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Commuting to avoid Saturation

We all know the whole schpiel, don't practice in a metro area. Competition is tough and getting tougher by the millisecond! Is a way to get the best of both worlds to simply take an hour long commute to your dental practice?

Suppose you really want to live in LA, or any other big desirable metro, since you are a young high flying dentist who doesn't want to spend his youth/entire life living in the middle of nowhere. But you also want to have a successful career, which is tough if you practice in the big metro. Could you just solve the issue by setting up a practice 30 miles away from a metro, in a more suburban/rural area. Is that a good strategy or are these areas heavily saturated as well?

What if you bought an existing successful practice in one of these suburbs? Then you don't have to worry about outcompeting peers for a patient base, because it will already be provided. You can focus on maintaining and growing your already healthy patient base. Are there any flaws in my logic, is this not feasible?
 

ryan_mercer

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    30 miles. Good grief. That's a considerably long distance. If you can make use of the time while commuting by doing productive stuff like reading thesis notes or a book, that would help. But, I prefer to be in close proximity with the schools/hospitals
     
    30 miles. Good grief. That's a considerably long distance. If you can make use of the time while commuting by doing productive stuff like reading thesis notes or a book, that would help. But, I prefer to be in close proximity with the schools/hospitals
    I don't think I could make use of that time because I most likely would be driving those 30 miles. Unless of course by then they have cars that completely drive themselves, then I could make use of that time.

    Also do you mean your dental practice being in close proximity to schools and hospitals or the place you reside being close to such institutions? In my scenario you would be living in an urban area and commuting out of it.
     
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    theleatherwalle

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      30 miles outside of the metro basically gets you to the suburbs, which tend to be saturated as well. you need to be thinking 45-60 miles out. Is an hour of commuting worth less competition/better collections? That is really a case by case basis. Some dentists do it and some don't. Personally, for the extra hour of commuting round trip you need to be adding at least an hour's worth of collections if not more to your day.
       

      charlestweed

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        I live 25-35 miles away from each of my offices and spend 30-45 minutes (each way) in traffic. I want to live in a nice safe neighborhood with good schools for my kids but my offices target mostly low income patients in poorer areas. I love treating low income patients because they respect the doctor, they rarely complain, they don't dictate the tx plan, and I can keep the overhead low etc. To make the daily commute less stressful, I buy a car that has the "autopilot" feature, the feature that allows the car to drive by itself in a top-and-go traffic. It's like having a personal chauffeur. Because of this awesome automobile technology, which has greatly improved over the years, I don't need to buy a house near my office.

        It's almost impossible to find an existing successful practice to buy. Doctors don't usually sell their practices when they are doing well. They sell because they can no longer manage their practice due to old age, high overhead, high rent, patients are leaving them for other offices, lazy staff who don't care and can't be fired etc. And if there is a successful one for sale, many other dentists will want to pay for it and it will be very expensive to buy. You will have to take out a very large loan to acquire it. Your business loan repayment amount will be very high and this will negatively affect your take home income. IMO, it's better to buy a failing office at a low price (some are listed for a lot less than if you start one from scratch) and work hard to build it back up. Low overhead is key.
         
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        THS

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          30 miles outside of the metro basically gets you to the suburbs, which tend to be saturated as well. you need to be thinking 45-60 miles out.
          Yeah I would say you need to be at least 60 miles out from a "major" city (more than 1M people). I think living in the suburbs and driving further out would be the way to go, so you're halfway in between the city and your office.
           
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          PreDentTechySon

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            To make the daily commute less stressful, I buy a car that has the "autopilot" feature, the feature that allows the car to drive by itself in a top-and-go traffic. It's like having a personal chauffeur. Because of this awesome automobile technology, which has greatly improved over the years, I don't need to buy a house near my office.
            .

            Is this a real thing?
             
            It's almost impossible to find an existing successful practice to buy. Doctors don't usually sell their practices when they are doing well. They sell because they can no longer manage their practice due to old age, high overhead, high rent, patients are leaving them for other offices, lazy staff who don't care and can't be fired etc. And if there is a successful one for sale, many other dentists will want to pay for it and it will be very expensive to buy. You will have to take out a very large loan to acquire it. Your business loan repayment amount will be very high and this will negatively affect your take home income. IMO, it's better to buy a failing office at a low price (some are listed for a lot less than if you start one from scratch) and work hard to build it back up. Low overhead is key.

            Is that just becoming the case or has it always been like that? Is it different for you since you are an orthodontist. My intention is to just be a GP. I've been browsing around on various websites looking for practices for sale, and there are many which are very high production practices that just have a retiring dentist, or a dentist looking to move locations. I have absolutely 0 experience with evaluating a dental practice, so I haven't done any real analysis of the practice cash flow etc. but the practices I have seen don't seem like a bad deal.

            I understand I will likely have to take out a loan of 800K+ to purchase a big dental practice (1 MM+) but from what I've read on many dental blogs is that purchasing a dental practice is the single best investment a dentist can make. It's a very good kind of loan, one which works in your favor, unlike a car loan or something of the like. I understand my take home income will be reduced by around 100K each year until the end of the loan term, but my vision is to eventually expand into a multipractice model. I feel like it would be integral to make that initial investment, and with the looks of the industry today, building your own practice seems very difficult, and you could end up spending way too much time in the process.

            The two primary routes today seem to be either you go work for a corporation or purchase an existing practice if you have the means to do it. I should graduate with very few student loans, so I would be ahead of some of my peers in terms of having the means to take out a massive loan.

            I will probably use the idea of buying failing offices at discounted rates when I look to expand my practice to multiple locations (or have partners). But I feel like I don't want to take the risk of a failing practice with my initial investment in my first practice. Once I get my foot in the door, I can work towards expansion.

            Do you feel as a practicing dentist that your overhead is lower with multiple practices since you can pool resources? I feel like the main benefit of expanding into a group practice would be to lower overhead and have a big, consistent patient base.
             
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            30 miles outside of the metro basically gets you to the suburbs, which tend to be saturated as well. you need to be thinking 45-60 miles out. Is an hour of commuting worth less competition/better collections? That is really a case by case basis. Some dentists do it and some don't. Personally, for the extra hour of commuting round trip you need to be adding at least an hour's worth of collections if not more to your day.

            Well I guess it depends on if you live in a central part of the city or on the edges. And with automated cars, I can realistically do all my notes/planning etc. for the day during the drive which I would have otherwise done after reaching the practice. So once I arrive at the practice I can start treating right away (after preparing all the equipment of course, but this can be negated by asking staff to get there 30 min earlier than I do to open up). I feel like a commute doesn't necessarily need to be a waste of an hour. I would say it's definitely much better than practicing in an area with many dentists right around the corner, because then it will be hard to maintain a patient base and get many new patients because other dentists could offer lower prices etc. which can cause a stir. Without the extra pressure of too many dentists around, you can build a loyal patient base that solely sticks to your practice.
             

            charlestweed

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              Is that just becoming the case or has it always been like that? Is it different for you since you are an orthodontist. My intention is to just be a GP. I've been browsing around on various websites looking for practices for sale, and there are many which are very high production practices that just have a retiring dentist, or a dentist looking to move locations. I have absolutely 0 experience with evaluating a dental practice, so I haven't done any real analysis of the practice cash flow etc. but the practices I have seen don't seem like a bad deal.

              I understand I will likely have to take out a loan of 800K+ to purchase a big dental practice (1 MM+) but from what I've read on many dental blogs is that purchasing a dental practice is the single best investment a dentist can make. It's a very good kind of loan, one which works in your favor, unlike a car loan or something of the like. I understand my take home income will be reduced by around 100K each year until the end of the loan term, but my vision is to eventually expand into a multipractice model. I feel like it would be integral to make that initial investment, and with the looks of the industry today, building your own practice seems very difficult, and you could end up spending way too much time in the process.

              The two primary routes today seem to be either you go work for a corporation or purchase an existing practice if you have the means to do it. I should graduate with very few student loans, so I would be ahead of some of my peers in terms of having the means to take out a massive loan.

              I will probably use the idea of buying failing offices at discounted rates when I look to expand my practice to multiple locations (or have partners). But I feel like I don't want to take the risk of a failing practice with my initial investment in my first practice. Once I get my foot in the door, I can work towards expansion.

              Do you feel as a practicing dentist that your overhead is lower with multiple practices since you can pool resources? I feel like the main benefit of expanding into a group practice would be to lower overhead and have a big, consistent patient base.
              Be careful about buying a practice from a retiring doc. Since they no longer have any debt to pay back, the retiring docs tend to care less about their practices. There is no more motivation for them to work hard like when they were in their prime years ago. They take time off and take vacations whenever they want to. They show up for work whenever they want to. They don't care if they show up late and make their patients wait. It's hard to have a successful practice with such lack of discipline and hard work. The selling agents always try to make the office appear to be successful.

              You also have to be careful about buying an office from a seller, who wants to relocate. The patients will leave you and follow the seller to his new office. Of course, there is a clause in the sale contract that prohibits the seller to take the patients away from you. But the patients still want to go see their old dentist ....it's the patients' choice and you cannot do anything about it.

              Good luck paying off the $800k business loan. I only took out $75k loan to set up my office from scratch and my monthly payment for that loan was $1500/month (5-year repayment plan). So if you owe 10+ times more, expect to pay close to $15k a month. And when you add staff salaries, rent, worker comp, property insurance, utility bills, advertisement etc, you would need at least $25-30k every month.....just to keep the office's door opened.

              Buying an existing successful practice does not necessarily guarantee that you will be successful like the seller. What if the seller over-treats everything but you are the type of person who cannot do this? What if the seller knows how to place implants and perform other complex procedures but you have to refer these cases out to specialists? What if the seller is better than you at communicating with the patients? All dentists are not created equal. Having a practice at the right location is important but that's not enough. You need to have a strong work ethic, good business skills, good clinical skills, and good chairside manner as well.

              I think you need to gain more experience from working for someone else first. Learn how to handle different types of complications. Once you have enough confidence in yourself, you can buy an existing office or set up one from scratch.
               
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              Be careful about buying a practice from a retiring doc. Since they no longer have any debt to pay back, the retiring docs tend to care less about their practices. There is no more motivation for them to work hard like when they were in their prime years ago. They take time off and take vacations whenever they want to. They show up for work whenever they want to. They don't care if they show up late and make their patients wait. It's hard to have a successful practice with such lack of discipline and hard work. The selling agents always try to make the office appear to be successful.

              You also have to be careful about buying an office from a seller, who wants to relocate. The patients will leave you and follow the seller to his new office. Of course, there is a clause in the sale contract that prohibits the seller to take the patients away from you. But the patients still want to go see their old dentist ....it's the patients' choice and you cannot do anything about it.

              Good luck paying off the $800k business loan. I only took out $75k loan to set up my office from scratch and my monthly payment for that loan was $1500/month (5-year repayment plan). So if you owe 10+ times more, expect to pay close to $15k a month. And when you add staff salaries, rent, worker comp, property insurance, utility bills, advertisement etc, you would need at least $25-30k every month.....just to keep the office's door opened.

              Buying an existing successful practice does not necessarily guarantee that you will be successful like the seller. What if the seller over-treats everything but you are the type of person who cannot do this? What if the seller knows how to place implants and perform other complex procedures but you have to refer these cases out to specialists? What if the seller is better than you at communicating with the patients? All dentists are not created equal. Having a practice at the right location is important but that's not enough. You need to have a strong work ethic, good business skills, good clinical skills, and good chairside manner as well.

              I think you need to gain more experience from working for someone else first. Learn how to handle different types of complications. Once you have enough confidence in yourself, you can buy an existing office or set up one from scratch.

              For a retiring dentist that isn't working as many hours, taking time off etc. Wouldn't it actually be a good thing if the office is still productive despite this. Or even if it isn't, a young dentist can come in and re-energize the practice right? Get it headed in the right direction again.

              When I said relocate, I meant more of moving to another state altogether. But now that I think about it, your scenario is probably more likely. Most dentists probably don't want to abandon their entire patient base and move to another location far away and have to build a new patient base. I can definitely see how many patients will follow the doctor as long as he stays nearby.

              For the 800k business loan, I was looking up the terms and it seems you can take a 10 year term, in which payments would be roughly 100k a year (probably a little bit more depending on the interest). For an 800k purchase, you would probably be buying a practice that gets around 1 MM+ in collections a year, and if you assume really high overhead (at 70%) since you will be just getting settled into the practice, maybe not up to speed etc. Then you should still net around 300k as the owner dentist, and then you can lower your taxable income through your retirement accounts, and interest on your business loan etc. And then you pay principle after that. Overall suppose your 300k turns into 135k after tax deductibles and Uncle Sam takes his cut, and then you subtract another 50k for the principle (I'm just assuming 50k principle and 50k interest, even though this is not how it actually works) then you are still left with around 75-85k for living expenses and to save/invest. There will be additional costs that arise, but it definitely seems doable. I'm not sure when you purchased your practice, but today 75k probably won't even get you an office chair:(

              I will definitely work for someone else/work corporate before diving into private practice. Nobody is perfect right outside of dental school, and if I will be aiming for a 1 MM+ practice then I will have to produce at that level before I purchase one. Banks will need to see that as well.

              For what it's worth, which isn't much right now, I don't just want to be a dentist in my community, I want to be THE dentist in my community. I'm not the kind of person to settle with just being good enough at my job. I've always been very competitive, and I want to be the best dentist this planet has ever seen. I might never meet that goal, but I will definitely try.

              Thanks for discussing with me Dr. Tweed!
               
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              charlestweed

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                For a retiring dentist that isn't working as many hours, taking time off etc. Wouldn't it actually be a good thing if the office is still productive despite this. Or even if it isn't, a young dentist can come in and re-energize the practice right? Get it headed in the right direction again.

                When I said relocate, I meant more of moving to another state altogether. But now that I think about it, your scenario is probably more likely. Most dentists probably don't want to abandon their entire patient base and move to another location far away and have to build a new patient base. I can definitely see how many patients will follow the doctor as long as he stays nearby.

                For the 800k business loan, I was looking up the terms and it seems you can take a 10 year term, in which payments would be roughly 100k a year (probably a little bit more depending on the interest). For an 800k purchase, you would probably be buying a practice that gets around 1 MM+ in collections a year, and if you assume really high overhead (at 70%) since you will be just getting settled into the practice, maybe not up to speed etc. Then you should still net around 300k as the owner dentist, and then you can lower your taxable income through your retirement accounts, and interest on your business loan etc. And then you pay principle after that. Overall suppose your 300k turns into 135k after tax deductibles and Uncle Sam takes his cut, and then you subtract another 50k for the principle (I'm just assuming 50k principle and 50k interest, even though this is not how it actually works) then you are still left with around 75-85k for living expenses and to save/invest. There will be additional costs that arise, but it definitely seems doable. I'm not sure when you purchased your practice, but today 75k probably won't even get you an office chair:(

                I will definitely work for someone else/work corporate before diving into private practice. Nobody is perfect right outside of dental school, and if I will be aiming for a 1 MM+ practice then I will have to produce at that level before I purchase one. Banks will need to see that as well.

                For what it's worth, which isn't much right now, I don't just want to be a dentist in my community, I want to be THE dentist in my community. I'm not the kind of person to settle with just being good enough at my job. I've always been very competitive, and I want to be the best dentist this planet has ever seen. I might never meet that goal, but I will definitely try.

                Thanks for discussing with me Dr. Tweed!
                Yes, you can work hard and re-energize any existing practice to make it more successful. You don’t necessarily have to buy the $800k one that produces 1mil a year in order to make it. You can have the same success with a $150k office that produces $250k/year. With this hard work mentality, you’ll be successful wherever you practice. There are plenty of successful dentists in saturated markets like LA and NYC.

                The retiring doc doesn’t need to work many hours and he is happy with his office’s current gross production because he has zero debt to pay back. So he thinks his office is worth a lot. But for a young grad like you with student loan + $800k business loan + a home mortgage + car loan etc, will this office’s current gross income be high enough? Is it worth taking out a $800k loan to acquire it?

                You are exactly right. Most dentists don’t easily abandon their practices by selling them to other dentists when they are doing extremely well. Why would they want to back to square one by starting a new office in a new area, where they are not familiar with? If they have to move to another state, they can hire a couple of associate dentists and just fly in a once or twice a month to manage the practice. I have a friend who owns a practice in San Diego but he lives in Irvine (more than 100 miles away). His associate dentist works 5 days/week for him. His office manager saves all the difficult high production cases (implant placements, surgical extractions etc) for him to perform on 2 Saturdays a month.

                Having worked for the corp offices for 15 + years, I have the opportunity to meet a lot of different GPs. Many of them used to have their own offices but had to sell them because they couldn’t manage them. The current managing dentist at the corp where I am at, bought a practice a few years ago. It’s a large 6 op office. He thought it was a good buy but then he realized that it didn’t produce as much as he had hoped. So he sold it to another GP and now he works at the same corp office with me.
                 
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                charlestweed

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                  Charlestweed has more technology in his car than all his practices put together LOL.
                  More technology = more headaches and more $$$ to maintain them. I like everything in my office to be under my control. I don't like to rely on the outside services (sale reps, IT guys, Invisalign reps, 3D printing companies, equipment companies, supply companies) to fix things for me. I don't like to beg the repair guys to come in ASAP to fix things for me. Wires, brackets, and a brain are all I need to straighten people’s teeth. At the orthotown forum (the forum for orthodontists), I’ve seen many of my colleagues, who are getting frustrated in dealing with their malfunctioning equipment. Some spend hours on the phone and the reps give them the runaround....and nothing gets solved. Feel sorry for these docs.

                  That’s why I only lease cars. I don’t care if they break down because they are not mine. They give me a loaner car while they fix my car. By the time the warranty expires, I return the car and get a new one with a new warranty.
                   
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                  2TH MVR

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                    More technology = more headaches and more $$$ to maintain them. I like everything in my office to be under my control. I don't like to rely on the outside services (sale reps, IT guys, Invisalign reps, equipment companies, supply companies) to fix things for me. I don't like to beg the repair guys to come in ASAP to fix things for me. Wires, brackets, and a brain are all I need to straighten people’s teeth. At the orthotown forum (the forum for orthodontists), I’ve seen many of my colleagues, who are getting frustrated in dealing with their malfunctioning equipments. Some spend hours on the phone and the reps give them the runaround. Feel sorry for these docs.

                    That’s why I only lease cars. I don’t care if they break down because they are not mine. They give me a loaner car while they fix my car. By the time the warranty expires, I return the car and get a new one with a new warranty.

                    I agree with you. I was just being funny.
                     
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                    charlestweed

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                      Off topic but humor me...



                      Can you provide an example of this situation? How can any employee be safe from being fired if you own the business?
                      When I took over an existing practice that I purchased in 09, I had to keep the existing office manager because:
                      1. She was in charge of all the insurance billings.
                      2. She kept track of the payments from the patients and from their insurance companies.
                      3 She knew how much each patient still owed us, who already paid off the balance, which patients were picky and in need of some TLC etc.
                      4. She had great communication skills. A lot of patients liked her. She's White. The previous doc is White. Most of the existing patients were White. The patients were already shocked when they suddenly saw me, a new Asian doctor. I wouldn't want to make the matter worse by replacing her with my current office manager, who is a Mexican American.

                      She was paid $25/hour, which was $7 more than what I pay my current manager. She was very slow because she got used to the slower working pace of her previous boss. After about 9 months, when I was more familiar with the office and the existing patients, I reduced her salary to $13/hour and demoted her to receptionist title. I thought she would leave me because of this salary cut but she decided to stay with me. She was 62 yo and had nowhere else to go. And 3 years later, she retired.
                       
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                      We all know the whole schpiel, don't practice in a metro area. Competition is tough and getting tougher by the millisecond! Is a way to get the best of both worlds to simply take an hour long commute to your dental practice?

                      Suppose you really want to live in LA, or any other big desirable metro, since you are a young high flying dentist who doesn't want to spend his youth/entire life living in the middle of nowhere. But you also want to have a successful career, which is tough if you practice in the big metro. Could you just solve the issue by setting up a practice 30 miles away from a metro, in a more suburban/rural area. Is that a good strategy or are these areas heavily saturated as well?

                      What if you bought an existing successful practice in one of these suburbs? Then you don't have to worry about outcompeting peers for a patient base, because it will already be provided. You can focus on maintaining and growing your already healthy patient base. Are there any flaws in my logic, is this not feasible?

                      Not worth it. You will understand when you own a business. There's a few that can do the commute, but you will be exhausted. It's not worth commuting when you own a small business. Good luck.

                      However, if you want to associate...then sure commute all you want. You will understand when you own a small business and have to go in on the weekends and fix this and that past hours...or come in early or manage the entire business on top of clinical...commuting for 30-1hr will be the worst thing in the world for you.
                       

                      knewstance

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                        When I took over an existing practice that I purchased in 09, I had to keep the existing office manager because:
                        1. She was in charge of all the insurance billings.
                        2. She kept track of the payments from the patients and from their insurance companies.
                        3 She knew how much each patient still owed us, who already paid off the balance, which patients were picky and in need of some TLC etc.
                        4. She had great communication skills. A lot of patients liked her. She's White. The previous doc is White. Most of the existing patients were White. The patients were already shocked when they suddenly saw me, a new Asian doctor. I wouldn't want to make the matter worse by replacing her with my current office manager, who is a Mexican American.

                        She was paid $25/hour, which was $7 more than what I pay my current manager. She was very slow because she got used to the slower working pace of her previous boss. After about 9 months, when I was more familiar with the office and the existing patients, I reduced her salary to $13/hour and demoted her to receptionist title. I thought she would left me because of this salary cut but she decided to stay with me. She was 62 yo and had nowhere else to go. And 3 years later, she retired.
                        Thanks for the reply! I guess sometimes it is better to pay an employee a little more rather than jeopardize your business.
                         
                        Not worth it. You will understand when you own a business. There's a few that can do the commute, but you will be exhausted. It's not worth commuting when you own a small business. Good luck.

                        However, if you want to associate...then sure commute all you want. You will understand when you own a small business and have to go in on the weekends and fix this and that past hours...or come in early or manage the entire business on top of clinical...commuting for 30-1hr will be the worst thing in the world for you.
                        What do you think about owning a home near your office, and also owning a home/apartment in metropolitan area nearby. So if there are any issues/extra work with the office then you can choose to live by your office the entire week, and if the schedule is a bit more free then you can live back in the city.

                        I know it can get quite expensive, but owning a small home in a rural area should be relatively cheap I would assume. The actual expensive one would be owning/renting an apartment in the city.

                        But in this scenario you can both manage your practice and enjoy your social life/hobbies too.
                         
                        More technology = more headaches and more $$$ to maintain them. I like everything in my office to be under my control. I don't like to rely on the outside services (sale reps, IT guys, Invisalign reps, 3D printing companies, equipment companies, supply companies) to fix things for me. I don't like to beg the repair guys to come in ASAP to fix things for me. Wires, brackets, and a brain are all I need to straighten people’s teeth. At the orthotown forum (the forum for orthodontists), I’ve seen many of my colleagues, who are getting frustrated in dealing with their malfunctioning equipment. Some spend hours on the phone and the reps give them the runaround....and nothing gets solved. Feel sorry for these docs.

                        That’s why I only lease cars. I don’t care if they break down because they are not mine. They give me a loaner car while they fix my car. By the time the warranty expires, I return the car and get a new one with a new warranty.
                        On the flip side though, would you actually get a high ROI with more technology because it will make your work more efficient, and you will be able to spend more time with patients than you would doing everything manually. Technology can be a hassle, but I've read that the way the dental industry is going, especially corporate, is that they are taking advantage of the new technology to make their practice more efficient. There would be an initial investment in said technology, but in the long run it could pay off well.

                        Yes, you can work hard and re-energize any existing practice to make it more successful. You don’t necessarily have to buy the $800k one that produces 1mil a year in order to make it. You can have the same success with a $150k office that produces $250k/year. With this hard work mentality, you’ll be successful wherever you practice. There are plenty of successful dentists in saturated markets like LA and NYC.

                        The retiring doc doesn’t need to work many hours and he is happy with his office’s current gross production because he has zero debt to pay back. So he thinks his office is worth a lot. But for a young grad like you with student loan + $800k business loan + a home mortgage + car loan etc, will this office’s current gross income be high enough? Is it worth taking out a $800k loan to acquire it?

                        You are exactly right. Most dentists don’t easily abandon their practices by selling them to other dentists when they are doing extremely well. Why would they want to back to square one by starting a new office in a new area, where they are not familiar with? If they have to move to another state, they can hire a couple of associate dentists and just fly in a once or twice a month to manage the practice. I have a friend who owns a practice in San Diego but he lives in Irvine (more than 100 miles away). His associate dentist works 5 days/week for him. His office manager saves all the difficult high production cases (implant placements, surgical extractions etc) for him to perform on 2 Saturdays a month.

                        Having worked for the corp offices for 15 + years, I have the opportunity to meet a lot of different GPs. Many of them used to have their own offices but had to sell them because they couldn’t manage them. The current managing dentist at the corp where I am at, bought a practice a few years ago. It’s a large 6 op office. He thought it was a good buy but then he realized that it didn’t produce as much as he had hoped. So he sold it to another GP and now he works at the same corp office with me.

                        It's interesting that many GP's cannot manage their practices. It has been said many times that in dental school they only prepare us for dentistry and not business. Do you think it would be wise to hire a dental business consultant? I know that corp offices usually provide support for the business side of the practice, but in the process the practice is not solely yours anymore. Can a business consultant provide the same kind of support?
                         

                        charlestweed

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                          On the flip side though, would you actually get a high ROI with more technology because it will make your work more efficient, and you will be able to spend more time with patients than you would doing everything manually. Technology can be a hassle, but I've read that the way the dental industry is going, especially corporate, is that they are taking advantage of the new technology to make their practice more efficient. There would be an initial investment in said technology, but in the long run it could pay off well.
                          This is not necessarily true. It's actually the opposite for my office. My office is 100% paper charts. I can write faster than I type. The computer in the office is mainly used for word processing and printing out patient's photos. There is no internet in the office, which helps prevent the staff from browsing the web and become lazy. I can see a lot more patients in a day than the offices that have all the high tech gadgets. For example, tomorrow, Sunday, I will have 102 patients on the appt book. With 6 chairside RDAs, we will finish treating all the patients by 12:30pm (we'll start at 8am).

                          Low tech also helps keep the staff busy. During non-clinic hours, instead of letting them sit around doing nothing, my staff will do things like calling patients to remind their appts (no need to waste $$$ on automated text system), pulling out charts ahead of time, tracing ceph films, making retainers, billing the insurance, printing out patients' photos etc. The more technology you have, the less thing for your staff to do to stay busy.

                          Technology is the culprit for driving up the cost of running the office. The orthodontists, who practiced in the 80s and 90s didn't have any of these gadgets. And yet, these orthos were able to see the same (or more) number of patients per day as the today modern ortho offices that have all the expensive equipments. Those sale reps just want your money.

                          I am working on a deal to acquire another existing office that currently uses digital charts. If the deal goes through, I plan to convert it back to paper chart system to increase the efficiency

                          It's interesting that many GP's cannot manage their practices. It has been said many times that in dental school they only prepare us for dentistry and not business. Do you think it would be wise to hire a dental business consultant? I know that corp offices usually provide support for the business side of the practice, but in the process the practice is not solely yours anymore. Can a business consultant provide the same kind of support?
                          I work with the managing GP at the corp today. He told me that he paid $600k for his previous office. He asked a lawyer and a consultant to evaluate the office and they said to him all the numbers looked good. So he bought it. And when he took over, he realized it was a big mess. He then sold it and now work with me at the corp office.
                           
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                          On the flip side though, would you actually get a high ROI with more technology because it will make your work more efficient, and you will be able to spend more time with patients than you would doing everything manually. Technology can be a hassle, but I've read that the way the dental industry is going, especially corporate, is that they are taking advantage of the new technology to make their practice more efficient. There would be an initial investment in said technology, but in the long run it could pay off well.



                          It's interesting that many GP's cannot manage their practices. It has been said many times that in dental school they only prepare us for dentistry and not business. Do you think it would be wise to hire a dental business consultant? I know that corp offices usually provide support for the business side of the practice, but in the process the practice is not solely yours anymore. Can a business consultant provide the same kind of support?

                          Technology is a huge waste of money.

                          A laser to take an impression doesn’t reimburse you more then traditional 5 cent cord. Same with digital impressions or whatever. Run your practice lean and mean. But there are other practices that do use technology to their advantage but those in my opinion are far and few in between. You do what’s right for your demographic and your practice goal. I still use paper charts from 20 years ago...I still have cabinets that are 10-20 years old...efficiency does not come from technology...efficiency comes from SYSTEMS in the office. For example, patient comes in for cleaning- before they are seated all insurance the day prior checked in and printed out, hygiene check 30 minutes into appointment, assistant inputs needed treatment plan which then my front receives it, at 50 minute mark, hygienist schedules their recall, walks them out, my front gives them estimate and benefit breakdown, they schedule for treatment. NEXT. The only thing "technology wise" that I can see that would help with the flow maybe converting paper charts to digital but I'm not willing to spend 10...20...30k on something when I'm doing just fine as is. Laser...digital milling...expensive whatever...waste of money. Go on amazon and go buy a intraoral picture taker for 5$ or you can be "technology hip" and spend 1000$ from your local dental supply rep. I think I know what answer you will choose.

                          Business consultant is a waste.

                          The key ingredients for success include is a ton of things. Go work in 4-5 associateships and see what works and doesn’t work. There are systems to everything and the good practices employ them. You don’t need to pay some consultant 20000 to teach you this. With the example above on how to get a patient in hygiene and into your restorative chair...do you really need someone to teach you this? or perhaps to "collect up front" prior to treatment? probably not...but if you do, I'll come teach you. Just pay me consulting fee. :p

                          You ask a lot of hypotheticals... which is sorta equivalent to how do I raise a kid and how do I teach them to do well to grow up to be good young adults. The answer is you just do it and do your best. With confidence, a plan and a goal you can make your practice work. Yes CE helps just like self help books on raising a child.... or a business consultant sorta like having a nanny teach your kids manners and doing homework well but the bottom line is that you are the key ingredient that will make or break the practice. And like I said... nanny...business consultant money down the drain...

                          Go work in a few associateships and see what the good dentists are doing to make it work. Go see how a good parent raises their kid sets boundaries holds them accountable and they will grow up hopefully to be good functioning adults.

                          I know I didn’t answer question but these hypothetical questions cannot be answered with an x y z answer. The biggest thing I can say that will influence your success is how you manage the business and how you come across to people. People care more about their dentist friendliness over how clinically good they are. They also care if they are seen on time and if they get a correct benefit breakdown and not stuck with a huge bill. We have all heard of the crappy dentist down the street that has a crazy busy practice but his work sucks being better off then the clinically good dentist who who sucks as a people person. To an extent this is true. Everything else comes second.
                           
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                          2TH MVR

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                            Since we're on the tech train. I envy Charlestweed's non tech approach. I believe his approach works because he's ALL IN with it. Low overhead, low tech and low prices. No ambiguity in his business approach.
                            The reality is that most ortho practices do not operate like that. Most traditional type practices utilize some type of practice software to allow appointments, patient and insurance electronic billing, email and text reminders, private patient portals where patient can view their financial and treatment details. Many insurance companies require that practices utilize online deposits.
                            If you are a specialty practice with multiple locations and you work with similar minded GP's ..... you need to have the capability to access patient information in real time from any office. If referral GP calls your office and asks for a recent pano on patient X. A fully digital office can email that pano immediately. From any location. At any time.

                            To repeat. I envy Charlestweed's approach.

                            All this software requires hardware that needs to be updated from time to time. Software that requires constant support. All of this costs $$$$$$. I have a theory about software. Do you think they design the software to be absolutely fault free? Hell no. If they did .... their software would be perfect and you would not need to pay for their constant support fees. The software was designed with bugs so you will always require their costly support.

                            A typical day in the private office. You come in Mon am. The receptionist greets you with her eyes down. Doc .... the computers are down. The staff calls the software company. They then want to log in via the internet. But guess what? Your internet also is not working that day. You call your ISP and finally get the internet back up. Call the software company and guess what? They tell you it's a hardware issue and we need to call our IT people. MORE MONEY.

                            I used to use 2 servers connected via an internet line for the 2 locations. One of our servers was infected and the scammers turned my server into a zombie server that simply allows me to work, but the server was also sending out their spam. I didn't know about it till the ISP calls me and tells me I have a virus. I said fine ....fix it. Nope. It's MY problem. Lets be clear. All of my servers and workstations have state of the art anti-virus/anti-malware software (more $$$$$$$$$). None of it worked. Called my IT guy. He had to back up my info. Remove all the data frm the server. Re-install all the software after spending time with the individual software companies. New IP address. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$.
                             
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                            Since we're on the tech train. I envy Charlestweed's non tech approach. I believe his approach works because he's ALL IN with it. Low overhead, low tech and low prices. No ambiguity in his business approach.
                            The reality is that most ortho practices do not operate like that. Most traditional type practices utilize some type of practice software to allow appointments, patient and insurance electronic billing, email and text reminders, private patient portals where patient can view their financial and treatment details. Many insurance companies require that practices utilize online deposits.
                            If you are a specialty practice with multiple locations and you work with similar minded GP's ..... you need to have the capability to access patient information in real time from any office. If referral GP calls your office and asks for a recent pano on patient X. A fully digital office can email that pano immediately. From any location. At any time.

                            To repeat. I envy Charlestweed's approach.

                            All this software requires hardware that needs to be updated from time to time. Software that requires constant support. All of this costs $$$$$$. I have a theory about software. Do you think they design the software to be absolutely fault free? Hell no. If they did .... their software would be perfect and you would not need to pay for their constant support fees. The software was designed with bugs so you will always require their costly support.

                            A typical day in the private office. You come in Mon am. The receptionist greets you with her eyes down. Doc .... the computers are down. The staff calls the software company. They then want to log in via the internet. But guess what? Your internet also is not working that day. You call your ISP and finally get the internet back up. Call the software company and guess what? They tell you it's a hardware issue and we need to call our IT people. MORE MONEY.

                            I used to use 2 servers connected via an internet line for the 2 locations. One of our servers was infected and the scammers turned my server into a zombie server that simply allows me to work, but the server was also sending out their spam. I didn't know about it till the ISP calls me and tells me I have a virus. I said fine ....fix it. Nope. It's MY problem. Lets be clear. All of my servers and workstations have state of the art anti-virus/anti-malware software (more $$$$$$$$$). None of it worked. Called my IT guy. He had to back up my info. Remove all the data frm the server. Re-install all the software after spending time with the individual software companies. New IP address. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$.

                            +1 technology is not the silver bullet that will make your practice stand out from the others. From a practice management standpoint- yes it has its uses and most offices are half paper/half digital, but converting to full digital may help...but the returns are meh questionable. From a clinical standpoint- dentists haven't gotten a raise in many years from insurance companies...why would you invest in an expensive laser when I can buy cord in bulk for 5$ and be good for 1 year. You still get paid the same either way if you take the impression with cord of laser. In addition technology can be a pain to work with. Do you know all the support costs $$$. Do you know that if your one assistant who does digital impressions leave...you have to train a new assistant to take digital impressions. Do you know that training someone and finding someone good at a dental assisting position is hard as hell?

                            The reality is doom and gloom, a few will make it big but the average practitioner will be stuck at the ADA average of whatever income they publish. Don't go into the business expecting to be one of the high outliers of 300-500 income. They don't represent the majority. Commuting "out" to make "big as a dentist" is getting way smaller. In the area I live, I don't live in a city...just an outside suburb. I would have to commute out 2-3 hours before the saturation "goes away." So i wouldn't count on commuting out because the reality is the 1000 other dentists have that same idea and already have setup shop.
                             
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                            charlestweed

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                              ...Go work in 4-5 associateships and see what works and doesn’t work. There are systems to everything and the good practices employ them. You don’t need to pay some consultant 20000 to teach you this. With the example above on how to get a patient in hygiene and into your restorative chair...do you really need someone to teach you this? or perhaps to "collect up front" prior to treatment? probably not...but if you do, I'll come teach you. Just pay me consulting fee.
                              I learned so much from my associate jobs. Unlike many orthodontist colleagues, I didn’t go to the AAO conventions to ask the sale reps for advice and to shop for managing software, computers, equipment, chairs etc when I set up my new office. I didn’t hire any consultant. I didn’t do any demographic study. I liked how brilliantly and effectively the 3 corps that I worked for ran their offices: simple paper chart system, high efficiency, and low overhead. So I just copied their successful business model. I bought the same x ray machine, sterilizer and used the same forms and legal documents that the corps used.
                               
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                              charlestweed

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                                Since we're on the tech train. I envy Charlestweed's non tech approach. I believe his approach works because he's ALL IN with it. Low overhead, low tech and low prices. No ambiguity in his business approach.
                                The reality is that most ortho practices do not operate like that. Most traditional type practices utilize some type of practice software to allow appointments, patient and insurance electronic billing, email and text reminders, private patient portals where patient can view their financial and treatment details. Many insurance companies require that practices utilize online deposits.
                                If you are a specialty practice with multiple locations and you work with similar minded GP's ..... you need to have the capability to access patient information in real time from any office. If referral GP calls your office and asks for a recent pano on patient X. A fully digital office can email that pano immediately. From any location. At any time.

                                To repeat. I envy Charlestweed's approach.

                                All this software requires hardware that needs to be updated from time to time. Software that requires constant support. All of this costs $$$$$$. I have a theory about software. Do you think they design the software to be absolutely fault free? Hell no. If they did .... their software would be perfect and you would not need to pay for their constant support fees. The software was designed with bugs so you will always require their costly support.

                                A typical day in the private office. You come in Mon am. The receptionist greets you with her eyes down. Doc .... the computers are down. The staff calls the software company. They then want to log in via the internet. But guess what? Your internet also is not working that day. You call your ISP and finally get the internet back up. Call the software company and guess what? They tell you it's a hardware issue and we need to call our IT people. MORE MONEY.

                                I used to use 2 servers connected via an internet line for the 2 locations. One of our servers was infected and the scammers turned my server into a zombie server that simply allows me to work, but the server was also sending out their spam. I didn't know about it till the ISP calls me and tells me I have a virus. I said fine ....fix it. Nope. It's MY problem. Lets be clear. All of my servers and workstations have state of the art anti-virus/anti-malware software (more $$$$$$$$$). None of it worked. Called my IT guy. He had to back up my info. Remove all the data frm the server. Re-install all the software after spending time with the individual software companies. New IP address. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$.
                                Yeah, I guess I am in the minority camp of the orthodontists who don’t like to change things. 2THMVR, I am sure you used paper charts and other low tech stuff before since you graduated 10 years before me. I remember when I did my ortho residency in the early 2000s, digital pan/ceph and paperless chart technology didn’t even exist…and if they did, they were probably at a very primitive stage.

                                My manager still fills out the insurance forms with a pen and we get the insurance checks in the mail…no digital billing, no direct deposit. Since our offices are only opened 12 days/month to treat patients, I need to create work for my manager to do to stay busy the other 10 days in a month. Having these 10 non-clinic days in a month allows my 3 F/T staff to better prepare for the busy clinic days ahead …such as calling the patients to remind their appts, keeping the supplies fully stocked, pulling out charts ahead of time to make sure no chart is loss, getting all the lab cases ready to be delivered, verifying the insurance benefit for new patients etc. With such careful planning ahead of time, we don’t really need the technology in order to have a smooth clinic flow.

                                This is the only piece of hardware that I have to upgrade every year….a $10 appointment book.
                                 

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                                The reality is doom and gloom, a few will make it big but the average practitioner will be stuck at the ADA average of whatever income they publish.

                                Honestly though, that is why I'm trying to do some research/find some ideas to maximize my chances of being a top dentist. I agree any simple solution, probably 1000's of dentists have already thought of it and tried to implement it, and commuting might not be an actual solution as I have found out in this thread. But there HAS to be something that sets dentists apart from each other, other than simply location.

                                Personally, I expect to be a good dentist, not an average one. If you only aim to be an average dentist, you will never become a great dentist. Only if you aim to become a great dentist can you actually become a great dentist. I have the same mindset in school right now. I don't expect myself to get the average GPA (3.6) to get into dental school, but rather I expect myself to get a perfect 4.0 GPA. This way, I aim for an A in every class, and I absolutely will not take a B as an acceptable grade. That mindset really has helped me do well in school. I do believe your success is dependent on what work you put in. Yeah there is a bell curve, and majority will be within 1 to 2 SD of the mean, but there will be those outliers, and those outliers are not there randomly, it's because they put in that work to achieve that type of success. Attaining a 4.0 is definitely an outlier, and majority won't attain it, but that doesn't mean that you should lower your expectations, but rather find a strategy to become that outlier. I would carry those same principles in setting up a dental business.
                                 
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