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- Dec 16, 2016
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Thanks for giving all us mortals something to strive for. You might be in the top few percentage of dentists, but it's good to know that it's still a possibility to be that successful in the field
Fair enough. There's no doubt in my mind solo practice isn't dead. Thanks for doing this AMA - if you're numbers are true then that's amazing and congratulations. You deserve every bit of recognition for that. Going forward, what would you estimate that your production per hour is? What about your hygiene production per hour?I work 5 days a week (35 hours)... Wed-Sunday (I don't know where people get the assumption that if I don't work Monday or Tuesday, I must be working only Wed-Fri). 60 hygiene patients is the max capacity, We dont hit max capacity every day, that would be crazy. Combined, I see an average of 45-60 patients a day in hygiene and ops; most we've ever seen is 76 I think in a day for hyg/ops. I can book all 60 hygiene, not all of them will show up. Your assumption is that all those active patients all come at their 6 month intervals; if only my patients were all that compliant, I could close my office to new patients. My active patient figure comes from my patient management system (Lighthouse).
It's not really that hard to reach the figures that we have up there if you throw ops in there. Example: Insurances pay 1200-1600 for RCT,b/u/crown, private is around 2400; that one patient alone has a value of 1200-2400. Extractions are 305 private, 110-171 for insurance. (These are single tooth figures) When you have 3-4 columns of these, they add up quickly. Not just that, walk-ins, same day conversions, etc...
Again, you don't have to believe me. I'm not going to bust out my 1040's, the financial data comes from my PMS/quickbooks. I'm here to let you guys know that solo practice isn't dead, hysteria around corporate dentistry is unfounded, and there is hope for the solo practitioner. I don't care so much as guarding this as trade secret, since I will hopefully be retired by then.
Hygiene plays a role in my office, but the majority of production comes from ops.
I honestly want to ask you this ; do you think your success is REPRODUCIBLE?Production depends on the patient distribution of the day. I tend to aggregate both hygiene and ops production into one; on a good day, I would say 2-2.2k/hour, slower days at 1.2k/hour. Average day is about 1.6k/hour. How do I get these averages? total production avg on a full day/ # hours worked. Sometimes ops saves the day, sometimes hygiene saves the day. When both collide, I'm kinda screwed, lol.
Thanks for sharing this, do you have any opinion of the HPSP program through the military? Clearly you're doing much better out the gate than military dentists, but you're also doing better than most who don't utilize the military either.
My plan is to go military, graduate debt free, and have enough money put aside to buy or start up a solo practice of my own by the time my obligations are up. Does this sound like a solid plan based on your real world experiences?
I honestly want to ask you this ; do you think your success is REPRODUCIBLE?
TanMan, let's dive into the numbers and details of the startup a little more.
1. You mentioned you paid for your startup in cash, how much did you spend? I think instead of a bulk number, it would be helpful if you broke it down by what you spent for specific categories (i.e. rent, construction, chairs, instruments, software, etc.). Also how did you get your equipment and who helped you purchase it, if anyone? Do you own the building? etc.
2. Is your office single standing or is it in a professional complex? How far to the nearest office similar to yours?
2. How did you market your office? What were you doing? Social media marketing, newspaper, magazines, postcards, etc?
3. Besides the PPO/FFS aspect, what differentiates your practice that prevents another dentist to come into your territory and steal a large portion of your patient base? Is it price and insurance mix alone, quality of work, or is there something else?
I have no doubt that TanMan has done exactly as he says. High production practices have less %overhead and there is lots of profit in "bread and butter" nonspecialty dentistry when done in that kind of volume.
I met a guy once who plays Major League baseball and no doubt he is raling in cash and will be able to retire in five years too. Good to dream about; not good to plan on.
For a typical dentist, the likelihood of replicating TanMan's results are in the same "ballpark" as getting into the Majors.
Leaving aside the challenge of scratch starting a multimillion$ office -- at the most fundamental level, very very very few talented and experienced dentists are even capable of personally producing $2M+/yr of fillings and crowns at the level of "clinically acceptable" or better (working across multiple rooms while also checking 3 hygienists).
TanMan, what is your scheduled Dr time for molar RCT/core/crown?
As a student: good to dream about; not good to plan on.
Great advice. If you were to start over, instead of paying rent, would you advise someone to buy a small office space or even break ground and build your own office? Or does the foot traffic from the strip mall plus TV/radio advertising make up for the office rent you pay (e.g. producing $2k/hr so $3750 monthly rent is essentally negligible)? I know that in LA, rent makes up a huge part of overhead, as it costs $20,000+/month to lease office space and that's less than 3000 sq ft.
Great thread tanman!
1.What state are you located in to have such a huge number of active patients ?
2.Do you think doing radio tv seo and adwords help bring in Medicaid patients (i know you don't see them, but i plan to)? How do you come up with the radio/tv content?
3.do you have a person that helps you do seo adwords ?
4. Can you talk about your financing options ?
5. How do you get your staff to work your hours? most staff have children and want to be with them on the weekends
Amazing thread.
A lot of questions have been asked in regards to the dentistry but I'm more curious about the business side of things. More specifically, what are some resources you can recommend to learn how analyze an area for startup or business methodology in general? I'm currently in my 2nd year and I know my school won't teach me anything I actually need to know about the business side of things and I would really like to start now rather than as an associate.
Can you outline your marketing budget for the first three months of startup ? Like what marketing you used and how $$ for each
I'll try and recall as much as I can. First month was a failure with flyers/printed media. I would not even consider them. Second month onward, we started off with radio and adwords. Started with about 50/day on adwords + 1500/month on radio + 500/month on seo. In december, I think we hit it relatively hard with 8-10k on the third month of operation because of the targeted message of "use your insurance before you lose it, and dental insurance doesn't roll over like roll over minutes" That was the first time we broke 100k production and that's what made me into a believer of advertising. I'm not sure exactly when we added TV, but my first experience with cable TV was very cheap. I was able to secure a dollar per spot when they had excess inventory they couldn't sell, but that was 2 years ago. If I were to do it again, I'd add on cable TV from the get go. Very good return on investment and branding equity. Just make sure you rotate your channels every few months so you dont capture the same audience over and over.
Another big hit, NFL advertising! We saw a massive influx of patients from bombardment of NFL TV advertising with our local fox affiliate station. I think I only paid 2750/month for 6 months.
Eventually, our budget normalized to about 12-20k/month (4k/month on adwords + 7-15k on traditional media (5k radio, rest on TV), depending on our seasonal strategy. There are some times you don't have to pump the advertising such as times you are closed (if you are going on vacation), after back-to-school (slowtember), black friday thanksgiving (people focused on shopping), etc... Due to our spend with advertisers, we can usually get right of first refusal, block out other offices from advertising with those stations, block their radio dj's from endorsing any other dentist. Sometimes we have opportunities to have some B-list celeb or local celeb endorse us and let us host their event. Might seem crazy to spend that much, but there's a method to the madness. I will admit though, this was a major gamble in the beginning. I spent the rest of my money on advertising hoping it would work and thank goodness it worked or I wouldn't be here today. Probably be working for corporate still.
This might be off topic but what is your own personal lifestyle like during this time when you're saving for retirement? Are you able to enjoy your money to a certain degree or do you invest everything back into your business and other projects?
Radio and tv reach a wide audience. How far do your patients travel to see you?
My thoughts would be eve though you do evening and weekends, they still want to be no more than 10min driving distance.
Thank you!I don't go out much, I got a house, got a very slightly used car (someone used it for a month, didn't want it, so they lost 30k in depreciation) recently, most everything else is reinvested back into businesses. Collect firearms as a hobby, live comfortably, don't have to worry about living expenses. That car was probably the first thing I've splurged on in the last 5 years.
Thank you!
I was wondering how you think one should compete/market/advertise in a hypersaturated market? I grew up in Toronto and hope to return there and buy my parent's practice from them, but Toronto is probably the most saturated city in all of Canada. Should I just give up that hope and look for areas where I can start up?
Just a thought, but do you need to market/advertise if you take over your parents' practice? I'm assuming they have a steady patient pool and those would just eventually roll over to you?Thank you!
I was wondering how you think one should compete/market/advertise in a hypersaturated market? I grew up in Toronto and hope to return there and buy my parent's practice from them, but Toronto is probably the most saturated city in all of Canada. Should I just give up that hope and look for areas where I can start up?
Thank you!
I was wondering how you think one should compete/market/advertise in a hypersaturated market? I grew up in Toronto and hope to return there and buy my parent's practice from them, but Toronto is probably the most saturated city in all of Canada. Should I just give up that hope and look for areas where I can start up?
Less competition means more growth, more growth means more money and retiring faster. So yes, I'd say give up, look for a less competitive area, setup there, and if you really want to return there, make as much money as you can and then get out. That way you are in a city that you want to live in while you're still young with a lot of money too. Otherwise, in extremely saturated areas, growth is slow, you'll end up working for 30 yrs with a mediocre lifestyle, then hope you have enough money to survive retirement and not be too old to enjoy your money. Being poor sucks, and does that really offset the location you'll be in? I never thought I would like Texas, but I call it my home now. Guns, cars, and money... what else can you ask for?
Edit: I realized that I didn't answer your first question, if you really want to be there, a large city can usually be divided into sections. Pretty much, stay away from bunches of dental offices, I'd stay in the outskirts of the city if possible with other adjacent suburbs that are more affluent. Look for areas to setup where the commute is from where people work to where they live (draw a line), and target your location along that line. It'll be a lot slower growth, more competitive, and you'll have to be a lot more aggressive. Don't fall for the price trap though, keep your exam fees higher than avg to filter out the riffraff and timewasters.
An interesting tidbitI just remembered: Why do Fridays and evenings lead to higher treatment acceptance? The patients are beat down already from the week, if they just got off work, they are tired and willing to just say yes a lot more; especially those that have been in pain all day or week.
On an additional note, if your parent's production is sufficient for you and the price is right, take it over, you have a headstart. I have some colleagues whose parents have poor production to where it would be hard to turn around in terms of efficiency, especially since some of them are still practicing and are not receptive to change and improvement. This would depend on the terms that your parents want in terms of transition, but if you really want to stay, just make sure it is for the right price.
Just a thought, but do you need to market/advertise if you take over your parents' practice? I'm assuming they have a steady patient pool and those would just eventually roll over to you?
Don't u think treating children is easier than adults ? Doing ol and ob is a lot faster than doing endo bu crownPatients will travel up to a 150 miles from the rural regions to see me if there is no dentist there and they are in severe pain. And willing to wait if I'm completely packed. Evenings and weekends are for working professionals that can't take time off work. They'll travel since the have to commute home anyway..
Don't u think treating children is easier than adults ? Doing ol and ob is a lot faster than doing endo bu crown
Competition is higher in the children's market, more annoying, and more stressful. If you had a 10yr plan to retire, could you handle children for 10 years? Sure, faster money by volume, but how many of those can you juggle at the same time. You can't jump around with children as much as their attention spans are lower and anesthetic wears off faster. Maybe if you're doing 20ssc's at a time under sedation, why not, but i'd rather stick to rct,bu,crown. I can juggle more patients and make more under less stress.
Definitely! I think Sunday is my highest hourly producing sometimes, rivals Saturday.Is Sunday appointment a big selling point?
How did you learn about Medicaid/ppo insurance billing ?
Is your practice set up as a S-corp or LLC?
TanMan, as an S-Corp can you not just pay yourself a reasonable salary, say 120K and invest the remainder of your Corp net income after your overhead into bonds/funds or something else so it doesn't count as income for you? If you're on PAYE or IBR your AGI can be significantly reduced so your loan payments would be next to nothing and then at the end of 25 years after everything is forgiven you can just liquidate some of your investment funds if you'd like for the tax bomb. Is that something legally allowed with an S-Corp? If so are you doing that?
What job posting site worked out best for you ?I'll see if I can find the name. I remember it is in Dallas but that's pretty much it.
I do have a CEREC machine, most of our single units are made here but if gold or zirconia is indicated, then I'll send it out to a lab.
What job posting site worked out best for you ?