but it took time, and he ended up going in a direction he hadn’t expected.

Nearly a year into his search, Dr Duplantis had looked at approximately 30 different practices and still hadn’t found the right fit. Then he met with a dentist who was looking for a partner. Rather than hiring an associate, this dentist wanted to bring someone in with a vested interest in the practice.

“We had a lot of compatibility in philosophy and vision. We both enjoyed working with other people but we also both valued the importance of ownership,” he says. “It was an unexpected surprise how well we meshed together.”

Twenty years later the partnership is still going strong at the Texas practice.

The Hardest Part of the Job

Although they have been successful, Dr Duplantis still wishes he knew more about the business side of running a practice when they first started. He’s a pretty good leader, he says, but “business is a different animal.” The dentistry and the scientific side become the easiest part of the job; the hardest is “maintaining the positivity and keeping your team motivated day in and day out,” he says. You have to plan ahead and have a keen business sense to be successful.

His Advice

Maintaining a partnership can be a challenge, but don’t let that discourage you from following that career path. The key to a successful partnership, he says, is finding someone with a similar vision and philosophy and establishing clear communication.

Before looking for a partner, it’s important to develop your personal vision and mission statement, he says. Think about where you want to be 5, 10, 20 years from now, and then find a practice that lines up with your goals.

Treat it like you’re buying a house: You have to find what best suits you. Buying into a practice is a huge commitment, so be patient. Don’t rush into something that isn’t the right fit.

“Don’t just look after hours. Ask if you can be a fly on the wall during business hours to see how the practice is run and make sure it lines up with what you’re trying to do,” he says. “Then make sure you create a work-life balance and that you don’t let the practice consume you. Keep up with CE from a clinical and business sense and make sure you keep striving to become better every single day.”