Let's Buy a Dental Practice

[The Hammer]

WOW!! I just noticed that this thread has now had over 80,000 visits!!

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[yosef3]

WOW!! I just noticed that this thread has now had over 80,000 visits!!

you should be splitting ad revenue with SDN!

 

[The Hammer]

Yes, that's precisely what I meant. Do you have regular, planned meetings with your staff to go through the books? I assume that each member of the staff understands his/her role and how it relates specifically to the numbers that are reviewed at each meeting?

The basic idea behind the book is empowering your staff to understand how they impact the numbers and turning business into a game that everyone plays to win (grow profits). At least that's what I took from it.

Yes this is exactly what I do. There was a dentist named Jim Pride who took me under his wing when I was right out of dental school and he probably influenced the way that I practice more than anyone else

http://www.prideinstitute.com/subpages/ourfounder/ourfounder.htm

He used to compare a dental practice to a football game. In football you have the yards marked on the field, a scoreboard, a referee to make sure the rules are obeyed and each player knows their role. Just like football players need to know what yard they are on and what the score is, your employees need to know the numbers and what they mean.

The more that your employees know about the numbers the more that they start to understand how their job affects the practice overall. The more empowered that they feel the better that they will do their job and the less supervision that they will require. This frees you up to be the dentist and cuts down on a lot of managerial hassle that you would have to deal with otherwise.

By the way this type of practice doesn't happen by accident and it doesn't happen over night either. It takes a lot of work on both your part and on your employees part. It also may take some hiring and firing until you find the right people for your practice.

 

[8 SNAKE]

The more that your employees know about the numbers the more that they start to understand how their job affects the practice overall. The more empowered that they feel the better that they will do their job and the less supervision that they will require. This frees you up to be the dentist and cuts down on a lot of managerial hassle that you would have to deal with otherwise.

Bingo! Remember this lesson, kids. Your employees are your customers, too.

You didn't mention this directly, but one more benefit of a practice like this is lower turnover. Employees who are actively engaged in their work and feel like a valuable part of the practice aren't sending out resumes. Your biggest problem will probably be the piles of resumes that show up at your front door, because word will get out and others will want to be a part of the team.

 

[SoulPower]

Bingo! Remember this lesson, kids. Your employees are your customers, too.

You didn't mention this directly, but one more benefit of a practice like this is lower turnover. Employees who are actively engaged in their work and feel like a valuable part of the practice aren't sending out resumes. Your biggest problem will probably be the piles of resumes that show up at your front door, because word will get out and others will want to be a part of the team.

Sounds like a great problem to have!

 

[The Hammer]

Sounds like a great problem to have!

Yes it is. I can teach anyone how to do any job in my office including mine but what I can't teach them is how to work. They either have a great work ethic or they don't and if they don't they don't last long with me.

 

[The Hammer]

Starting this week I should have some more interesting stuff to write about. Right now I am considering buying a 2,000 square foot office that a periodontist friend of mine is wanting to sell.

I'm once again talking to the banks about consolidating my loans and borrowing more money to move my practice. Let's see if the banks are a little easier to deal with now than they were a year ago at this time

 

[CleverThought]

Hey Hammer!

I've been faithfully following this thread taking notes (still in my undergrad, but it's never to early to plan)

I've been awaiting the post on hiring staff and finding a good OM. Is that upcoming in the near future?

 

[The Hammer]

Hey Hammer!

I've been faithfully following this thread taking notes (still in my undergrad, but it's never to early to plan)

I've been awaiting the post on hiring staff and finding a good OM. Is that upcoming in the near future?

Sure, I'll try to start writing about that in this week

 

[8 SNAKE]

Starting this week I should have some more interesting stuff to write about. Right now I am considering buying a 2,000 square foot office that a periodontist friend of mine is wanting to sell.

I'm once again talking to the banks about consolidating my loans and borrowing more money to move my practice. Let's see if the banks are a little easier to deal with now than they were a year ago at this time

If you get the chance, please describe both your current location and the potential new office. People can discuss the merits and drawbacks of each one and learn about evaluating a move like this.

 

[LetsGo2DSchool]

Let me share a story that many probably don't perceive when purchasing a practice.

I know a dentist in California who purchased an existing practice with 1200 patients. He thought he was in good shape as he would already bypass the 10 years needed to acquire that patient base.

However, most of these patients visited him once and never returned again. Today he has only 300 patients, is still trying to pay off the bank loan for his practice and is stuck with old chairs/equipment left behind by the former dentist. He attributes his loss of patients to his personality and inability to connect with them despite having great skills as a general dentist.

He's miserable and stuck in this hole and lives on a budget.

In retrospect, he would've been better off starting his own practice. He would probably still have a small number of patients and a bank loan, but at least his chairs/equipment would be relatively new.

 

[The Hammer]

If you get the chance, please describe both your current location and the potential new office. People can discuss the merits and drawbacks of each one and learn about evaluating a move like this.

The new practice that I am moving into is only about 50 feet away from the one I occupy now so other than gaining 1100 square feet more there isn't going to be that much of a transition. But you do have a great idea so I'll describe my last four offices and let's see what you guys come up with as pros and cons for each. Also rank them and let's discuss which ones would be your first choice and which one would be your last choice.

Practice 1 (1995-2004)

-Located in a strip mall with Wal-Mart and a big grocery store as anchors
-1500 square feet
-4 operatories for 2 dentists and 2 full time hygienists
-no windows or televisions in the operatories
-the space is rented and not owned
-no external signage
-nearest competitor (i.e. another dentist) about 1 mile

Practice 2 (2004-2009)

-located in a strip mall of 3 stores in the same complex as a Super Wal-Mart
- 3000 square feet
-6 operatories for 2 dentists and 2 full time hygienists
-all ops have a window that looks out onto a mountain and televisions
-space is rented and not owned
-large illuminated external sign that faces a very busy highway
-located about 1 mile from previous office on the same highway
-nearest competitor about 1 mile

Practice 3 (current location)

-located a block away from a large hospital
-located in a professional building with 5 other general dentists, an orthodontist and a periodontist. Shares the same parking lot with two other professional buildings with 2 oral surgery groups, a periodontist and 2 general dentists
-900 square feet
-3 ops for 1 full time dentist, 1 part time dentist and 1 full time hygienist
-ops have a small window and 40" plasma TV's
-space is rented and not owned
-no external signage
-about 15 miles from previous practice in a different county

Practice 4 (future location)

-located 1 block from a large hospital
-located in a professional building with 2 other general dentists and an oral surgery group. Shares the same parking lot with two other professional buildings with 1 oral surgery group, an orthodontist a periodontist and 5 general dentists
- 2000 square feet
-5 ops for 1 full time dentist, 1 part time dentist and 2 full time hygienists
-Ops have windows that look out onto well maintained landscaping and have 40" plasma TV's
- Shares the same parking lot with previous office
-will own the building
- medium size external signage

OK so let's see what sort of pros and cons everyone comes up with for these 4 practices. Feel free to ask any questions that you might have about these offices

 

[bjhath]

Hi Hammer,

I stumbled across this goldmine of a thread a few days ago and read it in its entirety over the course of a couple of days. There is a lot of great advice here and has given me a lot to think about.

I also think you have enough insight and perspective to put together a book that is both informative and enjoyable to read.

I am a third year at Pacific and plan to practice in the San Francisco Bay Area after graduation. Since this area is saturated with dentists, I think the best method of attracting new patients will be through internal marketing.

I have been shadowing two dentists over the past few years and don't think either has it quite right. Dr. A is great dentist from a technical standpoint, but neither him nor his hygienist have good bedside manner. I believe this practice is suffering more than most, in the current down economy, because of this poor patient-doctor relationship. Dr. B runs a very successful practice with a great, outgoing, friendly staff, and has a warm, inviting office. His internal marketing is successful, with him offering incentives/gifts to patients for referrals and he is very affable. However, he runs his patients through his chairs likes it’s a dental assembly line, and his treatment plans are, politely put, aggressive.

My current opinion is that putting the patient first and taking the time to establish real relationships/friendships, both in one's practice and community, is a great long term marketing strategy that will help maximize new patient referrals and treatment plan acceptance.

Could you please turn back to your marketing 'chapter' and provide some advice for internal marketing? I know you are a busy, busy man, but any input would be appreciated. Thanks.

 

[8 SNAKE]

Let me share a story that many probably don't perceive when purchasing a practice.

I know a dentist in California who purchased an existing practice with 1200 patients. He thought he was in good shape as he would already bypass the 10 years needed to acquire that patient base.

However, most of these patients visited him once and never returned again. Today he has only 300 patients, is still trying to pay off the bank loan for his practice and is stuck with old chairs/equipment left behind by the former dentist. He attributes his loss of patients to his personality and inability to connect with them despite having great skills as a general dentist.

He's miserable and stuck in this hole and lives on a budget.

In retrospect, he would've been better off starting his own practice. He would probably still have a small number of patients and a bank loan, but at least his chairs/equipment would be relatively new.

With all due respect, there isn't enough information in this post for people to form much of an opinion about the dentist or your conclusion. The dentist assumes that his personality is the problem, but there could be (probably are) a lot of issues in his practice. Unless he has horrible people skills, I have a difficult time believing that he ran off 3/4 of his patient base with his personality alone. How long has he owned the practice? What is the turnover in his office? How are competing practices doing?

 

[8 SNAKE]

Practice 1 (1995-2004)

-Located in a strip mall with Wal-Mart and a big grocery store as anchors
-1500 square feet
-4 operatories for 2 dentists and 2 full time hygienists
-no windows or televisions in the operatories
-the space is rented and not owned
-no external signage
-nearest competitor (i.e. another dentist) about 1 mile

I like the location of this practice a lot. Wal-Mart draws a ton of traffic in markets outside of urban areas (I don't believe that any of your practices have been in urban markets?). If you're in a rural or semi-rural area, you want your boat tied to the U.S.S. Wally. You're also the only dentist there, which is a nice plus. That could change at any time, though, so I don't give it a tremendous amount of weight.

I'd rather own than lease, so that is a drawback of this property. The other limiting factor is your space. It seems a bit cramped for two full-time dentists and hygienists. If the business can support it, I would either try to expand into an adjoining space when it becomes available or (better) build my own office in the same general area.

Practice 2 (2004-2009)

-located in a strip mall of 3 stores in the same complex as a Super Wal-Mart
- 3000 square feet
-6 operatories for 2 dentists and 2 full time hygienists
-all ops have a window that looks out onto a mountain and televisions
-space is rented and not owned
-large illuminated external sign that faces a very busy highway
-located about 1 mile from previous office on the same highway
-nearest competitor about 1 mile

Similar location as Practice 1, so I'm obviously a big fan of that. You have twice the space as Practice 1, along with better signage and offices. This location is my pick of the litter, with the same issue mentioned previously about not owning the office. If the practice is doing well, my plan would be to build as close to my existing location as possible and get rid of the only problem I see here (leasing).

Practice 3 (current location)

-located a block away from a large hospital
-located in a professional building with 5 other general dentists, an orthodontist and a periodontist. Shares the same parking lot with two other professional buildings with 2 oral surgery groups, a periodontist and 2 general dentists
-900 square feet
-3 ops for 1 full time dentist, 1 part time dentist and 1 full time hygienist
-ops have a small window and 40" plasma TV's
-space is rented and not owned
-no external signage
-about 15 miles from previous practice in a different county

This one is my least favorite. The space is quite cramped and I think you're missing out on money with only one hygienist. I'm not a fan of being in a building with five competing dental practices and don't feel that you gain much by having the specialists there. It's possible that you pick up a few patients because of that proximity, but what's to say they pick you over the five other options?

Practice 4 (future location)

-located 1 block from a large hospital
-located in a professional building with 2 other general dentists and an oral surgery group. Shares the same parking lot with two other professional buildings with 1 oral surgery group, an orthodontist a periodontist and 5 general dentists
- 2000 square feet
-5 ops for 1 full time dentist, 1 part time dentist and 2 full time hygienists
-Ops have windows that look out onto well maintained landscaping and have 40" plasma TV's
- Shares the same parking lot with previous office
-will own the building
- medium size external signage

Owning the building is the biggest carrot that I see here. You also have plenty of space to work and get that second hygienist to crank out revenue for the practice. You could probably also expand to a second full-time dentist in the future if you wanted to.

As with Practice 3, I'm not a fan of being one of several dentists in the same location. I don't want the perception that I'm lumped in with a big dental group and I'd much rather have a free-standing building of my own than a piece of something.

However, this isn't Burger King and I don't get it my way. Of the four practices, I would choose Practice 4 above the rest simply because of the property ownership. If we were making our selection based on all of the other factors, Practice 2 would get my vote, followed by 1, 4 and 3.

 

[caesarpredent]

Get married before dental school...

Why do you suggest this?

 

[caesarpredent]

I've been following your thread with much amusement. I wish I had been more informed about the reality of associateships coming out of dental school. We need more dentists like The Hammer to guide the new generations of dentists. Most of you don't know what you are in for...

It's sad to say this but most dentists-owners I have met were "lying sacks of s**t". Everyone looks after their own skin and nobody will think of your interests even if they suggest that they will mentor you or guide you. You will get the worst hours (usually evenings and weekends) and the lesser paying treatment plans. Upon hearing about my associateship experiences, a non-dental friend told me (tongue-in-cheek),"you are nothing more than a "high paid maid".

The fact that you are a professional does not mean others will respect you and treat you as a professional regardless of how well you perform and regardless of how nicely you treat others. If you are a female dentist associate (especially a younger one) , be ready to deal with a lot of jealousy with other female staff members .Sadly, jealousy with staff members is a very common problem that many female dentists (of any age group) have experienced. These staff members will try to find anything wrong with you or will make up lies about you and tell the owner. Forget about trying to form friendships with your staff - keep the boundaries very clear.

The ideal associateship is one in which the owner-dentist is thinking of retiring in the near future and there is a future buy-in possibility in sight. The owner will not mind that you get a good schedule and get the more comprehensive treatment plans. Starting from scratch means that you will have to carry a pager around 24/7 for emergencies to build up your practice and it will take you quite a while till you can earn a decent living and have a decent schedule. Some dentists I know that built their practice this way also had to work as associates in other offices to get some supplemental income. Starting from scratch is much riskier and as The Hammer mentioned, banks that lend business loans will think of them as higher risk too.

The Hammer is 100% right when he says that you won't get to the top working for someone else. You can take all the C.E in the world but you won't reach your full potential in an associateship position. This is especially true if the owner is a younger dentist and is just as ambitious as you are. I only know of one particular dentist (out of the many I have met) who works as an associate and travels for C.E courses all over the place with the owner. The owner is very supportive of her and encourages her to implement the things she learned in her courses. Count yourself as extremely lucky if you work for such an owner.

Do you think the female jealousy thing goes for a female owner of a practice or partner as well? I was wondering how that works with most of the staff being female as well.

 

[The Hammer]

I like the location of this practice a lot. Wal-Mart draws a ton of traffic in markets outside of urban areas (I don't believe that any of your practices have been in urban markets?). If you're in a rural or semi-rural area, you want your boat tied to the U.S.S. Wally. You're also the only dentist there, which is a nice plus. That could change at any time, though, so I don't give it a tremendous amount of weight.

I'd rather own than lease, so that is a drawback of this property. The other limiting factor is your space. It seems a bit cramped for two full-time dentists and hygienists. If the business can support it, I would either try to expand into an adjoining space when it becomes available or (better) build my own office in the same general area.




Similar location as Practice 1, so I'm obviously a big fan of that. You have twice the space as Practice 1, along with better signage and offices. This location is my pick of the litter, with the same issue mentioned previously about not owning the office. If the practice is doing well, my plan would be to build as close to my existing location as possible and get rid of the only problem I see here (leasing).




This one is my least favorite. The space is quite cramped and I think you're missing out on money with only one hygienist. I'm not a fan of being in a building with five competing dental practices and don't feel that you gain much by having the specialists there. It's possible that you pick up a few patients because of that proximity, but what's to say they pick you over the five other options?




Owning the building is the biggest carrot that I see here. You also have plenty of space to work and get that second hygienist to crank out revenue for the practice. You could probably also expand to a second full-time dentist in the future if you wanted to.

As with Practice 3, I'm not a fan of being one of several dentists in the same location. I don't want the perception that I'm lumped in with a big dental group and I'd much rather have a free-standing building of my own than a piece of something.

However, this isn't Burger King and I don't get it my way. Of the four practices, I would choose Practice 4 above the rest simply because of the property ownership. If we were making our selection based on all of the other factors, Practice 2 would get my vote, followed by 1, 4 and 3.

Great Post! Its great to see that you are really thinking through this stuff now rather than after you have bought a practice. I'll talk a little about each practice and what I liked and didn't like

Practice 1

This was the first practice that I bought in 1995. It was a very busy practice that had already outgrown its 1500sq ft before I bought it.

Pros:

1. As you pointed out in a rural setting Wal-Mart is the center of the universe and this office was in the busiest shopping center in the county.

2. I was the only dentist in the shopping center which was pretty cool as I tended to get all of the Wal-Mart employees

Cons:
1. The space was too small for 2 full time dentists and 2 full time hygienists. Each dentist really needs at least 2 ops to avoid a lot of down time while the op is being cleaned and set up for the next patient.

2. I HATED not having a window to let in sunshine. I felt like I was practicing in a cave

3. Owning is always preferable but in this case I'm glad I didn't. The Wal-Mart moved down the road (as they tend to do every few years) and the once busy shopping center became a ghost town. If I had owned my space I might still be stuck there.

OK next post I'll talk about Practice 2

 

[Cold Front]

Great Post! Its great to see that you are really thinking through this stuff now rather than after you have bought a practice. I'll talk a little about each practice and what I liked and didn't like

Practice 1

This was the first practice that I bought in 1995. It was a very busy practice that had already outgrown its 1500sq ft before I bought it.

Pros:

1. As you pointed out in a rural setting Wal-Mart is the center of the universe and this office was in the busiest shopping center in the county.

2. I was the only dentist in the shopping center which was pretty cool as I tended to get all of the Wal-Mart employees

Cons:
1. The space was too small for 2 full time dentists and 2 full time hygienists. Each dentist really needs at least 2 ops to avoid a lot of down time while the op is being cleaned and set up for the next patient.

2. I HATED not having a window to let in sunshine. I felt like I was practicing in a cave

3. Owning is always preferable but in this case I'm glad I didn't. The Wal-Mart moved down the road (as they tend to do every few years) and the once busy shopping center became a ghost town. If I had owned my space I might still be stuck there.

OK next post I'll talk about Practice 2

Check your PM doc.

 

[The Hammer]

Check your PM doc.

Checked and answered!

 

[The Hammer]

OK let me finish about my old and current locations. I have finally had a book arrive that I wanted to use when I posted about hiring and firing so hopefully I'll be able to return to that question. So about locations

Practice 1: Too small and when the Wal-Mart anchor moved down the street I was in a ghost town.

Practice 2: Pros:
1.The location was awesome, I was right in front of the new Super Wal-Mart and my sign was seen by 26,000 people daily.

2. All of my operatories faced the mountain, I had cable TV in the ops and all of the equipment was behind the patient in cabinets so that when they looked into the room all they saw was a chair, the mountain and the TV

3. I had plenty of space and everything was new

Cons:
1. I spent WAY too much money on the build out. Since I had never done this before I didn't shop around as much as I should have.

2. Even though I had plenty of space for everything else I felt my ops were too small. I wanted them all to face the mountain so I put 6 ops in 60 ft. It was OK but I definitely felt cramped. I also vastly underestimated the space that I would need for charts.

3. I made the decision to share the practice and take on a partner. This was the worst decision that I ever made. A partnership is like a marriage except you see your business partner more, you don't get to have sex with them and all you talk about is money. It is rare to find a good partner who shares the same vision for the practice with you. Most of the time it is like a bad marriage that will end in divorce and that is exactly what mine turned out to be.

4. I rented instead of owning

Practice 3

Pros
1.I bought it for $239,000
2. The doctor that I bought it from is a great guy and I enjoy having him as my associate
3. I was close enough to my old practice that I had some patients return to me. I was also able to hire some of my old staff back too.

Cons:
1. Everything basically. Not enough space with no hope of expanding, the equipment and furnishings are old. It was a good practice to buy and get up and running but I knew when I bought it that a move was in my future

2. I rent by the month rather than own

3. In a medical complex with several other dentists

Practice 4
Pros:
1.This is a space that was occupied by a friend of mine who is a periodontist, so it is already set up for a dentist and he is going to leave some of the equipment (like the compressor and vacuum).

2. The new office is about 50 ft from my current location

3. I will be owning this practice

Cons
1. Still in a medical complex with a boat load of dentists

Now one question that I think I answered at the beginning of this thread is when to rent and when to own. Owning is always preferable to renting except in certain situations:

1. It is better to rent if you are located in retail space: The reason it is better to rent is that if your main store anchor decides to move like the Wal-Mart did on my first practice then you need to be able to move as well. But if you are in a large retail area where stores move in and out regularly then owning would be the best. You just don't want to be in an area that is busy one day and a ghost town the next.

2. It is better to rent if you are buying a practice that you intend to move in the next 5 years. You don't want to own the place if you plan on vacating in just a couple of years. But if you have a renter waiting in the wings then owning it would be a great idea. Being a landlord has many tax advantages to it and is a great secondary stream of income.

For me renting has always just worked out. My first practice was in a ghost town when the Wal-Mart moved. Since I was a renter I just up and moved when my lease was up.

My second practice was located in the new Super Wal-Mart shopping plaza so I was renting there because it is about to move across town to a better location. If I still owned that practice I would be looking to move too.

My new location is too small so when I bought it I knew that I would be moving in less than 2 years so I did not buy it. My next practice is in a stable area so I will finally buy a dental office.

One last thought, I have been asked which of my locations was the best, the retail area or the professional space. Here are the pros and cons of each

Retail Pros
1. Tons of exposure, make the best use of signage here
2. Usually not much competition in the same shopping area

Cons
1. The chance that the hot shopping spot may up and move at any moment leaving you high and dry
2. Usually pay a hirer rent and Common Area Maintenance

Professional space Pros
1. It is rare for a hospital to move so not as much of a chance of being left high and dry
2. Other professionals means more referrals to you

Cons
1. More competition literally next door
2. Much less exposure

For me since I am 18 years into practice I have already made a name for myself so being next to other dentists is not as big of a deal as it would have been when I was first starting out. Right now I am receiving a ton of referrals for implant restoration because I am located right between two large Oral Surgery practices. The building that I am buying is perfect and the price is most definitely right.

If I were starting right out of dental school or if I had moved to an area where I had not practiced before I would definitely look at locating back into a retail spot. The amount of exposure is unreal and just putting a well lit sign with your phone number on it will generate a ton of new patients.

 

[UBCStudent128]

My draw was usually based on what my living expenses were. For example if my mortgage, my utilities and other assorted bills all amounted to $4000 a month then I would usually make my draw $6000-7000. The rest of the money went into maxing out my retirement, reinvesting in the practice etc. As for tricks or tips just hire a very good business savvy accountant who helps you take advantage of the ever changing tax laws.

Yep. All salaries including your draw are included in your overhead.

Wow, that is a tricky question because it depends on so many things so I will give you my WAG ( wild a s s guess)

An average general practice dentist in their own practice say 2-5 years out still paying off school/practice debt will probably be making anywhere from $150,000 to $190,000 pre-tax.

Once you have paid off that debt and have been out for 6 or more years you can make as much as you are willing to work for. I would say on average that could be anywhere from $176,000- $250,000 or much more if you hustle.

Sorry for bringing up an old post but I was really curious, with your "wild a s s guess", are you including the extra 60k draw ?

If not, the 150k~190k guesstimate for private-practice dentists are actually income after your draws?

 

[The Hammer]

Sorry for bringing up an old post but I was really curious, with your "wild a s s guess", are you including the extra 60k draw ?

If not, the 150k~190k guesstimate for private-practice dentists are actually income after your draws?

Pre-tax most dentists that I know make anywhere from $125,000-250,000 or more. The most that I made pre-tax in one year was $402,090 but I was a sole owner with a full time associate dentist, two full time hygienists and my office was open 5 days a week from 8-5. I also had paid off the original practice loan and I had been in practice at the same location for 10 years. However I personally only worked about 176 days that year. I got over 100 hours of CE that year and took a couple of mini-vacations.

I'm not trying to say that I'm Dr. Super Dentist because honestly if I did it then anyone can do it if you plan smart and work hard at it.

It also helps if you have a good personality and aren't a total tool shed

 

[The Hammer]

So when I'm not drilling, filling, billing and chilling and making the tooth dust fly I like to play bass. Here is a photo of my band playing this past fourth of July (hence the flag shirt I'm wearing)

I've played bass since High School and had a band all through dental school and I've been in one band or another since I graduated. You can't do dentistry all the time, you have to have something that you like to do that is non-dental related to recharge your batteries.

 

[bababooya]

Pre-tax most dentists that I know make anywhere from $125,000-250,000 or more. The most that I made pre-tax in one year was $402,090 but I was a sole owner with a full time associate dentist, two full time hygienists and my office was open 5 days a week from 8-5. I also had paid off the original practice loan and I had been in practice at the same location for 10 years. However I personally only worked about 176 days that year. I got over 100 hours of CE that year and took a couple of mini-vacations.

I'm not trying to say that I'm Dr. Super Dentist because honestly if I did it then anyone can do it if you plan smart and work hard at it.

It also helps if you have a good personality and aren't a total tool shed

Is that number after paying all the overhead (associate dentist, hygenists' salaries. etc)?

 

[UBCStudent128]

Pre-tax most dentists that I know make anywhere from $125,000-250,000 or more. The most that I made pre-tax in one year was $402,090 but I was a sole owner with a full time associate dentist, two full time hygienists and my office was open 5 days a week from 8-5. I also had paid off the original practice loan and I had been in practice at the same location for 10 years. However I personally only worked about 176 days that year. I got over 100 hours of CE that year and took a couple of mini-vacations.

I'm not trying to say that I'm Dr. Super Dentist because honestly if I did it then anyone can do it if you plan smart and work hard at it.

It also helps if you have a good personality and aren't a total tool shed

Those pre-tax numbers are numbers with 65% overhead paid off, which includes your own draws of around 5000/month right?
Then technically you are making 60 000 in addition to that pre-tax 125 000 ~ 250 000?
That seems to be way more than I expected...

 

[The Hammer]

Is that number after paying all the overhead (associate dentist, hygenists' salaries. etc)?

Yes, this was what was left after all of the expenses associated with a dental practice including owner draw were taken out.

 

[DrDientes]

So when I'm not drilling, filling, billing and chilling and making the tooth dust fly I like to play bass. Here is a photo of my band playing this past fourth of July (hence the flag shirt I'm wearing)

I've played bass since High School and had a band all through dental school and I've been in one band or another since I graduated. You can't do dentistry all the time, you have to have something that you like to do that is non-dental related to recharge your batteries.

Wish it were as easy for me to keep playing through dental school as it is for you. I play drums, so living in a city like SF its not really feasible to play in your room to take a break, I definitely miss playing with other instruments though...

 

[7 Iron]

Yes, this was what was left after all of the expenses associated with a dental practice including owner draw were taken out.

Owner draw is part of overhead? Then what happens to the remaining money? It just stays in the practice account?

 

[The Hammer]

Owner draw is part of overhead? Then what happens to the remaining money? It just stays in the practice account?

The IRS pretty much makes you draw a salary which is your owner draw. What you decided to do with what is left over after all of your expenses are paid is something that you and your accountant decide on. Assuming that you aren't using it to repay loans a large part of it should go into your retirement and other investments (and maybe some toys too )

 

[The Hammer]

Wish it were as easy for me to keep playing through dental school as it is for you. I play drums, so living in a city like SF its not really feasible to play in your room to take a break, I definitely miss playing with other instruments though...

I went to dental school in Memphis so cost of living there is nothing compared to what you have to pay in Marin county. I was in Dental school from 1989 to 1993. My two roommates and I rented a 2500 sq ft house for $550 a month.. We turned the breakfast "nook" into our dental lab with handpieces and an air compressor. One of my roomies was one of the guitar players in my dental school band. We turned the large dining room into our practice space, we had our monitors, amps and drums permanently set up in the dining room so that we could jam at the drop of a hat and we played whenever we could.

Playing with my friends was a great stress reliever for all of us (we were all in the same dental school class). You really have to find a good outlet for the stress in dental school so that you don't obsess over it 24/7 which is very easy to do. Its funny but some of the best times I've had in my life were during some of my worst periods of stress in dental school. The depth of crap that we were in made us appreciate the good times even more.

 

[The Hammer]

Ok I'd like to go back over the hiring process that I use. If anyone has anything that they'd like to add (or something that I have left out) please please post it. I am always eager to hear other people's experiences and ideas on this subject. I'll also talk about what I look for when I am looking for a good Office Manager as well.

I am going to try to be as thorough as possible so please don't get offended if I list something that is common sense. As dental students I know that you all are the best and brightest of the best and brightest but I have to include everything so I don't forget any detail (and I probably will anyway). So let's have a stab at this shall we?

This is the process that I use to hire all the positions at my office. I cross train all of my positions so that an assistant can work at the front desk and a front desk person can assist if push comes to shove.

THIS IS IMPORTANT: For me dental office experience is nice but not necessary as I can train anyone to do any job at my office including my own. What I cannot train them is how to work and be professional. Either they have a great work ethic before I hire them or they don't. If they know how to work hard it doesn't matter if they currently work cleaning toilets I can train them to be a great assistant. Even if they are currently an office manager at another dental office, if they are constantly AWOL or the type of employee who causes dissension amongst the staff then they have no business working for me.

The only exception to this is when I hire a hygienist as I expect them to have already graduated from an accredited hygiene program.

So let's get started:

The first thing I do is place a want ad online (craigslist, monster, the local ADA component) and I still usually place one in the local papers. The ads usually read something like this:

Very busy Roane County (this was my previous location) dental office seeks motivated hard worker for (assistant, receptionist etc). Previous dental experience desired but not necessary. Mon-Fri no weekends or holidays ever. Deadline for resume' submission is (I tend to give about 2-3 weeks) Please send resume' to ........

I will set up a non-specific email for the resumes' (I don't use my name or my office name in the email address) and I will also set up a mailbox at the newspaper office or post office for the snail mailed resumes'. I NEVER have them sent to my office. I don't want people to "just drop by" or to otherwise tie up my front desk inquiring about the progress of the hiring. I also don't want current patients or people I know in the community getting pissed off at me because I don't immediately hire them for the job. At this point I like to keep some anonymity.


It is very important to give a deadline for accepting resumes' or you will be getting them until Armageddon. I like to go about 2-3 weeks which in the past has been plenty of time. When I have just used newspaper want ads the most resumes' I have received within the 3 week deadling was 613, the least was 321. Apparently a lot of people want to work in a dental office.

What I look for in a resume.

1. High School graduate (duh)

2. Local to the office (for me this was a driving distance of no more than 20 miles)

3. Long periods of continuous employment with no long gaps of unemployment (double duh)

4. A job that involved dealing with the public and handling money

5. The more responsibility they had (i.e. did they have anyone working under them) the better

6. Any experience in a medical setting ( I need to know if they are going to faint at the sight of blood). This is important whether they are the OM or an assistant. Believe it or not this has been a problem a few times in the past.

7. Their current place of employment. Are they currently dealing with the public, handling money, supervising other workers etc?

8. I look at how well written and complied the resume' is. Any misspelling, grammatical errors or coffee stains are an automatic fail. This day and age with computers and automatic spell check there is no excuse for this anymore. Handwritten or on spiral notebook paper is a fail (I have had more than a few come in on spiral notebook paper, written with a pencil)

I then sort the resumes' into 4 stacks:

"A" Stack: Well written and composed. Great employment record and some previous (or current) medical experience

"B" Stack: Same as above but with no medical experience.

"C" Stack: Overall a good resume' but with questions (like a gap in employment)

"D" File: "D" as in Delete or shred.

Once I have my remaining 3 stacks complied I have a staff meeting and let the staff go over them to see if they pick up anything that I may have missed. Any resume' that the staff red flags get sent to the "D" File. Any positive information that they come up with can move a "C" to the "A" stack.

Once I have finalized my stacks of resumes' I start making my "Initial Contact Calls." These are the calls where I decide who goes from the initial phase of the hiring circus to the second round and where all of the "A-C" stacks become one.

My next post I will talk about what information I have BEFORE I make the calls and what questions I will ask during the calls.

 

[Oracle DMD]

So when I'm not drilling, filling, billing and chilling and making the tooth dust fly I like to play bass. Here is a photo of my band playing this past fourth of July (hence the flag shirt I'm wearing)

I've played bass since High School and had a band all through dental school and I've been in one band or another since I graduated. You can't do dentistry all the time, you have to have something that you like to do that is non-dental related to recharge your batteries.

where can I find one of those American flag shirts??!! It says "I'm a patriot...but I'm here to party." Love it.

 

[Oracle DMD]

Wouldn't it be kinda wrong to let the current staff go through the resumes of the applicants on account that they will be peers if in fact they're hired at some point? Maybe not wrong, but problematic is probably a good word.

 

[SoulPower]

Wouldn't it be kinda wrong to let the current staff go through the resumes of the applicants on account that they will be peers if in fact they're hired at some point? Maybe not wrong, but problematic is probably a good word.

It might not be that big of a deal, since the time between them looking over information and actually working alongside the person could be a couple of weeks, I'd guess. Or even the people highlighting info are just "scavenging" not really learning the info.

 

[8 SNAKE]

Wouldn't it be kinda wrong to let the current staff go through the resumes of the applicants on account that they will be peers if in fact they're hired at some point? Maybe not wrong, but problematic is probably a good word.

What problems do you see? I'm not criticizing your point, but I don't see issues so I wonder what I might be missing? Most resumes (that I've gone through) don't list salary history, SSN or other sensitive data, so that shouldn't be a concern. The resumes could also be edited to omit the applicants' names and addresses to ensure a more unbiased view if that is a potential issue.

I'm jumping the gun on Hammer's conversation a bit, but many offices involve the staff in the hiring process because fit is such a crucial component in a practice. Even after new associates are hired, it's often for a probationary period so that both sides can determine if it's a good fit. During that time, the existing staff is likely to learn everything that was on the new hire's resume even if they don't see it with their own eyes.

 

[justwant]

Hammer and Oracle,

what do you guys think of brighter.com. This site is really scary and it seems like a very very bad thing for dentists. Will dentists be forced to lower their prices? What is the effect of it on dentistry?

Thanks.

 

[The Hammer]

Wouldn't it be kinda wrong to let the current staff go through the resumes of the applicants on account that they will be peers if in fact they're hired at some point? Maybe not wrong, but problematic is probably a good word.

Not really. The resumes' are just basically work histories and sometimes a list of references. I omit any salary data so there's really not that much to it.

 

[8 SNAKE]

Hammer, do you ever poach employees that catch your attention? As an example, lets say you notice a cashier at your local Wal-Mart who does an exceptional job with customers and has a fantastic attitude. You notice her and make it a point to see her work a few times to make sure the behavior is consistent. Once you see that it is, you approach her about becoming a dental assistant because she'd be an excellent fit for that job and it would seemingly be a move up for her as well.

In my opinion, this can be an ideal way to add talent to your staff. You have to be careful (especially in smaller towns) not to get a reputation as a poacher, though.

 

[Oracle DMD]

What problems do you see? I'm not criticizing your point, but I don't see issues so I wonder what I might be missing? Most resumes (that I've gone through) don't list salary history, SSN or other sensitive data, so that shouldn't be a concern. The resumes could also be edited to omit the applicants' names and addresses to ensure a more unbiased view if that is a potential issue.

I'm jumping the gun on Hammer's conversation a bit, but many offices involve the staff in the hiring process because fit is such a crucial component in a practice. Even after new associates are hired, it's often for a probationary period so that both sides can determine if it's a good fit. During that time, the existing staff is likely to learn everything that was on the new hire's resume even if they don't see it with their own eyes.

well, even if you omit the more sensitive info, what if you have a motivated employee that calls the previous workplace to get some dirt, or if they know the previous employer for some reason and calls to tell the employer that their employee is leaving. IMHO, hiring and firing should be left to the docs and maybe the office manager...maybe. Hiring is not a group decision. If you are looking to you staff for their opinions, maybe after a working interview or something would be better.

 

[Oracle DMD]

Hammer and Oracle,

what do you guys think of brighter.com. This site is really scary and it seems like a very very bad thing for dentists. Will dentists be forced to lower their prices? What is the effect of it on dentistry?

Thanks.

dentists control what insurances they take. if they are desperate, they'll take it but it doesn't look sustainable. i don't know the details of their compensation for the dentists, but it doesn't look good.

 

[The Hammer]

Hammer, do you ever poach employees that catch your attention? As an example, lets say you notice a cashier at your local Wal-Mart who does an exceptional job with customers and has a fantastic attitude. You notice her and make it a point to see her work a few times to make sure the behavior is consistent. Once you see that it is, you approach her about becoming a dental assistant because she'd be an excellent fit for that job and it would seemingly be a move up for her as well.

In my opinion, this can be an ideal way to add talent to your staff. You have to be careful (especially in smaller towns) not to get a reputation as a poacher, though.

Once again snake you impress me with your wisdom beyond your years


Yeah, its a great idea and I do it all the time. Two of my best employees were single moms working as cashiers. I hired them and trained them. They both started at the front desk as receptionists, then I sent them to assisting school at night (they worked during the day) and they became assistants. They both applied and got accepted to the local hygiene program and worked for me part time while they were in school and eventually became hygienists. Like I said before I can teach anyone any job at my office including my own but I can't teach them how to work. I can just give them the opportunity and the incentive to do the best job that they know how.

 

[The Hammer]

where can I find one of those American flag shirts??!! It says "I'm a patriot...but I'm here to party." Love it.

Big J if you really want one just pm me your size and address and I'll go and get it for you. I bought it at a Country/Western Clothing store. It's a "Mo Betta" shirt. Garth Brooks wore Mo Bettas in his videos and made Mo Betta's really popular in the 90's.

 

[8 SNAKE]

well, even if you omit the more sensitive info, what if you have a motivated employee that calls the previous workplace to get some dirt, or if they know the previous employer for some reason and calls to tell the employer that their employee is leaving. IMHO, hiring and firing should be left to the docs and maybe the office manager...maybe. Hiring is not a group decision. If you are looking to you staff for their opinions, maybe after a working interview or something would be better.

Under no circumstances should the staff make reference calls about potential employees unless that is his or her specific responsibility. I also wouldn't expect a staff member to dish dirt on a prospective candidate to that person's employer. It could happen, but the odds are very low if you have built a quality team that you know and trust. Such behavior would be swiftly dealt with and there would not be an opportunity for a repeat offense.

In my opinion, hiring in a dental practice is very much a team decision. With that said, the doc is the head of that team and makes the final call. Everyone has to know who gets the ultimate say, but it would be a massive mistake not to include the team in personnel decisions.

 

[The Hammer]

well, even if you omit the more sensitive info, what if you have a motivated employee that calls the previous workplace to get some dirt, or if they know the previous employer for some reason and calls to tell the employer that their employee is leaving. IMHO, hiring and firing should be left to the docs and maybe the office manager...maybe. Hiring is not a group decision. If you are looking to you staff for their opinions, maybe after a working interview or something would be better.

You bring up some good points Big J as usual but I think that once I have gone over my entire process you'll understand why I let the employees in on the hiring process. By the time I let the employees look at resumes' I have done my own face to face interview, talked with previous employers and personal references, done a back ground check and have it narrowed down to 2 or 3 applicants.

On the day that I bring the last applicants in to meet the staff we end work early and I have food brought in and we do an "eating" interview with the final applicants. I give the staff a "personal file" which is a truncated version of the applicants resume' plus a summary of what I have learned in my own interview with the applicant, their references and personal contacts.I DO NOT SHARE the salary, benefits or back ground check information.

The final decision to hire is mine but I want an idea of how well the personalities of the current staff will mesh with the new hire and I want to see if they pick up on anything that I may have overlooked. I could get the same results in a working interview but since I sometimes hire people who have no dental experience a working interview isn't always practical.

Also by letting the staff in on the hiring process they become "invested" and feel a responsibility towards the new hire that they otherwise wouldn't if I had just hired them by myself. Since the staff feels like they had a say in who I hired they are more likely to make an effort to help the new hire adjust and assimilate into the practice. Eventually you have a staff that all have ties to one another and are invested in their success or failure rather than just a group of people hired to do a job.

But I am getting ahead of myself. I'll be able to explain a little better as we go along, but great questions nonetheless

 

[8 SNAKE]

Once again snake you impress me with your wisdom beyond your years

You know what they say, Hammer. A smart man learns from his mistakes; a wise man learns from the mistakes of others.

I learned a long time ago that life is much easier when you pay attention.

 

[flabernak]

Once I have my remaining 3 stacks complied I have a staff meeting and let the staff go over them to see if they pick up anything that I may have missed. Any resume' that the staff red flags get sent to the "D" File. Any positive information that they come up with can move a "C" to the "A" stack.

You bring up some good points Big J as usual but I think that once I have gone over my entire process you'll understand why I let the employees in on the hiring process. By the time I let the employees look at resumes' I have done my own face to face interview, talked with previous employers and personal references, done a back ground check and have it narrowed down to 2 or 3 applicants.

On the day that I bring the last applicants in to meet the staff we end work early and I have food brought in and we do an "eating" interview with the final applicants. I give the staff a "personal file" which is a truncated version of the applicants resume' plus a summary of what I have learned in my own interview with the applicant, their references and personal contacts.I DO NOT SHARE the salary, benefits or back ground check information.

Many thanks for a very informative thread. Just trying to clear up some confusion, it looks like you have two different statements about when you share candidate info with your staff. Perhaps you can go into more specifics when you post more about the process.

Also I have another question regarding the eating interview. Do you bring the final applicants in on different days? Or all on the same day and put them into some type of group interview?

Thanks!

 

[The Hammer]

Many thanks for a very informative thread. Just trying to clear up some confusion, it looks like you have two different statements about when you share candidate info with your staff. Perhaps you can go into more specifics when you post more about the process.

Also I have another question regarding the eating interview. Do you bring the final applicants in on different days? Or all on the same day and put them into some type of group interview?

Thanks!

I bring all the candidates in on the same day. I'll explain more in my next post.

 

[The Hammer]

Ok once I have complied my final stack of resumes' I start my initial calls. Here are the things that I ask.

1. What does their current job entail
2. Why do they want to leave
3. Why do they want to work in a dental office
4. Would they be willing to go to assisting school
5. What are their salary requirements

I also ask about any questions that I might have about their job history. If they sound OK on the phone I mail them an "Application for Employment" and move on to the next step

 

[doctorsmile4]

Hi Hammer,

You wont believe 2 months back I stayed up all night and read this entire thread in one go. Its been very inspiring to see your journey and the business acumen you have.
I am a foreign trained dentist and I am currently preparing for NBDE 1. I have the exam in Novemeber.
I am very enthusiastic about owing my own pvt practice some day down the line and its great that I could come across your valuable tips.

Thanks
Smiley..