What happened in 2019 for Dentists vs Corporations?

[Cold Front]

The number of new grads has not changed much from 2018 v 2019, which was about 6,300 a year.

The 2 biggest dental corporations, Heartland and Aspen both opened their 1,000th and 800th offices this month, respectively. Both DSO’s opened about 60-70 offices each in 2019 - the smaller DSO’s opened significant number of offices between them as well. Overall, a 5-10% growth for all traditional DSO’s combined, while silent DSO’s are growing even faster - like MB2 Dental.

So in 2020, there will be no increase in new dentists/new grads (a good 20-30% will go to residencies and specialize) while corporate dentistry is expected to open at least 1,000 new offices - by either purchasing existing offices or building new offices from scratch. The growth in solo dentist offices will slow down and be outpaced by the growth in DSO offices by 3 to 1, if not more. The dentist workforce pendulum will continue to swing further into the DSO side, something we all knew would happen but it’s only happening faster.

Heartland Dental Achieves Growth Milestone with Support for 1,000 Dental Offices Nationwide

/PRNewswire/ -- Heartland Dental, the nation's largest dental support organization, announced a record-setting milestone today as the company provides support...

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Aspen Dental Celebrates Major Milestone With Opening of 800th Office

CHICAGO--(BUSINESS WIRE)--Dec 19, 2019-- Aspen Dental, the largest and fastest-growing branded network of dental offices in the country, is closing out the decade by celebrating a significant milestone: the opening of the 800th Aspen Dental location in Southern Pines, NC.

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[knewstance]

by either purchasing existing offices or building new offices from scratch.

I think this will be a big factor in market saturation. If they are buying existing offices, in general, the market will stay the same in that region. Where adding new offices obviously that contributes to market saturation.

 

[2TH MVR]

If they are buying existing offices, in general, the market will stay the same in that region. Where adding new offices obviously that contributes to market saturation.

Not necessarily. Especially for specialists. Corp buys existing GP office. Corp has their own specialists. The specialist next door loses the original GP referrals and now has a new competitor. In other words .... The specialist loses twice. This happened to me in BOTH of my Ortho practices.

 

[Cold Front]

Not necessarily. Especially for specialists. Corp buys existing GP office. Corp has their own specialists. The specialist next door loses the original GP referrals and now has a new competitor. In other words .... The specialist loses twice. This happened to me in BOTH of my Ortho practices.

It’s a downhill game for dentists wanting to have their own autonomy in the long run. Practice ownership is still good today and at least the next 10 years. But with many new grads getting 10+ corporate offers from day 1 - and getting them enticed to work longer by offering them bigger benefits and partnership positions and more $$$ - who would say no to that? Corporations know more about young dentists’ career goals than young dentists themselves.


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[Ladm8]

Can anyone provide insight about what the 'right' answer is when asked about DSO's at interviews? I think they partially solve an access to care issue since most of them take welfare patients. but many DSO's are operated private equity and this sort of money in dentistry will not be good in for the autonomy of our profession in the long run.

 

[charlestweed]

There are only 2 options, if you don't want to move to rural areas:

1. Set up your office right next to the corp office and compete against them by offering better services such as offering honest tx recommendations, fewer redos, shorter wait time, having a real receptionist to answer all the calls (and not some automated answering services), weekend office hours, accepting more insurance plans, charging similar fees etc. The corp offices can make huge profit from treating low income patients. So why can't you? You have lower overhead. Your office rent is lower. You spend less money on advertisement. You are the dentist and don't have to pay associate dentist salary.

2. If you don't know how to compete against the corp offices, then work for them.

 

[Cold Front]

There are only 2 options, if you don't want to move to rural areas:

1. Set up your office right next to the corp office and compete against them by offering better services such as offering honest tx recommendations, fewer redos, shorter wait time, having a real receptionist to answer all the calls (and not some automated answering services), weekend office hours, accepting more insurance plans, charging similar fees etc. The corp offices can make huge profit from treating low income patients. So why can't you? You have lower overhead. Your office rent is lower. You spend less money on advertisement. You are the dentist and don't have to pay associate dentist salary.

2. If you don't know how to compete against the corp offices, then work for them.

I would disagree with the 1st option - the opposite could be true as well.

Many DSO’s have competent dentists working for them. The chair side skills rule still heavily applies. A highly experienced with a good personality DSO dentist versus an average skilled solo dentist could make the solo dentist lose patients to the DSO dentist. You can’t assume you are going to be successful as a solo dentist by opening next to a DSO office without truly knowing what you are up against - the DSO dentist(s) skills and other qualities.


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[charlestweed]

I would disagree with the 1st option - the opposite could be true as well.

Many DSO’s have competent dentists working for them. The chair side skills rule still heavily applies. A highly experienced with a good personality DSO dentist versus an average skilled solo dentist could make the solo dentist lose patients to the DSO dentist. You can’t assume you are going to be successful as a solo dentist by opening next to a DSO office without truly knowing what you are up against - the DSO dentist(s) skills and other qualities.

Then you have to accept the defeat and your own failure because your skills are inferior to those of your competitors.

 

[Cold Front]

Then you have to accept the defeat and your own failure because your skills are inferior to those of your competitors.

In that example yes. But I wouldn’t bet $200-300k in building or buying an office next to a DSO office without knowing the competition well. The same way you would vet other solo dentists in the area. You can be highly confident and highly experienced - but there is always the chance you are not as good as the DSO dentist next door, clinically and personality. I worked in DSO offices where the dentists were some of the best I have seen in the field.


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[charlestweed]

In that example yes. But I wouldn’t bet $200-300k in building or buying an office next to a DSO office without knowing the competition well. The same way you would vet other solo dentists in the area. You can be highly confident and highly experienced - but there is always the chance you are not as good as the DSO dentist next door, clinically and personality. I worked in DSO offices where the dentists were some of the best I have seen in the field.


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Successful dentists are succesful not only because they are clinically competent but also because they know how to make their patients feel comfortable. If I were a patient, I would choose a dentist who posesses these qualities as well. If you don't have confidence in yourself and think your skills are inferior to those of your competitors, then there is always an option #2......you still make money.

 

[AONLINE]

But with many new grads getting 10+ corporate offers from day 1 - and getting them enticed to work longer by offering them bigger benefits and partnership positions and more $$$ - who would say no to that?

If a new grad does not care about autonomy, then this is an ideal situation for them, right? Less headache due to running business and the money is just as good... Especially when the corp makes you partner.


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[ToothJockey]

If a new grad does not care about autonomy, then this is an ideal situation for them, right? Less headache due to running business and the money is just as good... Especially when the corp makes you partner.


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I think the money is significantly worse, because corp takes a huge chunk of whatever work you put in. If a corp pays you 300k a year as a partner, you better believe they are making even more off your hard work than that. In private practice that same doc putting in the same amount of hard work could be making double that income. At the end of the day they are a private equity group, they are greedy for money. They're gonna milk the dentists for every last dollar and the dentist won't know or maybe won't care. Then a few years later the dentist will come on SDN or DentalTown and complain how they are working too much and not getting paid enough. Lets face it dentists are just burger flippers with advanced degrees to a corporation.

@Cold Front What do you think the market share for corp will be in 20 years? Right now its pretty low, around 10-15% or so I think, but it's growing exponentially. I feel like eventually it will slow down. There will always be dentists who want their autonomy, and want to run their own practice. Even dentists who work at Corps, they typically don't work there long term, it's just a way of getting a start in the profession, until they build up their own practice.

 

[Cold Front]

@Cold Front What do you think the market share for corp will be in 20 years? Right now its pretty low, around 10-15% or so I think, but it's growing exponentially. I feel like eventually it will slow down. There will always be dentists who want their autonomy, and want to run their own practice. Even dentists who work at Corps, they typically don't work there long term, it's just a way of getting a start in the profession, until they build up their own practice.

According to the ADA, the growth of DSO is reported to be 14% a year and rising, while growth of solo practice is 7% and declining. So we have these 2 events changing the dynamics of the dentist workforce to an inflection point - a turning point in which a dramatic change will happen that will result something similar to what we’ve seen in the pharmacy profession in the 1970-1990’s.

Pharmacy started like dentistry, with solo pharmacy shops dominating the industry. Then over few decades, corporations took over, completely making it difficult for a solo pharmacist to own his/her own shop - because Phamacy corporations heavily pushed the insurance industry and the manufacturers to support the corporate business models than solo business models. We have the same issue today in dentistry, where corporations is slowly molding the insurance industry and dental suppliers to be more favorable to corporate dentistry business models.

So in 20 years, I think dental corporations will figure out how to keep solo practitioners from entering or practicing in certain markets by buying their offices - just the charts/records, then close the office, with a 5-10 years non-compete clauses. So we could see corporate exclusive markets, or territories, just like CVS and Walgreens cornered the pharmacy business. I have a friend who had a pharmacy shop near a CVS pharmacy store, and she was approached by CVS corporate, and was told to leave the area for a fee - based on how many clients she had, plus a job offer at a local CVS pharmacy store. She took it, and had to accept a 5 yrs non-compete clause in the area. Could this happen in dentistry? Absolutely. Could it happen next year? No. In 20 years? I can see it happening - specially if more dental schools open and more new grads enter the market, just like it did in the pharmacy profession - the catalyst to their corporate take over.


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[ToothJockey]

According to the ADA, the growth of DSO is reported to be 14% a year and rising, while growth of solo practice is 7% and declining. So we have these 2 events changing the dynamics of the dentist workforce to an inflection point - a turning point in which a dramatic change will happen that will result something similar to what we’ve seen in the pharmacy profession in the 1970-1990’s.

Pharmacy started like dentistry, with solo pharmacy shops dominating the industry. Then over few decades, corporations took over, completely making it difficult for a solo pharmacist to own his/her own shop - because Phamacy corporations heavily pushed the insurance industry and the manufacturers to support the corporate business models than solo business models. We have the same issue today in dentistry, where corporations is slowly molding the insurance industry and dental suppliers to be more favorable to corporate dentistry business models.

So in 20 years, I think dental corporations will figure out how to keep solo practitioners from entering or practicing in certain markets by buying their offices - just the charts/records, then close the office, with a 5-10 years non-compete clauses. So we could see corporate exclusive markets, or territories, just like CVS and Walgreens cornered the pharmacy business. I have a friend who had a pharmacy shop near a CVS pharmacy store, and she was approached by CVS corporate, and was told to leave the area for a fee - based on how many clients she had, plus a job offer at a local CVS pharmacy store. She took it, and had to accept a 5 yrs non-compete clause in the area. Could this happen in dentistry? Absolutely. Could it happen next year? No. In 20 years? I can see it happening - specially if more dental schools open and more new grads enter the market, just like it did in the pharmacy profession - the catalyst to their corporate take over.


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I see what you mean. There are a ton of dentists selling their practices to corps, which means those practices are not available for new grads to buy. That means the corps can keep growing. The selling dentists get much more money that way too, since corps pay a premium for practices, but they still make a profit.

Is there anything dentists can do to stop this takeover? Will the market share for corps reach near 100%, like pharmacy?

And what should be the goal for someone entering the profession today, but who doesn't want to partner with corporate? I'm guessing if you only have 20 years or so, you gotta make as much money as possible as fast as possible, hustle like crazy and invest like crazy, sell the practice, become financially independent and retire before it all goes downhill. A long 40 year career is probably not feasible anymore, working that long independently and competition will gobble you up, working that long for a corp and you will burn out.

Also, what are your thoughts on medicine? Private equity groups are gobbling up dermatology practices, surgical practices. A ton of doctors work for hospitals, which is pretty much corporate. Do you think corp will have a similar takeover in medicine?

 

[ToothJockey]

Also for what it's worth, I prefer going to my personal barber than Great Clips to get my haircuts. At the end of the day it's just cutting hair, but I love the service my barber provides. It costs me double or even triple the price going to my barber than going to Sports Clips or Great Clips, but I don't think I'll ever go to a corporate barbershop ever again.

This is just to give a comparison. Way back, every barber had his own business, there were no corps. Now there are lots of corporate barbershops, and they have definitely taken a huge market share. But at the end of the day, private barbershops still exist and they are still thriving (my barber increased his rates by 20%, but he still has a completely full schedule), because it's about the service they provide. They make you feel comfortable, you can build a relationship with your barber etc.

IMO, There are going to be patients out there who want a dentist they can go to regularly, unlike a corp setting where you will see a new dentist every time you go. They want that higher quality service, they want to build a relationship with their dentist. I see it in the dental office I shadowed at. There were patients that literally drove 100 miles just to see the owner dentist, because they had been seeing him their whole life, and they moved but they still wanted to go to the same dentist. It's about trust. In my experience, pharmacy is nothing like this. I don't care who gives me my meds. I don't even know their names.

 

[2TH MVR]

According to the ADA, the growth of DSO is reported to be 14% a year and rising, while growth of solo practice is 7% and declining. So we have these 2 events changing the dynamics of the dentist workforce to an inflection point - a turning point in which a dramatic change will happen that will result something similar to what we’ve seen in the pharmacy profession in the 1970-1990’s.

Pharmacy started like dentistry, with solo pharmacy shops dominating the industry. Then over few decades, corporations took over, completely making it difficult for a solo pharmacist to own his/her own shop - because Phamacy corporations heavily pushed the insurance industry and the manufacturers to support the corporate business models than solo business models. We have the same issue today in dentistry, where corporations is slowly molding the insurance industry and dental suppliers to be more favorable to corporate dentistry business models.
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The difference between us and pharm is that dentists actually produce something. Pharmacy does not. Pharmacists appear as an EXPENSE on the P&L whereas dentists are a revenue producing expense. Pharmacy is done. Automation is the next nail in the coffin for pharmacy.

A long 40 year career is probably not feasible anymore, working that long independently and competition will gobble you up, working that long for a corp and you will burn out.

Also, what are your thoughts on medicine? Private equity groups are gobbling up dermatology practices, surgical practices. A ton of doctors work for hospitals, which is pretty much corporate. Do you think corp will have a similar takeover in medicine?

Anything is feasible. You are over analyzing again. Yes. Corps are everywhere and are gaining momentum, but there are still rural areas where a dentist can set up a mom and pop traditional practice. Will that area see Corps? Maybe, but Corps like big, urban areas with plenty of people. A small, efficient, well-known, good reputation dental practice will have a better chance of success in those rural areas. The question then becomes? Can you and your family live in a rural setting? Easy to say yes until you actually have to live there.

Medicine is more Corp than dentistry. Dentistry is following the Corp medical model. Even medical Corps are putting out SMALLER clinics (like dental Corps) rather than the big hospitals.

Medicine has it's own problems. Go read their boards.

Also for what it's worth, I prefer going to my personal barber than Great Clips to get my haircuts. At the end of the day it's just cutting hair, but I love the service my barber provides. It costs me double or even triple the price going to my barber than going to Sports Clips or Great Clips, but I don't think I'll ever go to a corporate barbershop ever again.

This is just to give a comparison. Way back, every barber had his own business, there were no corps. Now there are lots of corporate barbershops, and they have definitely taken a huge market share. But at the end of the day, private barbershops still exist and they are still thriving (my barber increased his rates by 20%, but he still has a completely full schedule), because it's about the service they provide. They make you feel comfortable, you can build a relationship with your barber etc.

IMO, There are going to be patients out there who want a dentist they can go to regularly, unlike a corp setting where you will see a new dentist every time you go. They want that higher quality service, they want to build a relationship with their dentist. I see it in the dental office I shadowed at. There were patients that literally drove 100 miles just to see the owner dentist, because they had been seeing him their whole life, and they moved but they still wanted to go to the same dentist. It's about trust. In my experience, pharmacy is nothing like this. I don't care who gives me my meds. I don't even know their names.

Agreed. People are all different. People don't rate all SERVICES equally. Convenience plays a HUGE part ... especially with the new generation. Why go to the store and buy food when I can have it delivered? Why make a hair appt when I can just drop in without an appt whenever I WANT TO GO to get my haircut. I personally pay extra to see a prosthodontist. I like the small office. I can afford this. Many cannot. Is this prosthodontist successful? I have no idea. BTW: in my Corp ..... patients see the SAME dentist or specialist. An argument can be made that an employed dentist gets to spend 100% of their time treating patients. Yes. There is pressure to produce, but that exists in both Corp and Private. Production is necessary for any business to thrive.

One more thing about ownership. It's not easy for everyone to own their own practice. You need to have some concept of running a small business. You will spend more hours running your practice than any dentist employee working at a Corp. There will always be the constant stress on producing enough to pay the ever increasing monthly bills. Ownership is great IF YOU ARE BEING COMPENSATED FOR YOUR EXTRA EFFORT. If you do not make sufficient revenue and are struggling ...... than ownership is not for you. There is just so much involved in running a small business. Many here say they want to own their own practice, but few here really understand the time involvement necessary. You wear many different hats when you have your own practice. The number of new hats never ends.

I'm all for dentist ownership, but pick the right area.

 

[Cold Front]

Is there anything dentists can do to stop this takeover? Will the market share for corps reach near 100%, like pharmacy?

And what should be the goal for someone entering the profession today, but who doesn't want to partner with corporate? I'm guessing if you only have 20 years or so, you gotta make as much money as possible as fast as possible, hustle like crazy and invest like crazy, sell the practice, become financially independent and retire before it all goes downhill.

Also, what are your thoughts on medicine? Private equity groups are gobbling up dermatology practices, surgical practices. A ton of doctors work for hospitals, which is pretty much corporate. Do you think corp will have a similar takeover in medicine?

Dentists can’t stop DSO’s. Corporations have passed the point of no return in my opinion. DSO’s were born in the hands of dentists - every DSO was started by a dentist or a dentist was used to help it start. They were allowed to flourish by dentists, and now many DSO’s have grown to the level of too big to fail. They have seats at dental boards, part of corporate conglomerate America and have very strong ties to financial and economic influential people in this country - through their parent companies and deep pocket investors.

The goal for any new grad today (or the next 20 years) is to acknowledge that DSO’s are a chain of competition that can be at anywhere the new grad works. The new grad patients and future patients are also highly aware of the DSO brand names; Aspen, Heartland, Pacific, SmilesDirectClub, and so on. A consumer/patient who was psychologically trained in the era of corporate conveniences will understand that the dental chains are competing for them and will try to get the best service at the cheapest cost - by reading Google reviews and YouTube feedbacks. Social media has given DSO’s a big leap to grow faster and connect more with potential patients. If a perspective patient searches Aspen Dental on google - suddenly, Aspen now knows that patient is looking for them and they can track and target the patient in other social media networks with ads and offers. Solo dentist offices doesn’t do that - they are all destination offices and many still use word of mouth and a website for patients to find them. While DSO’s function as a well oiled corporate machine that taps into a lot more consumer data and information (not to mention billboards, tv ads, and sponsorships) to find new patients through highly marketing specialists and algorithms. It’s a losing battle for the solo dentist.

I haven’t researched medicine - but I think MD’s have already joined big hospital networks that gives them more benefits and income than a solo MD - at least their specialists do.


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[Cold Front]

Also for what it's worth, I prefer going to my personal barber than Great Clips to get my haircuts. At the end of the day it's just cutting hair, but I love the service my barber provides. It costs me double or even triple the price going to my barber than going to Sports Clips or Great Clips, but I don't think I'll ever go to a corporate barbershop ever again.

Corporations have workshops for the new dentists and staff. They prioritize patient experiences more than clinical skills to be the center of their business. Most patients do not go home and look at their fillings in the mirror and then rate their dentists. If you closely read dental reviews, patients talk about how nice the dentist and their staff was - how beautiful the office looked, how quickly they were seen, how close the office was to their workplace or home, and so on. Corporate dentistry spends lot more money than a solo dentist to maximize the office ambiance that the patient expects. There are a lot of good and better coffee shops than Starbucks in the country, why didn’t they became big and successful like Starbucks? Because Starbucks service experience is to the T for the most coffee drinkers.

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[Cold Front]

The difference between us and pharm is that dentists actually produce something. Pharmacy does not. Pharmacists appear as an EXPENSE on the P&L whereas dentists are a revenue producing expense. Pharmacy is done. Automation is the next nail in the coffin for pharmacy.

I disagree. An employee is an employee, whether they produce or not.

The following undisputed and inevitable factors are what DSO’s are banking on.

1. Female Dentists: Majority of new grads are and will continue to be females (who are looking for flexible hours in a job - which is what DSO’s offer) > more DSO dentists.

2. Saturation: More dental schools opening > more new dentists with very high student loans > less practice ownership due to additional debt and cost > more DSO dentists.

3. Partnerships: DSO’s will continue to merge (there were more mergers in 2019 than any previous years, specially with invisible DSO’s). The bigger the merger > the more consolidation of dentists between DSO groups > the more resources available to corner markets even further and change the definition of a “dentist job” > more DSO dentists.

All these changes are happening today, and will continue to happen exponentially. We just don’t care enough to look the changes more closely, because majority of dentists tell themselves those changes won’t happen.


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[ToothJockey]

I'm actually curious how DSO's work, is it like any other job. Can you be fired for not meeting productivity quotas?

If so, I don't understand the appeal of why so many dentists like working for DSO's. I thought people got into the profession for the relatively high job security.

Also, how do DSO partnerships work, what is the model like. Does the dentist buy 51% of the practice, and the DSO has 49% ownership? Or the other way around? What are the compensation models like for a partner dentist, can they buy multiple practices within the DSO?

Can a specialist be a partner in a DSO? If you are forced to work with DSO's in the future, is it better to be a specialist so atleast you can earn more money. GP's were on even playing fields because they could take income from hygiene, and ownership, but in a DSO structure I'm guessing GP's will be stuck at 120k a year while specialists can earn much more since their procedures charge much more.

 

[Cold Front]

I'm actually curious how DSO's work, is it like any other job. Can you be fired for not meeting productivity quotas?

It depends on how bad the production is. Corporations with over 50 offices can afford to have few of their offices operating in the red - assuming there are few of their other strong offices can offset for the low production offices. They would not fire the dentists at the poor performing offices because it’s more costly to have no dentist office than to have a poor performing dentist office.

The big corporate offices are always hiring dentists as an insurance policy against their revolving door. Aspen dental is a classic example of this - they always have a job position open at every office, even though there is a dentist office working there - specially at offices where Aspen highly suspects dentists could leave soon.


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[ToothJockey]

It depends on how bad the production is. Corporations with over 50 offices can afford to have few of their offices operating in the red - assuming there are few of their other strong offices can offset for the low production offices. They would not fire the dentists at the poor performing offices because it’s more costly to have no dentist office than to have a poor performing dentist office.

The big corporate offices are always hiring dentists as an insurance policy against their revolving door. Aspen dental is a classic example of this - they always have a job position open at every office, even though there is a dentist office working there - specially at offices where Aspen highly suspects dentists could leave soon.


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I’ve noticed from past threads that you worked at Aspen once. You said they offer some type of ownership. From what I know corporate entities in medicine don’t really offer ownership, they just offer employment.

What’s different about corporate dental companies offering ownership?

Are there ownership options for specialists as well?


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[charlestweed]

Corporations have workshops for the new dentists and staff. They prioritize patient experiences more than clinical skills to be the center of their business. Most patients do not go home and look at their fillings in the mirror and then rate their dentists. If you closely read dental reviews, patients talk about how nice the dentist and their staff was - how beautiful the office looked, how quickly they were seen, how close the office was to their workplace or home, and so on. Corporate dentistry spends lot more money than a solo dentist to maximize the office ambiance that the patient expects. There are a lot of good and better coffee shops than Starbucks in the country, why didn’t they became big and successful like Starbucks? Because Starbucks service experience is to the T for the most coffee drinkers.

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I went to a few of these corp meetings. The majority of the dentists and staff, who attended the meetings, fell asleep because they didn’t care. Most of them would rather be at home with the spouses and kids than to waste a day listening to some useless lectures about practice management. After all, these dentists are just the corp’s employees….and just like most employees, they don’t care if the corps they work for succeed or not. They only care about getting paid on time. You would think that they care since their pays are based on the percentage of the production, right? Wrong, they just want to do the easy money cases and dump the difficult PITA patients to another associate GP or to the in-house specialists so they can go home on time to see their kids. When the dentists and the staff don’t care, the customer service quality goes down as well. That’s why you see a lot of angry patients leaving the corp offices for private offices.

When you treat your patients at your own office, you always try to do your best to take care of them because you need word-of-mouth referrals for your business growth. It’s your good reputation that you have to work so hard to maintain. The patients recognize it and are very appreciative of your effort. If every solo practice owner is willing to reach out to low income patients and accept more insurance plans like the corp offices, the corp offices will not be able to survive.

Dentistry will be fine in the future. It will always be better than medicine. You guys are shocked but I am not at all because I am practicing in CA, where new corp offices are opened up everywhere. Corp offices have dominated long before I became an orthodontist. My first job was at a corp office. And 15+ years later, I still work for corp. Without the good income from corp offices, I wouldn’t be able to come up with the money to set up my own office. Without the jobs at the corp office, I wouldn’t be able to gain the experience and the speed that help me succeed in my own private offices. Corp offices have made a lot of bad business decisions as well. Working for the corp helps me see both good and bad things at the corp.....so when I work at my own office, I try to avoid making the same bad mistakes that the corp offices make.

 

[Cold Front]

I’ve noticed from past threads that you worked at Aspen once. You said they offer some type of ownership. From what I know corporate entities in medicine don’t really offer ownership, they just offer employment.

What’s different about corporate dental companies offering ownership?

Are there ownership options for specialists as well?


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Most states require a dentist to own the practice, and barred corporations owning an office solely. So DSO’s started offering partnerships to associate general dentists that already worked at their offices - 49:51 for dentist😀SO. It was also a way for DSO’s to lock a dentist at the practice, prevent him/her from moving on to something else. We use to call it a deal with the devil at Aspen.


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[ToothJockey]

Most states require a dentist to own the practice, and barred corporations owning an office solely. So DSO’s started offering partnerships to associate general dentists that already worked at their offices - 49:51 for dentist😀SO. It was also a way for DSO’s to lock a dentist at the practice, prevent him/her from moving on to something else. We use to call it a deal with the devil at Aspen.


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So in the future, essentially every dental practice in the country will be like this? About 20% of dentists or so will be “owners” in a DSO, and the rest 80% will be associates working at corps for smaller 120k salaries.

If that’s the case, then should a new grad today be proactive and buy ownership in a corp, so that in the future they will end up “owners” instead of associates.

Can say an Oral Surgeon do the same thing, buy partnership shares in an incorporated OS practice, and then they have a whole referral network, as well as ownership.

What percent of overall profits does the owner dentist take home?

In my mind, if you can’t beat em, join em.


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[Cold Front]

So in the future, essentially every dental practice in the country will be like this? About 20% of dentists or so will be “owners” in a DSO, and the rest 80% will be associates working at corps for smaller 120k salaries.

If that’s the case, then should a new grad today be proactive and buy ownership in a corp, so that in the future they will end up “owners” instead of associates.

Can say an Oral Surgeon do the same thing, buy partnership shares in an incorporated OS practice, and then they have a whole referral network, as well as ownership.

What percent of overall profits does the owner dentist take home?

In my mind, if you can’t beat em, join em.


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Here is the link to Aspen’s POP (Practice Ownership Program).

Path To Ownership

Discover the path to dental practice ownership with Aspen Dental. We offer dentists the skills and support they need to become a successful owner or partner.

www.aspendentaljobs.com

There are doctors I met who owned 6-8 Aspen POP offices... probably made $2-3M/yr minimum each. But their life sucked; Aspen had control over their schedule, their vacations, they were in a puppet show. If Aspen asked them to jump, they would say how high? DSO’s just see numbers, not people.


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[ToothJockey]

Here is the link to Aspen’s POP (Practice Ownership Program).

Path To Ownership

Discover the path to dental practice ownership with Aspen Dental. We offer dentists the skills and support they need to become a successful owner or partner.

www.aspendentaljobs.com

There are doctors I met who owned 6-8 Aspen POP offices... probably made $2-3M/yr minimum each. But their life sucked; Aspen had control over their schedule, their vacations, they were in a puppet show. If Aspen asked them to jump, they would say how high? DSO’s just see numbers, not people.


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Honestly, it’s probably a terrible lifestyle, but what choice do we have?

In my mind, worst comes to worst, do this, make as much money as possible, invest heavily, and retire in 10-20 years. I would still much rather choose this path then slave away 120k a year as an associate for 40 years.



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[Cold Front]

Honestly, it’s probably a terrible lifestyle, but what choice do we have?

In my mind, worst comes to worst, do this, make as much money as possible, invest heavily, and retire in 10-20 years. I would still much rather choose this path then slave away 120k a year as an associate for 40 years.



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Pick your poison.

If I was a new grad today, I would bet on myself and open my own practice over associateship and DSO route. You just have to work hard (Charles’s 6 days schedule) and be in the dog house for few years - and you will eventually pay off all your debt and be liberated in a decade, tops. Start planning today, don’t wait until you graduate. I started planning in my 3rd year of school - and it paid off well with my practices and other assets, with a 30 hrs/week schedule by age 40. You would be surprised how much you are really worth if you go about dentistry the right way.

Your success is in your hands, literally.


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[ToothJockey]

Pick your poison.

If I was a new grad today, I would bet on myself and open my own practice over associateship and DSO route. You just have to work hard (Charles’s 6 days schedule) and be in the dog house for few years - and you will eventually pay off all your debt and be liberated in a decade, tops. Start planning today, don’t wait until you graduate. I started planning in my 3rd year of school - and it paid off well with my practices and other assets, with a 30 hrs/week schedule by age 40. You would be surprised how much you are really worth if you go about dentistry the right way.

Your success is in your hands, literally.


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For sure, I plan on private practice ownership anyways, I don’t want to be a solo dentist. I think starting a multi specialty practice is my best bet if I want to compete with corps. Open 60+ hrs a week, convenience for the patient, specialty procedures in house, lower overhead etc.

Solo practice won’t survive in the future, dentistry is changing, but there are other methods that might survive besides corporate. It’s similar to medicine, private specialty groups still exist despite the corporate environment.

However, I want to specialize as well, so I probably won’t start practicing for another decade. Who knows what the profession will be like by then. Ownership in corp is my backup option if everything goes bad.

No way am I going to be an underpaid associate for a corporation so they can benefit off my hard work, not long term at least, at that point I would rather just quit and do something else.


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[charlestweed]

Solo practice won’t survive in the future...

Solo practices will do fine in the future. Don't let the stats scare you. Corp offices open a lot of new offices but that doesn't mean all of these new offices are doing well. The 2 offices that belong to the corp that I work currently for have lost a lot of patients in the last 5 years. Do you know why? It's because the company recently opened 5-6 new offices only a couple of miles away from these 2 offices....and these new offices are competing among themselves for patients, who live in the same area. I really don't know what my company's CEO was thinking. Many of their offices are struggling to get new patients and yet they continue to open more new offices nearby. One of these new offices has been opened for more than 5 years and there are enough patients for 1 associate dentist and 1 ortho, who comes in 2 days/month.....no OS, no perio. So if patients need to see an OS, they are referred to a busier branch office nearby.

A GP friend of mine is currently building a new 3000sf office in the Sacramento area. It's a 2-doctor husband and wife dental practice. Their current 1800sf office is too small and they want to expand. They own this new office building outright....no business loan. My wife's GP boss' office is another successful story. He accepts HMO, he hires in-house specialists, and his office is located in the same center with Western Dental.

 

[Cold Front]

My wife's GP boss' office is another successful story. He accepts HMO, he hires in-house specialists, and his office is located in the same center with Western Dental.

How does HMO and specialists work together? Aren’t the fees too low for a specialist to accept HMO? And who gets reimbursed - the specialist or the owner/general dentist?




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[charlestweed]

How does HMO and specialists work together? Aren’t the fees too low for a specialist to accept HMO? And who gets reimbursed - the specialist or the owner/general dentist?

You have to know how to tx plan and find ways to refer to the specialists since HMOs pay the specialists more. If you think you may have to go sub gingival for a crown prep, refer to periodontist for crown-lengthening, which only takes 15-20 minutes to perform. The owner uses my wife’s license to bill the insurance. His manager handles all the billings. My wife just shows up for work and gets 50% of whatever she produces.

 

[Cold Front]

You have to know how to tx plan and find ways to refer to the specialists since HMOs pay the specialists more. If you think you may have to go sub gingival for a crown prep, refer to periodontist for crown-lengthening, which only takes 15-20 minutes to perform. The owner uses my wife’s license to bill the insurance. His manager handles all the billings. My wife just shows up for work and gets 50% of whatever she produces.

HMO’s work differently in different states and territories.

My offices takes CIGNA HMO now and they pay $5-6 per patient for the 200 patients assigned to each of my offices. None of these patients actually show up (maybe 1 patient for the last 3 months) and my offices get paid either way. These HMO checks pay for my mortgage and cars - which is kind of nice, since there are no patients to see (yet!) and no overhead.

I’m considering asking CIGNA to increase the assignment to 400 patients per office, because that will increase the odds of my offices seeing someone with that plan.

How many patients HMO are assigned to your wife’s boss office? It must be a high number - considering he keeps specialists busy, I’m assuming maybe 1-2 times a week per specialist to see those HMO patients? Is the owner also taking HMO from different insurances as well?


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[2TH MVR]

I went to a few of these corp meetings. The majority of the dentists and staff, who attended the meetings, fell asleep because they didn’t care. Most of them would rather be at home with the spouses and kids than to waste a day listening to some useless lectures about practice management. After all, these dentists are just the corp’s employees….and just like most employees, they don’t care if the corps they work for succeed or not. They only care about getting paid on time. You would think that they care since their pays are based on the percentage of the production, right? Wrong, they just want to do the easy money cases and dump the difficult PITA patients to another associate GP or to the in-house specialists so they can go home on time to see their kids. When the dentists and the staff don’t care, the customer service quality goes down as well. That’s why you see a lot of angry patients leaving the corp offices for private offices.

Dentistry will be fine in the future. It will always be better than medicine. You guys are shocked but I am not at all because I am practicing in CA, where new corp offices are opened up everywhere. Corp offices have dominated long before I became an orthodontist. My first job was at a corp office. And 15+ years later, I still work for corp. Without the good income from corp offices, I wouldn’t be able to come up with the money to set up my own office. Without the jobs at the corp office, I wouldn’t be able to gain the experience and the speed that help me succeed in my own private offices. Corp offices have made a lot of bad business decisions as well. Working for the corp helps me see both good and bad things at the corp.....so when I work at my own office, I try to avoid making the same bad mistakes that the corp offices make.

Everyone's situation will be different. @charlestweed uses the Corps to augment his revenue. I use it as a means to earn money while I enjoy the years heading into retirement. We are fine with the Corps because we have very little debt and some money in the bank.
But if I was new dentist ... I would not consider Corp dentistry a lifelong career. As @Cold Front opined .... it is obvious that Corp dentistry will be the main provider of dentistry in the future. It's not here yet, but it is coming. There is still time for young dentists to open practices in rural, non-Corp areas. If you must live in a saturated area .... then take a page out of @charlestweed handbook. Work BOTH. Have a private practice and augment your revenue with Corp work. It's not a big deal. It's just a job.

I can't speak for other Corps, but the one I work for sees mostly low income. I can only control my part of treating the patients. Yes ... the other parts of the patient equation such as billing, patient waiting times, etc. .... is not ideal. My Corp does not care. If they lose one low income patient due to poor service ..... 10 more will replace that patient.

Yes ... it is hard for those new grads entering the Corp arena. But with everything in life .... more experience leads to easier times. Having owned and run multiple practices in the past .... I understand what it takes to make the business of dentistry profitable. I get it. Most new dentists do not. They tire of the Corp routine and eventually will burn out.

 

[ToothJockey]

Yeah I think the future of dentistry will be sorta like medicine. Majority of dentists will be part of a corp (like majority of doctors are part of hospital systems), but there will always be ambitious private practice docs. Most likely they will have to practice in groups rather than solo, to compete with the corps, but who knows.

And I think you’re right, dentists will eventually burn out from working corps, unless maybe their a specialist. Low income, lots of patients. But their transition to private practice will be difficult, if not impossible. I want to start off my career on the right foot so I don’t get stuck in the trap.


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[Cold Front]

Everyone's situation will be different. @charlestweed uses the Corps to augment his revenue. I use it as a means to earn money while I enjoy the years heading into retirement. We are fine with the Corps because we have very little debt and some money in the bank.
But if I was new dentist ... I would not consider Corp dentistry a lifelong career. As @Cold Front opined .... it is obvious that Corp dentistry will be the main provider of dentistry in the future. It's not here yet, but it is coming. There is still time for young dentists to open practices in rural, non-Corp areas. If you must live in a saturated area .... then take a page out of @charlestweed handbook. Work BOTH. Have a private practice and augment your revenue with Corp work. It's not a big deal. It's just a job.

I can't speak for other Corps, but the one I work for sees mostly low income. I can only control my part of treating the patients. Yes ... the other parts of the patient equation such as billing, patient waiting times, etc. .... is not ideal. My Corp does not care. If they lose one low income patient due to poor service ..... 10 more will replace that patient.

Yes ... it is hard for those new grads entering the Corp arena. But with everything in life .... more experience leads to easier times. Having owned and run multiple practices in the past .... I understand what it takes to make the business of dentistry profitable. I get it. Most new dentists do not. They tire of the Corp routine and eventually will burn out.

I agree with all of the above.

I think the job market behavior changed over the years - young dentists move around more these days because there are more job opportunities available. I would guess; for every new grad, there are probably 10-20 jobs open/offers to choose from. Corporations are texting, calling and emailing them all the time. The jobs themselves are not as great as owning a practice, but they are everywhere - which leads to kind of a dating process between DSO’s and young dentists. This can last for years or even a decade. The founders of LinkedIn wrote a book (The Alliance) about this behavior, between corporations and their professional employees.




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[charlestweed]

How many patients HMO are assigned to your wife’s boss office? It must be a high number - considering he keeps specialists busy, I’m assuming maybe 1-2 times a week per specialist to see those HMO patients? Is the owner also taking HMO from different insurances as well?

I asked but my wife doesn’t know. She just comes to work at his office 3 Mondays a month. And here are 1099 payments that my wife has received from his office for the last 4 years:

2015: $53,269.53
2016: $40,973.27
2017: $65,991.75
2018: $49,618.42

It’s a 50:50 split. So whatever the amount my wife’s boss pays her, he gets the same amount……for doing nothing…..for simply referring cases to my wife. He also employs in-house endo, OS, pedo, and ortho. It’s a small old 1800sf 6-op office, which he bought from the previous dentist 20 years ago. The Western Dental office, which is located in the same center with his office, opened about 10 years ago.

 

[charlestweed]

Everyone's situation will be different. @charlestweed uses the Corps to augment his revenue. I use it as a means to earn money while I enjoy the years heading into retirement. We are fine with the Corps because we have very little debt and some money in the bank.

Yup, I am going to stick to this easy corp job for as long as possible. There are not a lot of easy job out there that pay you $200+ an hour for sitting around all day long….having 2-hour lunch….going home 30-45 minutes before the shift ends…and the assistants do most of the manual labor for you. It would be foolish of me to leave this amazing job. To you, we are underpaid. But to me, we are way overpaid when compare our job to that of the physicians, pharmacists and optometrists.

But if I was new dentist ... I would not consider Corp dentistry a lifelong career. As @Cold Front opined .... it is obvious that Corp dentistry will be the main provider of dentistry in the future. It's not here yet, but it is coming. There is still time for young dentists to open practices in rural, non-Corp areas. If you must live in a saturated area .... then take a page out of @charlestweed handbook. Work BOTH. Have a private practice and augment your revenue with Corp work. It's not a big deal. It's just a job.

A dentist shouldn’t consider working for someone else (either for the corp or for another practice owner) for the rest of his/her life, especially if he/she owes more than $500k in student loan. He will just be like a pharmacist or an optometrist….zero autonomy and getting stuck at a certain income level. In order to pay off the debt and to retire sooner, he needs to make more money by opening his own office. IMO, corp job is a better place to start for a new grad dentist. He will be more prepared when he is forced to work under the stressful busy environment of the corp office. By treating higher patient volume at the corp offices, he will gain more clinical experience and become faster than new grad dentists, who are spoiled working at a much slower pace private office. Another benefit of working at the corp is you get more benefit (401k, malpractice insurance, health insurance etc). The third benefit is the corps have a lot more patients; therefore, you don't have to worry about your hours getting cut like when you work at a private office.....the income flow is more stable and steady at the corp. And the fourth benefit of working for the corp is you learn how the corp offices make profit from treating mostly low income patients……ie how to keep the overhead low, how to deal with slow lazy unmotivated staff, how to tx plan HMO cases etc.

 

[ToothJockey]

Yup, I am going to stick to this easy corp job for as long as possible. There are not a lot of easy job out there that pay you $200+ an hour for sitting around all day long….having 2-hour lunch….going home 30-45 minutes before the shift ends…and the assistants do most of the manual labor for you. It would be foolish of me to leave this amazing job. To you, we are underpaid. But to me, we are way overpaid when compare our job to that of the physicians, pharmacists and optometrists.

A dentist shouldn’t consider working for someone else (either for the corp or for another practice owner) for the rest of his/her life, especially if he/she owes more than $500k in student loan. He will just be like a pharmacist or an optometrist….zero autonomy and getting stuck at a certain income level. In order to pay off the debt and to retire sooner, he needs to make more money by opening his own office. IMO, corp job is a better place to start for a new grad dentist. He will be more prepared when he is forced to work under the stressful busy environment of the corp office. By treating higher patient volume at the corp offices, he will gain more clinical experience and become faster than new grad dentists, who are spoiled working at a much slower pace private office. Another benefit of working at the corp is you get more benefit (401k, malpractice insurance, health insurance etc). The third benefit is the corps have a lot more patients; therefore, you don't have to worry about your hours getting cut like when you work at a private office.....the income flow is more stable and steady at the corp. And the fourth benefit of working for the corp is you learn how the corp offices make profit from treating mostly low income patients……ie how to keep the overhead low, how to deal with slow lazy unmotivated staff, how to tx plan HMO cases etc.

To be fair, you’re an ortho. I’m sure GP’s at your corp feel like they are underpaid for their grind lol

I agree with everything though, corp is a good starter job, and it can supplement income for a specialist, but ownership is/should be the goal.

I’ve noticed that a little over 1/5 of dentists aged 25-35 work in corps, which is normal, its their starter job, a lot of them might transition into private practice. But also about 1/5 of dentists aged 35-50 also work full time in corps, for them they will probably never own a practice, they are probably gonna be stuck in corp for life, which is unfortunate because they never get to experience the joy of ownership, their name on the practice, the respect in the community etc.


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[charlestweed]

To be fair, you’re an ortho. I’m sure GP’s at your corp feel like they are underpaid for their grind lol

I can’t believe how 2 extra years of schooling (after dental school) can make such a big difference in my life, which is much better than what I could have imagined or hope for. Ortho would still be a great specialty if I only make half as much as what I make now. I don’t understand why a lot of my ortho colleagues don’t feel the same way as I do. Why can’t they see that they are very lucky?

 

[ToothJockey]

I can’t believe how 2 extra years of schooling (after dental school) can make such a big difference in my life, which is much better than what I could have imagined or hope for. Ortho would still be a great specialty if I only make half as much as what I make now. I don’t understand why a lot of my ortho colleagues don’t feel the same way as I do. Why can’t they see that they are very lucky?

Most people (myself included) tend to compare themselves to people in better situations then them. That's why even rich people who seem to have everything are never satisfied, because they compare themselves to other richer people who have even more. They don't compare themselves to 99% of the population that has it much worse than them.

Even a dental associate with the worst associating job in America, getting paid 100 dollars a day or something, has it a billion times better than the kid in Africa who doesn't even have access to clean water.

 

[2TH MVR]

I can’t believe how 2 extra years of schooling (after dental school) can make such a big difference in my life, which is much better than what I could have imagined or hope for. Ortho would still be a great specialty if I only make half as much as what I make now. I don’t understand why a lot of my ortho colleagues don’t feel the same way as I do. Why can’t they see that they are very lucky?

Oh, I agree. We belong to a very special profession (ortho). We're spoiled. But lets just say I felt LUCKIER 10 years ago. 😀

 

[2TH MVR]

Most people (myself included) tend to compare themselves to people in better situations then them.

Sometimes not just other people, but YOURSELF in the past. But ...... to be clear .... I make good money at the Corp based on 3-4 days per week. Not OMFS money, but good money. But that amount I make right now is almost 30-40% less than what I made during my hay day. Why is it less? 1. Corporations saturating the ortho market. 2. aligners. 3. at some point most dentists, not all .... but most dentists as they get older ..... they try just a little bit less. They are not as hungry as they were when they were younger. Less begging for referrals (oh ...I hated that part, but I was pretty good at it when i was younger). All of this adds up to a plateau of revenue and then a gradual decline.

But I cannot complain. As a Corporate specialist .... I essentially make double what the GPs make with less effort and stress.

Corporate life is not as glamerous as owning your own practice, but it is the answer to some dentists like myself.

But as I've said in the past. As a young dentist .... don't get trapped into working Corp. Start your own practice in the right location. There is still time. I see it all the time. Dentists working in Corp often get lazy and just do not want to take a RISK and start or buy a private practice. The "lifers" at a Corp setting are usually the least happy dentists. But I'm smiling all the time. 🙂

 

[e00z]

Sometimes not just other people, but YOURSELF in the past. But ...... to be clear .... I make good money at the Corp based on 3-4 days per week. Not OMFS money, but good money. But that amount I make right now is almost 30-40% less than what I made during my hay day. Why is it less? 1. Corporations saturating the ortho market. 2. aligners. 3. at some point most dentists, not all .... but most dentists as they get older ..... they try just a little bit less. They are not as hungry as they were when they were younger. Less begging for referrals (oh ...I hated that part, but I was pretty good at it when i was younger). All of this adds up to a plateau of revenue and then a gradual decline.

But I cannot complain. As a Corporate specialist .... I essentially make double what the GPs make with less effort and stress.

Corporate life is not as glamerous as owning your own practice, but it is the answer to some dentists like myself.

But as I've said in the past. As a young dentist .... don't get trapped into working Corp. Start your own practice in the right location. There is still time. I see it all the time. Dentists working in Corp often get lazy and just do not want to take a RISK and start or buy a private practice. The "lifers" at a Corp setting are usually the least happy dentists. But I'm smiling all the time. 🙂

Offtopic...but could you expand on what it takes to establish and maintain a healthy referral network as an ortho? Back when you were churning along as an owner, and perhaps also what it takes in this day and age?

 

[charlestweed]

Sometimes not just other people, but YOURSELF in the past. But ...... to be clear .... I make good money at the Corp based on 3-4 days per week. Not OMFS money, but good money. But that amount I make right now is almost 30-40% less than what I made during my hay day. Why is it less? 1. Corporations saturating the ortho market. 2. aligners. 3. at some point most dentists, not all .... but most dentists as they get older ..... they try just a little bit less. They are not as hungry as they were when they were younger. Less begging for referrals (oh ...I hated that part, but I was pretty good at it when i was younger). All of this adds up to a plateau of revenue and then a gradual decline.

But I cannot complain. As a Corporate specialist .... I essentially make double what the GPs make with less effort and stress.

Corporate life is not as glamerous as owning your own practice, but it is the answer to some dentists like myself.

But as I've said in the past. As a young dentist .... don't get trapped into working Corp. Start your own practice in the right location. There is still time. I see it all the time. Dentists working in Corp often get lazy and just do not want to take a RISK and start or buy a private practice. The "lifers" at a Corp setting are usually the least happy dentists. But I'm smiling all the time. 🙂

For a practice to continue to get new patients and to maintain the same production level as previous years, it requires non-stop effort from the owner. Word of mouth alone is not enough to grow your practice. The GPs will refer you fewer patients or stop referring competely because their practices are slowing down, or they have a new favorite orthodontist to refer their patients to, or they hire in-house ortho to work for them. You need reach out to new dental offices in the area on a regular basis. As soon as you stop marketing your office and let your associate and manager run your office, your office production drops immediately.

I remember when my GP friend passed away suddenly from a heart attack, a few of his friends and my wife took turn to help treat the patients at his office. In just a couple of months, the production had dropped significantly. We had to convince his wife to sell the practice right away before its value dropped further.

The common reason why older doctors don't produce as much as they once did is they stop working hard. Whenever they feel like taking a day off, they just cancel their patients and don't care if they lose their patients or not. They stop taking risks and refer difficult more time consuming cases to the specialist offices. I am one of these older doctors....I am 48 yo. I no longer go door to door to meet the new GPs in the area. I recently relocated my office to a new office building and I didn't even bother finding out who the general dentist, whose office is just one floor above me, is. As a result, my office production has gone down a little bit. And that's OK. I have passive income from rental properties and I have my part time corp job.....and hopefully I will be 100% debt-free by the end of next year. I will retire and close up shop whenever my practices stop making profits.

 

[Cold Front]

I am 48 yo... hopefully I will be 100% debt-free by the end of next year.

You should treat yourself to a nice vacation next Christmas.

I’m 40 now, and 48 sounds like right about the age I should be debt free too. This will be a shocker to some readers, but my debt once reached $7M. That’s not a typo, but it was mostly in commercial real estate loans - I didn’t rush into paying off my student loans after I graduated from DS. I still carry about $4M in loans today, kind of scary at first glance, but very secured with class A tenants with long term leases. I don’t know what I will do when I’m debt free, but if it was today, I would have rewarded myself with something to mark the occasion/milestone. Maybe a nice watch, a river cruise in Europe, a dinner date with the wife at a 3 star Michelin restaurant, or something similar.



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[ToothJockey]

You should treat yourself to a nice vacation next Christmas.

I’m 40 now, and 48 sounds like right about the age I should be debt free too. This will be a shocker to some readers, but my debt once reached $7M. That’s not a typo, but it was mostly in commercial real estate loans - I didn’t rush into paying off my student loans after I graduated from DS. I still carry about $4M in loans today, kind of scary at first glance, but very secured with class A tenants with long term leases. I don’t know what I will do when I’m debt free, but if it was today, I would have rewarded myself with something to mark the occasion/milestone. Maybe a nice watch, a river cruise in Europe, a dinner date with the wife at a 3 star Michelin restaurant, or something similar.



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How did you manage that? You bought 7 million dollars worth of real estate? How did banks even approve that loan, seems high risk, no?


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[Cold Front]

How did you manage that? You bought 7 million dollars worth of real estate? How did banks even approve that loan, seems high risk, no?


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I probably answered this question in previous posts, but this WAS my debt at one point:

1. Practice A and Practice B (both in leased spaces) loans: $500k

2. Practice A 5yr lease ends, I bough an empty lot next door and built a building for 2 spaces (practice A and a national wireless tenant): $1.5M

3. Practice B 5yr lease ends, bought the building (with 5 other national tenants) from landlord - he initially said no, so I tried again after a year and he said yes: $3M

4. My home mortgage: $800k

5. My student loans: $280k

6. Side businesses/investments: about $900k

I’m not recommending anyone to do what I did - nor motivating others to get themselves into debt. This is just for discussion purposes.


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[Cold Front]

You got big testicles

Fear is normal in growing businesses and securing your future - specially with debt. It happens all the time with other small businesses/small caps and their growth to go even bigger (to mid caps) through debt. No one ever built a successful business without taking a big (calculated) risk.


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[ToothJockey]

Almost all millionaires had to get into debt at some point, whether it was starting a business, investing, or school. Even look at the big corporations in dentistry, almost all of them have millions of dollars of debt, everytme they purchase a new practice they probably go more in debt.

Is it really that easy to leverage debt though? Why don't other people do it?