Let's Buy a Dental Practice

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The Hammer

The Hammer

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OK who wants to hear about buying a dental practice in the real world? Well join me as I venture into the world of debt, a retiring owner/dentist, practice brokers, issues with the remaining staff, retaining patients, talking with the bank for a loan, pouring over financials, demographic surveys, production predictions, future overhead calculations, interior design, logo design, practice rebranding, advertising, patient recruitment, staff recruitment, debt management and having a hostile ex-wife who still lives in the area. Plus I will try to address issues that are unique to recent grads looking to go into practice and to answer any questions that you might have. Also I am going to use real numbers but I will change just enough information so that I don't violate any confidentiality agreements that I have already signed. So lets get started
 
Topic 1: "I just graduated with debt, what am I going to do?"

OK so you are about to graduate as a dentist and there are basically six paths that you can take:

1. AEGD or GPR
2. Go into a speciality
3. Go into a practice owned by a family member
4. Become an associate
5. Buy a pre-existing practice
6. Open your own practice

Since I am mostly going to cover in depth the last two options, let me comment on the first 4.

1. AEGD or GPR. OK before I piss anyone off let me say that my opinion is purely my own and I am approaching these two programs as a general dentist with debt whose ultimate destination is private practice. That being said I don't think that either of these programs will aid you that much in entering into private practice. Yes both will give you extra time to build your speed and confidence and teach you some techniques that you may use once you hang up your shingle but here is what they won't do

1. Service your debt
2. Give you real experience in a real dental office
3. Start building your patient base
4. Teach you any practice, staff or patient management techniques
5. Establish you or your new practice in your community

In other words if your ultimate goal is owning your own dental practice these programs will just delay your progress towards that goal. Yes you will gain speed but you will also gain speed in private practice and you will be paid for it. Yes you might learn some new skills but you can learn those through CE and be taught by people who can show you how best to implement these techniques in your practice to maximum profitability.

2. Go into a specialty- If you want to be an ortho, endo, OMFS, pedo etc then this is the route for you. 'Nuff said

3. Go into a family practice - this can be an ideal situation or a lingering hell. These are issues are best handled by a family therapist and not me. Your family member will help you with the dental issues however.

OK next post I will cover being an associate and tell you about my experiences as an associate and having had three associates.
 
do you see more obsticles for a new grad buying a practice vs a seasoned vet like yourself? what are your thoughts about using transition companies like Mercer vs just hiring a lawyer to go through it all with you?
 
Oracle DMD said:
do you see more obsticles for a new grad buying a practice vs a seasoned vet like yourself? what are your thoughts about using transition companies like Mercer vs just hiring a lawyer to go through it all with you?
Click to expand...

Usually the biggest difference is that I have a proven track record in that I can show them what I have produced in the past whereas as a new grad you are an as of yet an unproved entity. But dental offices are for loan companies a sure bet as they almost never go under and tend to never default on their loans. I might get a lower interest rate like 6% verse 9% for 7 years but that would be the only difference.

If you have never bought an office before using a transition company is usually a good idea and I have actually worked worked with Imtiaz Manji and Mercer on a couple of deals and they are pretty good (I will talk about them later). Using a lawyer who has done several transitions is pretty good too. Going it alone with a lawyer just writing up what you tell him is not a good idea. There are so many things that go into a buy out that if you haven't gone through it before you can miss something important that can and probably will come back to bite you on the a s s.

BTW you fall into my "lucky Bastard" category as a dental student with a big set of brass heuvos to begin with who has a kick a s s practice waiting for him. You suck😀
 
Associateships

So you think you might want to associate with a senior dentist or as I like to call it "learning on someone else's dime." Associateships can be a very good experience. You should get paid reasonably well, you have an older dentist with more experience to help you out and you get to see the inner workings of a real dental office up close.

The best circumstance is being an associate in the office that you eventually want to purchase. You will be getting paid to learn the flow of the office you eventually will own. You get to see which staff members are good and which ones need to go and you get to know the patient base. Even an associateship where you are doing the grunt work (i.e extractions, medicare) is still good if you are being paid reasonably well.

So what should you be paid? A reasonable amount is 20-25% of your collections minus lab. But if you are being paid a percentage of collections you need to be doing the kind of work that will pay you. If you are doing mostly Medicare then 25% of your collections will be crappy. If you are doing mostly medicare then you should ask for a guaranteed monthly salary and if your 25% of collections exceeds this then you get paid the difference. This is a good idea for several reasons:

1. It makes sure that the front office keeps your schedule filled. You are not responsible for keeping your schedule filled. You are an employee and if they want you to work they should provide the work. Any dentist who employes you and also expect you to provide your own patients is screwing you and you should leave immediately

2. You are freeing up the senior doc to do more profitable procedures so he is making more money. If he expects you to do this and still wants you pay you the same money you could get working at McDonald's then leave.

So how much should I ask for as a guaranteed monthly salary? That is easy. Total up your monthly debt service: School debt, car payment, rent or house payment, utilities etc. Total up every bill that you will be paying each month. Also don't forget disability and malpractice insurance, health insurance, license fees, professional privilege tax, how much gas you will use going to and from the office. Then add in how much you need will need each month to live. This is how much you should ask for each month. And have it broken down so that you can show the senior doc where you are getting the figure that you are asking for.

Be careful what you sign. Always have any contract that you are offered gone over with a lawyer who has done this sort of work before. It is always worth the money to have anything that might impede your ability to practice looked over.

I was an associate for 2 years right after I graduated from dental school. The dentist I worked for was a total a s s hole. I was doing his medicare patients while he did all of the fixed prosth. I had him pay me a fixed salary each month. He then had the gall to tell me at the end of the first year that I hadn't produced enough based on collections. It was only after I totaled up the number of procedure I had done during the year verses the number he had done that he shut up. I actually did more work than he did, but because it was reduced fee medicare of course I didn't make as much money.

He had promised me that he would sell me half of his practice and add onto his current office within 2 years. I never signed a contract which was fortunate for me. When I finally pressed him after about a year and a half about the contract, the one that he gave me was not the one that we had negotiated before I can to work for him. The new one left when I would buy into the practice open ended and left to his discretion. When I asked him when I would be allowed to buy in he told me "You're not ready to own a practice yet, I'll tell you when you are." I started calling practice brokers that afternoon. Within about four months I had entered into the purchase of my first practice.

The funny thing is one of my classmates was the next sucker to work for this jerk. Everyone warned this guy and told him that he should call me first. My classmate told them "The Hammer just didn't know what he was doing." Well my classmate signed a contract with Dr. A s s hat (apparently the one he tried to get me to sign) and my classmate went bankrupt within 2 years because he was never allowed to buy into the practice.

I would love to say that this type of exploitation of new dentists is the exception and not the rule but unfortunately more often than not it is the rule so be careful when you are entering into your first associateship.

More to come..........
 
Great information. It really is a shame that there are people like that in this world.
 
The Hammer said:
Associateships



The best circumstance is being an associate in the office that you eventually want to purchase. You will be getting paid to learn the flow of the office you eventually will own. You get to see which staff members are good and which ones need to go and you get to know the patient base. Even an associateship where you are doing the grunt work (i.e extractions, medicare) is still good if you are being paid reasonably well.
Click to expand...


As an aside from another dentist....

Hammer's personal experience as an Associate Dentist is typical!!!!

In the 20 or 25 cases of young dentists working as an associate for another dentist and planning to buy in that I know, only one worked out.
It seems that old dentists just cannot bring themselves around to giving up the practice to anyone.
 
Saddleshoes said:
As an aside from another dentist....

Hammer's personal experience as an Associate Dentist is typical!!!!

In the 20 or 25 cases of young dentists working as an associate for another dentist and planning to buy in that I know, only one worked out.
It seems that old dentists just cannot bring themselves around to giving up the practice to anyone.
Click to expand...

Thanks SS. If you go into a buy out situation make sure that in no uncertain terms your contract allows you to fire the current owner at will at anytime if he wants to "stay for the transition". If you pay the note, you drive the boat👍
 
This is a great thread. I plan work as an associate for a while after graduating (not too keen about the idea of owning my own practice, at least not right now) so the association part was really helpful to me. Keep up the good work 👍
 
When would you recommend someone to start looking for a practice or an associateship? I went to a lunch and learn, and the dentist started at the end of second year. Then, you hear 4th years who graduate in 3 months ponder what they should do...
 
DrReo said:
When would you recommend someone to start looking for a practice or an associateship? I went to a lunch and learn, and the dentist started at the end of second year. Then, you hear 4th years who graduate in 3 months ponder what they should do...
Click to expand...

Decide on what route you want to take. Then I would start looking around Christmas break of your forth year. Any earlier and most practice brokers won't take you seriously because you still have a lot of time before you graduate and you may change your mind. Also most dentists once they decide to sell want to sell ASAP and probably won't want to wait 6 months or more until you graduate, pass your boards and get your license to practice. And to be honest it just doesn't take that long to find an office to either buy or work in. I've been searching since June 1 and I was offered 4 associateships and I found 5 practices that I considered buying. Granted I have been practicing for several years but it truly is a buyers market out there right now.👍
 
The Hammer said:
Decide on what route you want to take. Then I would start looking around Christmas break of your forth year. Any earlier and most practice brokers won't take you seriously because you still have a lot of time before you graduate and you may change your mind. Also most dentists once they decide to sell want to sell ASAP and probably won't want to wait 6 months or more until you graduate, pass your boards and get your license to practice. And to be honest it just doesn't take that long to find an office to either buy or work in. I've been searching since June 1 and I was offered 4 associateships and I found 5 practices that I considered buying. Granted I have been practicing for several years but it truly is a buyers market out there right now.👍
Click to expand...

great thread hammer! i always learn so much from your posts! it's probably too early for me to ask this (granted i haven't even started school) but i'm gonna ask anyways. for our first associate job hunt, would you recommend calling/sending out mass resumes or going to a practice broker? does it make sense to assume that going through a practice broker will connect you with dentists who are more desperate to sell, thus offering us newbs better associateships? thanks!
 
The Hammer said:
Associateships
So what should you be paid? A reasonable amount is 20-25% of your collections minus lab. But if you are being paid a percentage of collections you need to be doing the kind of work that will pay you. If you are doing mostly Medicare then 25% of your collections will be crappy. If you are doing mostly medicare then you should ask for a guaranteed monthly salary and if your 25% of collections exceeds this then you get paid the difference.
Click to expand...
Again, this is a awesome thread.

What's your take on chain offices? i.e. Kool Smiles, Small Smiles, Gentle Dental, etc.

One of the above recently offered me a contract at a brand new office, another dentist and I will be running the mill:

1. Guarantee $500 minimum, or 22% collection, whichever is higher.
2. It's a full medicaid office.
3. They estimate employee monthly gross billing to be $72k, and from this they would collect 98.5%, 22% of that collection ($14k a month) goes to the associates pocket. Question is, is this actually doable? will I be working like a robot or a human being? 🙂
 
in my experience, 22% of collections is very low. here in FL the going rate is 30-35% (depending on who pays lab bills, etc). and to be honest with you, to produce $72K/month on medicaid is going to be very difficult. i dont know what the medicaid reimbursement rates are in your area, but here i would have to see ~30-40 patients a day to do that. not fun

Cold Front said:
Again, this is a awesome thread.

What's your take on chain offices? i.e. Kool Smiles, Small Smiles, Gentle Dental, etc.

One of the above recently offered me a contract at a brand new office, another dentist and I will be running the mill:

1. Guarantee $500 minimum, or 22% collection, whichever is higher.
2. It's a full medicaid office.
3. They estimate employee monthly gross billing to be $72k, and from this they would collect 98.5%, 22% of that collection ($14k a month) goes to the associates pocket. Question is, is this actually doable? will I be working like a robot or a human being? 🙂
Click to expand...
 
Cold Front said:
Again, this is a awesome thread.

What's your take on chain offices? i.e. Kool Smiles, Small Smiles, Gentle Dental, etc.

One of the above recently offered me a contract at a brand new office, another dentist and I will be running the mill:

1. Guarantee $500 minimum, or 22% collection, whichever is higher.
2. It's a full medicaid office.
3. They estimate employee monthly gross billing to be $72k, and from this they would collect 98.5%, 22% of that collection ($14k a month) goes to the associates pocket. Question is, is this actually doable? will I be working like a robot or a human being? 🙂
Click to expand...

Stay away from these hells unless you have no other options. These places always offer high salary and guaranteed this and that but the reality is that once you begin, you've got 40+ screaming kids a day who all somehow "need" SSC/Pulps on 8 of their teeth. That's how you do 72k a month. 98.5% collections is a joke on medicaid. Usually they take 2-4 months and reimbursement is very very delayed so be extremely careful signing a **collections** contract with these devil companies.
 
The Hammer said:
Associateships
So what should you be paid? A reasonable amount is 20-25% of your collections minus lab. But if you are being paid a percentage of collections you need to be doing the kind of work that will pay you. If you are doing mostly Medicare then 25% of your collections will be crappy. If you are doing mostly medicare then you should ask for a guaranteed monthly salary and if your 25% of collections exceeds this then you get paid the difference. This is a good idea for several reasons:

....

Be careful what you sign. Always have any contract that you are offered gone over with a lawyer who has done this sort of work before. It is always worth the money to have anything that might impede your ability to practice looked over.

I was an associate for 2 years right after I graduated from dental school. The dentist I worked for was a total a s s hole. I was doing his medicare patients while he did all of the fixed prosth. I had him pay me a fixed salary each month. He then had the gall to tell me at the end of the first year that I hadn't produced enough based on collections. It was only after I totaled up the number of procedure I had done during the year verses the number he had done that he shut up. I actually did more work than he did, but because it was reduced fee medicare of course I didn't make as much money.

He had promised me that he would sell me half of his practice and add onto his current office within 2 years. I never signed a contract which was fortunate for me. When I finally pressed him after about a year and a half about the contract, the one that he gave me was not the one that we had negotiated before I can to work for him. The new one left when I would buy into the practice open ended and left to his discretion. When I asked him when I would be allowed to buy in he told me "You're not ready to own a practice yet, I'll tell you when you are." I started calling practice brokers that afternoon. Within about four months I had entered into the purchase of my first practice.

The funny thing is one of my classmates was the next sucker to work for this jerk. Everyone warned this guy and told him that he should call me first. My classmate told them "The Hammer just didn't know what he was doing." Well my classmate signed a contract with Dr. A s s hat (apparently the one he tried to get me to sign) and my classmate went bankrupt within 2 years because he was never allowed to buy into the practice.

I would love to say that this type of exploitation of new dentists is the exception and not the rule but unfortunately more often than not it is the rule so be careful when you are entering into your first associateship.

More to come..........
Click to expand...

It is sad how many times I hear the same exact comments. It's always, "he didn't work out because he 'just didn't get it'". There are always new docs to get abused and it could've been a blessing or a curse that you didn't sign a contract, but fortunately for you, it was a blessing in disguise. Funny because all the broker companies push contracts to guarantee this and that blah blah blah.

These days in dentistry, while a regional thing, I would expect a new grad to get offered 25-30% production with a daily guarantee. As somebody with a couple years of experience, I would expect 30-35% with or without a daily guarantee.

I feel very strongly about daily guarantee + % of production or collections. Say you go to someplace that only offers % of collections and doesn't keep your schedule full? They lose a little money but you lose a LOT of income. Daily guarantees keep your schedule busy.

Be careful with % of collection plans because many employers do not reveal their collections records or what their write-offs are. Employees are paid on % of collections strictly to benefit the poor dental practices of the employer (i.e. poor collections dept, slow dental plan reimbursement etc, disorganized accounting).

Avoid medicaid like anything you have avoided in your whole life. It is a slow and depressing hell that sucks your life into an abyss. Not only is your reimbursement low, the patients are entitled and nasty, the federal government holds accountability over your head and if you mis-bill $1.00, you could go to jail.

The ideal associateship is offered this:
$500 daily guarantee (8-9 hours daily) with 30% of production over $1,650. (i.e. this is a guarantee of $120k year + incentives for both dentist and offices)

A compromise is the following:
$400 daily guarantee (8-9 hours), with 35% collections over $1,200 in more dental plan based offices. (i.e. this is a guarantee of $96k a year + very very big incentive for high producers)

Now very few offices are offering salaries like these nowadays due to economy, but should be your ideal as you start looking.
 
nitrolegs said:
great thread hammer! i always learn so much from your posts! it's probably too early for me to ask this (granted i haven't even started school) but i'm gonna ask anyways. for our first associate job hunt, would you recommend calling/sending out mass resumes or going to a practice broker? does it make sense to assume that going through a practice broker will connect you with dentists who are more desperate to sell, thus offering us newbs better associateships? thanks!
Click to expand...

It is never too early to start thinking about your future. I do it all the time. It is what helps you to navigate your way through change. Here is where you need to look for an associateship

1. Your school may have a placement service
2. You state's component of the ADA
3. Practice Brokers (although these guys are really geared towards sales)
4. Internet companies like "ihiredental.com and dentalpost.net" these guys are thick with associateship offers.
5. Dental sales reps. These guys always have their ears to ground about practice transitions so they are a good resource as well.
6. I would also just call all the doctors in the area in which you want to practice and ask if they know of anyone looking to hire. Then once I made contact over the phone I would then send them a CV (I'll go over CV creation later in this thread). If you have spoken with them they are more likely to retain your CV and give it to someone than just throw it away.

Well I hope this helps. Good luck with Dental School and enjoy your free time now as good memories of a life outside of Dental School will really help you pull through the tough times👍
 
Cold Front said:
Again, this is a awesome thread.

What's your take on chain offices? i.e. Kool Smiles, Small Smiles, Gentle Dental, etc.

One of the above recently offered me a contract at a brand new office, another dentist and I will be running the mill:

1. Guarantee $500 minimum, or 22% collection, whichever is higher.
2. It's a full medicaid office.
3. They estimate employee monthly gross billing to be $72k, and from this they would collect 98.5%, 22% of that collection ($14k a month) goes to the associates pocket. Question is, is this actually doable? will I be working like a robot or a human being? 🙂
Click to expand...
Chain dental offices can be a good thing. I had several friends who went to work for a denture mill chain once they graduated. Chains are usually more likely to hire new grads and I can assure you, they will keep you BUSY! But as Mike has warned some of them can be a living nightmare. An all medicaid practice is a hell of a lot of work for not that much money. Lots of screaming kids and to insure that your schedule stays full often they will double or triple book. So sometimes you will have a busy schedule but most of the time you will have a freaking insane schedule. It can be like drinking out of a fire hydrant. The best chains to work for are those that just offer cheap dentistry. You won't get rich but you will get lots of experience and the dental IQ of your patients will be slightly higher and you are not going to do this forever.👍
 
mike3kgt said:
It is sad how many times I hear the same exact comments. It's always, "he didn't work out because he 'just didn't get it'". There are always new docs to get abused and it could've been a blessing or a curse that you didn't sign a contract, but fortunately for you, it was a blessing in disguise. Funny because all the broker companies push contracts to guarantee this and that blah blah blah.

These days in dentistry, while a regional thing, I would expect a new grad to get offered 25-30% production with a daily guarantee. As somebody with a couple years of experience, I would expect 30-35% with or without a daily guarantee.

I feel very strongly about daily guarantee + % of production or collections. Say you go to someplace that only offers % of collections and doesn't keep your schedule full? They lose a little money but you lose a LOT of income. Daily guarantees keep your schedule busy.

Be careful with % of collection plans because many employers do not reveal their collections records or what their write-offs are. Employees are paid on % of collections strictly to benefit the poor dental practices of the employer (i.e. poor collections dept, slow dental plan reimbursement etc, disorganized accounting).

Avoid medicaid like anything you have avoided in your whole life. It is a slow and depressing hell that sucks your life into an abyss. Not only is your reimbursement low, the patients are entitled and nasty, the federal government holds accountability over your head and if you mis-bill $1.00, you could go to jail.

The ideal associateship is offered this:
$500 daily guarantee (8-9 hours daily) with 30% of production over $1,650. (i.e. this is a guarantee of $120k year + incentives for both dentist and offices)

A compromise is the following:
$400 daily guarantee (8-9 hours), with 35% collections over $1,200 in more dental plan based offices. (i.e. this is a guarantee of $96k a year + very very big incentive for high producers)

Now very few offices are offering salaries like these nowadays due to economy, but should be your ideal as you start looking.
Click to expand...

Great post. I really appreciate input like this. Keep them coming👍
 
mike3kgt said:
Stay away from these hells unless you have no other options. These places always offer high salary and guaranteed this and that but the reality is that once you begin, you've got 40+ screaming kids a day who all somehow "need" SSC/Pulps on 8 of their teeth. That's how you do 72k a month. 98.5% collections is a joke on medicaid. Usually they take 2-4 months and reimbursement is very very delayed so be extremely careful signing a **collections** contract with these devil companies.
Click to expand...
Thanks.

So, I thought in chain offices, you don't do quadrant dentistry? or you do? How can they schedule you multiple pulpotomies on 1 patient, and then still book couple of dozenr kids who need the same tx on the same day?

Also, the associate gets paid after medicaid pays the office? 👎
 
Cold Front said:
Thanks.

So, I thought in chain offices, you don't do quadrant dentistry? or you do? How can they schedule you multiple pulpotomies on 1 patient, and then still book couple of dozenr kids who need the same tx on the same day?

Also, the associate gets paid after medicaid pays the office? 👎
Click to expand...

Medicaid clinics are notorious for overbooking to prevent no shows. If nobody shows up then fine but if they do then you are screwed. You are having to rush through one patient to face another frustrated angry patient and mother who have been kept waiting.
 
Excellent thread! Thanks so much for doing this! 🙂 👍
 
OK so now we have gotten to whether to buy an already existing dental practice or to start your own. I am pretty biased about this but I will try to be as objective as possible. To me there is no question that you should buy a pre-existing practice. So now let me tell you my reasoning

1. Right now and for the foreseeable future it is going to be a buyer's market. There are more dentists retiring and dying than there are graduating from dental school and some of them are practically giving their practices away or they are just walking away from them. Dentists that are selling their practices are more likely now than ever to do owner financing for the new grad. It is a really good time to buy.

2. Banks are more likely to loan you money if you are buying an existing practice than if you hang out your own shingle. Why? Because a practice is a proven entity with a financial history. You however are an unproven entity. You might attract a lot of patients right off the bat or more than likely you won't. If you are buying a practice that is already making money the banks will feel like you can keep it going at least enough to pay your monthly note.

3. It is just a cheap to buy as it is to build. Like I said before most dentists are willing to wheel and deal because they are wanting to get out and get something rather than just close up shop and get nothing. Chances are they will give you a good deal on their equipment because they will already have taken advantage of the tax depreciation on it and they will also cut you a break on the goodwill. More than likely they have been trying to sell their practice for a while and are ready to jump at the first nibble. Building your own entails costs that you will not have to incur if you buy an existing practice like build out expenses, getting new verses used equipment (you can buy refurbished equipment but it will still cost you more than what an owner will let you have his for) and an increase in advertising budget to let people know that you are open for business and looking for staff.

4. You are making money from day one with an existing practice whereas with a start up you might be making money or you might be waiting awhile. You will have a staff up and ready to go with an existing practice or you will have to find and train a staff with a start up. You will have a patient base with an existing practice or you will have to build one up with a start up.

So what is the advantage of a start up? There are a couple of advantages
1. The practice is totally your vision from day one. You dictate the philosophy and scope of practice and there is no "getting introduced" to the patients because you are the only doc that has ever been there.

2. If you find a location or a niche that is not being served then opening a practice might be a good idea.

And those are about all the pros for opening a start up. With an existing practice you have a staff, a location that is known, a reputation in the community and a patient base from day one. You also are making money to repay your debt from day one. And with it being a buyer's market right now and with the banks being more competitive for getting your business, to me it is a no brainer. And so that is why I have bought an existing practice in the past and that is why I am buying an existing practice right now. More to come👍
 
The Hammer said:
It is never too early to start thinking about your future. I do it all the time. It is what helps you to navigate your way through change. Here is where you need to look for an associateship

1. Your school may have a placement service
2. You state's component of the ADA
3. Practice Brokers (although these guys are really geared towards sales)
4. Internet companies like "ihiredental.com and dentalpost.net" these guys are thick with associateship offers.
5. Dental sales reps. These guys always have their ears to ground about practice transitions so they are a good resource as well.
6. I would also just call all the doctors in the area in which you want to practice and ask if they know of anyone looking to hire. Then once I made contact over the phone I would then send them a CV (I'll go over CV creation later in this thread). If you have spoken with them they are more likely to retain your CV and give it to someone than just throw it away.

Well I hope this helps. Good luck with Dental School and enjoy your free time now as good memories of a life outside of Dental School will really help you pull through the tough times👍
Click to expand...


Great thread, thanks for the info! 👍

I've been doing those steps...so far calling up the dent supply companies haven't yielded anything. I'm about to start cold calling offices. Do you try to send them all your CV?

What are your thoughts on working interviews? Have you done a lot of them?

You probably don't have this problem, but some offices ask for min. xxx years of experience/AEGD. What's a way to try to break that if you're coming straight out of school.

Also, if you don't mind me asking what area you're looking at. Thanks!
 
Cold Front said:
Thanks.

So, I thought in chain offices, you don't do quadrant dentistry? or you do? How can they schedule you multiple pulpotomies on 1 patient, and then still book couple of dozenr kids who need the same tx on the same day?

Also, the associate gets paid after medicaid pays the office? 👎
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At chain offices you are pressured to do maximum dentistry no matter what. Often times in Medicaid or in large corporate dental it's whole-mouth dentistry or at least quadrant or right/left side dentistry. I used to work 5 chairs at a time at any given time with every patient requiring "full-mouth" dentistry. Room 1 would require full mouth extraction and alveoplasty, room 2 would require 10-14 restorations so on... this is life in these practices. You get room 1 numb, move to room 2, get numb, go back to room 1, extract all teeth, gauze pressure, get room 3 numb, go back to room 1, alveoplasty, suture, and then go to room 2, prep, etc etc. Good thing I had an EFDA to do the restorations, but I would make sure that even though I was practicing in a dump, my ethics could not allow unacceptable dentistry to go out the door. Now I certainly couldn't spend the time to "comfort" patients, and anesthesia would last 30 seconds, it was the result of the environment.

Patients would have to wait (with appointments mind you) for 3 hours in the waiting room. Patients would get grumpy, then I would get grumpy and kick them out. Corporate would push production over anything else in the whole world.

I know that at some pediatric mills, there would be 4 kids who somehow all need 8 Pulp/SSCs sitting in rooms waiting for you. These offices would strap kids down if they didn't cooperate, the procedure would last MAX 1 hour. If you, as a new grad, could not keep up with this schedule, well that's okay if production $$ is still high, but if you could not keep up and your numbers were low, you would be rapidly without a job... even if you had a contract.

Thankfully my salary was tied to %production, which I realize now, after the fact, was so incredibly important on welfare or medicaid fee structure.

These types of offices fill a need, but only you can figure out if it fills your need at this time. We, as a profession, are rapidly going down the route of this type of dentistry for all, however, we all have to figure out how to resist this by not signing a deal with the devil.
 
puncho said:
Great thread, thanks for the info! 👍

I've been doing those steps...so far calling up the dent supply companies haven't yielded anything. I'm about to start cold calling offices. Do you try to send them all your CV?

What are your thoughts on working interviews? Have you done a lot of them?

You probably don't have this problem, but some offices ask for min. xxx years of experience/AEGD. What's a way to try to break that if you're coming straight out of school.

Also, if you don't mind me asking what area you're looking at. Thanks!
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OK I am going to take a sidetrack and go over how to get past the front desk when you are looking for a job. I actually am going to talk to the bank, my lawyer, my account, the practice broker, the owner/seller, my equipment rep, my computer guy, my cable guy, my phone guy, my new front office lady, my new assistant, my interior designer and meet a woman I met at an online dating site. So I am going to be pretty busy between now and Saturday so just be patient with me and I will answer everything🙂
 
The Hammer said:
OK I am going to take a sidetrack and go over how to get past the front desk when you are looking for a job. I actually am going to talk to the bank, my lawyer, my account, the practice broker, the owner/seller, my equipment rep, my computer guy, my cable guy, my phone guy, my new front office lady, my new assistant, my interior designer and meet a woman I met at an online dating site. So I am going to be pretty busy between now and Saturday so just be patient with me and I will answer everything🙂
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Online dating site? Really? Please also share with us how you differentiate the gold diggers from the genuine sweet hearts! 🙄
 
The Hammer said:
OK I am going to take a sidetrack and go over how to get past the front desk when you are looking for a job. I actually am going to talk to the bank, my lawyer, my account, the practice broker, the owner/seller, my equipment rep, my computer guy, my cable guy, my phone guy, my new front office lady, my new assistant, my interior designer and meet a woman I met at an online dating site. So I am going to be pretty busy between now and Saturday so just be patient with me and I will answer everything🙂
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i'd love to hear about how the date went! i'd also love to hear about the path you took after dental school. how did you go about getting your first job? what are some things you WISH you had known? common mistakes that new dentists make when approaching their first associateship? ...just throwin out some ideas...
 
If you know, how much is the cost of a practice in San Diego now and in a couple of years?
 
oralcare123 said:
If you know, how much is the cost of a practice in San Diego now and in a couple of years?
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thats a crazy question.... how much is the cost of a house in san diego now and in a couple of years? lol your asking the same thing. depends on a million different things, gross income, overhead, how many new patients, etc, etc, etc
 
+1, I am rolling with any thread that has "The Hammer" as its author.
 
I mean average practice, three chairs in good area, something for the begining, but not a dump.House is 500 000 -1.5mln
 
Some good advice given to me by the surgeon I worked for:

If buying an existing practice, fire all the staff and tell them they can re-submit their resumes for their old positions (along with all the new applicants). This way everyone knows you are the boss and there is no carry over from previous owner. Plus, this gives you the chance to get rid of Bertha the receptionist who is over payed from 30 years of 50 cent raises, too old, and not cute enough.
 
preOMFS said:
Some good advice given to me by the surgeon I worked for:

If buying an existing practice, fire all the staff and tell them they can re-submit their resumes for their old positions (along with all the new applicants). This way everyone knows you are the boss and there is no carry over from previous owner. Plus, this gives you the chance to get rid of Bertha the receptionist who is over payed from 30 years of 50 cent raises, too old, and not cute enough.
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you actually dont want to fire anybody the first few months. you want to keep everything the same, and then figure out whos going to stay and who has to leave. i purchased my practice in February, quickly realized that one of the assistants was not going to work out. ended up firing her in June.
 
omaralt said:
you actually dont want to fire anybody the first few months. you want to keep everything the same, and then figure out whos going to stay and who has to leave. i purchased my practice in February, quickly realized that one of the assistants was not going to work out. ended up firing her in June.
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Yep. It won't take you long to figure out who stays and who needs to go but you don't want to roll heads right off the bat. You also don't want to alienate your entire staff on day one. The most important asset in your dental practice is your staff. This is a major fundamental that most dentists never realize and they and their practices suffer because of it.

You do not want a staff who just show up for a paycheck or "know you are the boss" because they are afraid that you might fire them. You want staff who feel like they are contributing to something bigger than themselves. You want staff who feel like you are interested in them continuing in their career in dentistry and not just showing up to make you money.

If you can empower your staff, allow them a say in the growth of the practice then you will find your practice grow and your bank account along with it. This is the difference between a leader and a "boss".

Its funny but every time I tell a dentist this it reminds me of that scene from "A League of Their Own" when Tom Hanks chews out one of the female baseball players and she starts crying. The rest of the team jumps on Tom Hanks and he says "there's no crying in baseball!" At this time the majority of your staff will undoubtably be female. There is a different dynamic for a predominately female staff in a healthcare environment than say an all male staff building cars.

In a healthcare environment the natural tendency for your staff is to become more nurturing. It is to your advantage to encourage this. This is how your office will become known as "a warm and caring office." Since your patients will be in contact with your staff more than you the patients will form a bond with one of more of your staff. This is what will keep them coming back (well that and hopefully some good dentistry). If you have staff turnover you will experience patient turnover as well. Also it costs you time and money to hire and train new staff. This is a really good book that I recommend to anyone in a managerial position. Get it now and memorize every word

http://www.amazon.com/Truth-About-Managing-People-2nd/dp/0132346036/ref=sr_1_13?ie=UTF8&s=books&qid=1277594665&sr=1-13
 
Ok todays lesson is called "Where do I want to live?"

The first step in buying a practice is deciding where you want to live. There are practice opportunities every where so decide where you want to live and then look for opportunities in that area. For example I wanted to live in the eastern part of my home state Tennessee. So I looked for available offices in that third of the state. I didn't have a preference for which city to live in, I just wanted to live in that third of the state. Now you may have a more specific idea of where you would prefer to live (or if you are married your spouse may have a specific idea for you😀) So lets look at the pros and cons of different places to live:

Big City (New York, Chicago, LA etc) - In times past I would tell you to avoid the really big cities because they are always over saturated with dentists. But as the population increases and the number of dentists decreases the opportunities are starting to get better in the big cities.

Pros: Its a really big city!!

Cons: Usually over saturated with dentists, lots of competition, higher cost of living equals a higher overhead, patient's trying to "keep up with the Jones" means less disposable income which means less dentistry.

Solution: Lots of dentists means lots of opportunities to associate/partner or simply buy out an older dentist and in the big cities there are plenty of them. In fact you might be able to get a pretty good deal simply because the glut of dentists from the 80's government's response to the perceived "dentist" shortage are getting close to retirement age. I think that in for the next 20 years you are going to see a slow but steady wave of dentists retiring and there will be more of them than there will be buyers. Take advantage of this.

One other alternative that you may want to consider is this. On the outskirts of the big cities developers are always building new communities. Find one of these pockets of growth and establish yourself in it. Directly market to the new home owners and get involved in the new community. The only downside to this is if the economy tanks before the community is really underway it will die on the vine and you will be up a creek so be careful.

Smaller cities: College towns, cities between two larger cities

Pros: Its like a big city, but smaller! Great tailgate parties

Cons: Basically the same as the big cities. Most of the dentists will tend to locate in the city itself and fewer will be in the outlying areas. The smaller cities are more prone to be effected by economic change as they typically have fewer industries than a big city. And always be careful locating in a city where the entire economy is based on one industry like the auto industry or the tourist industry (I call this the "Detroit Effect")

Solution: Same as above, either buy an existing practice in the city or find the "bedroom" communities and seek opportunities there.

Rural areas: These are areas that are say more than 50 miles from a large metropolitan area

Pro: Little to no competition, your involvement in the community will have a larger impact for your practice, you really won't have to advertise that much. Word of mouth will generate lots of patients. Lower cost of living.

Cons: How much do you enjoy watching the grass grow? Also your life will be under much more scrutiny in a smaller community. You also might have to accept more PPOs/HMOs and even some Medicaid. And you can definitely count on treating children.

Solution: If there is an available practice in one of these communities you should be able to pick it up on the cheap. Hanging out your shingle here will be easier as you may be the only game in town. Also lower cost of living means paying off your debt sooner, you will be able to save more money and you will be able to buy plenty of plane tickets to go to places where the most popular attraction isn't the local Wal-Mart .

There are plenty of opportunities no matter where you want to locate. Just be sure you understand what obstacles your practice will face going in. Have plans in place before you go into practice to either overcome or manage these obstacles so they don't blindside you.

Next Topic: Location, Location, Location 👍
 
The Hammer said:
OK I am going to take a sidetrack and go over how to get past the front desk when you are looking for a job.
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Appreciate all the info, Hammer. Hoping to hear about this sidetrack! 😛
 
thinking about picking up that book. Is it too early for a freshman student dentist?
 
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