What to do with extra space?

[TanMan]

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It finally happened, the shop next door is closing up and I have dibs on getting an additional 1500 square feet for the office.

Now, my question to you guys would be, would you take an additional 1500 square feet for your office given my circumstances? I currently have 13 rooms as a solo GP and my main hesistation is whether I would be able to do 20 rooms solo (assume I can put 7 more rooms in 1500 sq feet, I can cram more, but I assume I need additional storage/bathroom). I've thought of the various scenarios of what I could do if I were to acquire the space, or should I just leave the space and not expand any further. I would like to retire soon but the one thing that gets to me is that I feel the need to challenge myself further to see if I can go beyond the 13 rooms or is this my true limitation. However, I don't want to have underutilized space either in the case that I would not be able to handle all 20 rooms simultaneously. Other question would be if I could sell a larger office with 20 rooms more easily or would it be more difficult?

One alternative is expand and hire a specialist to do procedures that I don't want to do such as peds or sleep apnea (I was thinking of doing a smile direct club style of sleep apnea, maybe call it sleep direct club). I'm not looking into ortho since I get a ton of referrals of cash patients from ortho. If I were to introduce a specialty, I would not connect it to my existing office (branding) so I don't have to be responsible for postops. Another option is 3rds, but increased regulatory requirements for IV sedation facilities make it less appealing, and 3rds would not be worth it without IV sedation. Last option is either a higher end version of my office or a lower end version of my office (Medicaid dental, denture mill, clearchoice style, or dental spa).

Another option is not to go into dentistry altogether and go into a different industry. Some things that seem in demand here right now are daycare, smoke shops, and payday loans.

I'd like to hear what you guys think, maybe I'm missing something in my analysis.

 

[schmoob]

Acquire and expand. Consider the resale value of such a large practice.
like you said, you can incorporate sedation and maybe take on an OMFS full time. You could also possibly increase hygiene. Or you can have an in-house lab, a CBCT... lots of options.

 

[laundry]

What's your retirement timeline? Ask yourself what limitations are you facing WITHOUT that space? If you can't solve those limitations without adding to it, then get it. If you can, then why add an extra fixed expense?

 

[ToothJockey]

you can incorporate sedation and maybe take on an OMFS full time.

Why would an OMFS work for a GP full time? There wouldn't be enough volume of 3rds/implants from solely 1 office to make it worth the surgeons time, he will be better off financially partnering with a specialist group or opening his own office.

 

[Typical Average Student]

I feel like a payday loan or smoke shop would decrease the visual appeal of your dental office. I'd say acquire and lease to a medical practice or pharmacy

 

[TanMan]

My retirement timeline was supposed to be in a year or two, but given that I have some capital intensive projects, it's up in the air. My limitations without that space is that I can't advance my production much more with the current systems in place. Since I have the existing infrastructure (vacuum/compressor lines overhead), cost of adding additional chairs is not as bad compared to if I had to place them underground. Additional capital costs are relatively cheap compared to a denovo office, the big question is utilization and increase in productivity. I'm essentially trying to identify if potential production will be worth the initial capital costs + increased fixed/variable costs. The big thing is that the incremental gain in net profits must be worth the additional efforts/headaches and not end up cannibalizing my own production.

This is why I've put forth the choices in the poll. If there was a way I could handle 20 chairs (9 ops, 11 hyg), I have to see IF I can fill all those chairs and also meet the demand by myself. Going solo has its risks; either I can't fill them and it would've been better to reallocate them in the schedule OR I can't meet the demand by myself and I have to spend a lot in extra dental labor.

Second scenario would be to hire a specialist to take on cases that I don't want to do. Unfortunately, specialists are expensive and it has to be a low overhead specialty. Thinking it over, the most logical add-on seems to be OS or perio. I'm leaning more towards perio. I don't care who does it, as long as I don't have to field postops. Perio can do 3rds, IV sedation, LANAP, SCTG, implants.

Now, as @ToothJockey has mentioned, the patient volume could be the difficult part. I need to know how many full sets of 3rds would a perio/OS expect to make it worth their while. You will be surprised that given some of the personal/professional circumstances that some of our specialists colleagues experience, some of them are unable to partner or own a practice. I'm not going into specific details (but I'm sure you can infer what I'm talking about), but as long as they have an active or even probationary license, they are stuck floating for GP offices. Unfortunately, for IV sedation, you can't leave the room until they are good for discharge, then you can delegate monitoring.

 

[schmoob]

Have you thought about bringing on a pedo and expanding into that market?

 

[BingDent]

You are amazing.

I am curious how you operate 20 chairs all by yourself. How many doctors, assistants, hygienist do you have in a typical day?

On average, how many patients was seen by hygiene and how many by you?

 

[2TH MVR]

Seriously. If anyone can make a good business decision ...it would be YOU.

 

[Extirpator]

Accredited surgical center oriented towards dentistry. May be viable if OR access is difficult for local pediatric dentists

 

[allDAT]

Not enough information for anyone to offer advice. Talk to your CPA and CFP (if you have one). More earned income isn't necessarily worth the effort depending on your marginal tax bracket. You may want to consider alternative investments that generate passive income. Here's info on passive income streams from the IRS: Passive Activity Losses Real Estate Tax Tips | Internal Revenue Service

Some things I would consider doing before expanding (you already have 13 ops which is a ton of space).
1. Drop the lowest paying PPO.
2. If you're taking HMOs, get rid of those.
3. Expand your hours in the same space so you're not increasing your fixed costs.

Your CPA would be able to run the numbers for you to help with some projections. We can't do that for you on this forum.

 

[TanMan]

Have you thought about bringing on a pedo and expanding into that market?

I've thought about pediatrics, but the market has contracted with decreasing and unpredictable medicaid reimbursements. The pediatric market has contracted to the point where these medi-mills have to expand into the adult and ppo/ffs segment. Trying to enter a market where specialized pediatric mills are trying to break through/diversify into adult markets, for me at least, appears counter-intuitive.

You are amazing.

I am curious how you operate 20 chairs all by yourself. How many doctors, assistants, hygienist do you have in a typical day?

On average, how many patients was seen by hygiene and how many by you?

I only do 13 (not 20) chairs myself right now. The big question is whether I can do 20 chairs solo and whether I should expand for 20 chairs (solo or w/ a specialist). I am the only doctor, with 8 assistants and 3 hygienists. Front staff not included. I see almost every patient for exams and procedures. We can see 40-85+/day. I am studying my procedural time/efficiency to see how I can speed up even more to accomodate more rooms. It's not easy, since there are certain procedures that don't have utmost predictability in completion time.

Accredited surgical center oriented towards dentistry. May be viable if OR access is difficult for local pediatric dentists

I have not done enough research to see whether this is viable. I know hourly operating costs are a bit high for a surgicenter, I definitely need to look into the profitability, demand, and reimbursements.

Not enough information for anyone to offer advice. Talk to your CPA and CFP (if you have one). More earned income isn't necessarily worth the effort depending on your marginal tax bracket. You may want to consider alternative investments that generate passive income. Here's info on passive income streams from the IRS: Passive Activity Losses Real Estate Tax Tips | Internal Revenue Service

Some things I would consider doing before expanding (you already have 13 ops which is a ton of space).
1. Drop the lowest paying PPO.
2. If you're taking HMOs, get rid of those.
3. Expand your hours in the same space so you're not increasing your fixed costs.

Your CPA would be able to run the numbers for you to help with some projections. We can't do that for you on this forum.

I'm not asking for tax advice or estate planning. I'm asking on what to do on a potential expansion. I have other investments that are passive at this time.

I've thought of expanding because sometimes, 13 ops is not enough. However, I am afraid of underutilization of the space but I also do not want to hire someone who's just going to take my procedures. That's why I was tossing around the idea of hiring a specialist, side business, or having an area where I can hire auxiliaries to do work with billable hours.

I've already dropped the lowest paying PPOs, I don't take HMOs, and expanding hours is going to increase my variable/staffing costs. The big problem with expanding hours is that I might just end up speading out the procedures/patients from a 33 hour week to a 40 hour week. That means more costs, more time I have to be at the office, and lower profitability.

So... I'm not asking for you or anyone to run the numbers (I do my own number crunching once I see something fit my potential expansion/business model), I'm asking on people's thoughts on what to do (if any) on available space. There might be something I'm missing or haven't thought of.

 

[wannagiveup]

Assuming you are at capacity, maybe increase fees and don't expand. With expansion, another option would be to rent the space out to a specialist for passive income. What's your PPO to FFS ratio? Are you getting a good deal on this extra 1,500 sq ft space (assuming you are purchasing it rather than leasing)?

 

[TanMan]

Assuming you are at capacity, maybe increase fees and don't expand. With expansion, another option would be to rent the space out to a specialist for passive income. What's your PPO to FFS ratio? Are you getting a good deal on this extra 1,500 sq ft space (assuming you are purchasing it rather than leasing)?

We are at capacity and beyond sometimes. We've already cut out relatively less profitable segments of our practice. I'm slightly reluctant to increase our fees due to the population's price sensitivity, although a lot of that price sensitivity goes out the door when emergencies are involved. Since I do not own the space, but have the right of first refusal, I need to determine the use of space, potential business development(s), and whether I can generate a non-competing business next door (i.e I don't want a GP associate because they will take my bread and butter, maybe specialists, but they take a huge chunk of production) Second option is to open another office 90 miles away, but the increase in NOI is not very much (10-20% per office). Ideally, if we're talking about an extension of the existing dental office, I'd like to see true production(collection) go up at least 1-1.5MM, especially if a specialist can charge higher fees. Looking at the books/financing procedures of corporate chains, I know that a lot of these corporate specialists have very high production but high default (upwards of 70%+)/low collections (think 95 dollar down on 5k treatment). Looks good on paper, terrible financially.

I am getting a pretty good deal on the space, but I am leasing the space. Essentially a year of rent free and lower rent per sq ft ($1.08/sq ft, already including triple net). No TI though. I have thought of purchasing the whole strip, but I am spread a bit thin on infrastructure/manufacturing projects.

Perhaps I'm expecting too much from a part time specialist, but I'm pretty torn on expansion. Worst thing is to increase my overhead with negligible increase in profits. Best case, I take a significant share of the specialty market in my region. I'll keep you guys posted on developments. Thanks for everyone's input. Gotta study these options. Must hit 4-5MM.

 

[BingDent]

If you hire an associate that does less profitable stuff while you do only high profit stuff, you will hit 4-5mm in no time.😉

Your rent is SUPER CHEAP, expansion is a no brainer.

 

[P7898]

Get an in house perio or pedo and make a surgery wing or pedo/ortho wing. Or find what you refer out the most and ad a specialist to redeem that.

 

[Twwyy]

40 to 85 patient a day
you took care of all 13 chair including exams...

mathematically it is hard
if you spent 10 min each exam + 5 min writing a note for the same exam, you need 15 min or lets say 10 min total if you are super speedy
and if you see minimum 40 patient out of 85+for exam, that's mean 400 to 600 min which in turn 6.6 hrs to 10 hrs and this is just exams without any procedure

how many working hours your office do per day?

 

[TanMan]

40 to 85 patient a day
you took care of all 13 chair including exams...

mathematically it is hard
if you spent 10 min each exam + 5 min writing a note for the same exam, you need 15 min or lets say 10 min total if you are super speedy
and if you see minimum 40 patient out of 85+for exam, that's mean 400 to 600 min which in turn 6.6 hrs to 10 hrs and this is just exams without any procedure

how many working hours your office do per day?

Usually 7 hours (8 hours on Saturday, but my staff is good at pushing up patients so that we get out in 7), and 5 hours for my half day. 5 mins writing a note for every patients - too long. I have autonotes. I dictate the fill in the blank parts of my autonotes and I review at the end of the day. My exams tend to be quick since a lot of times, I've reviewed the radiographs before going in already and have determined treatment(s) before I even walk in.

Here was my schedule for today. Blurred for privacy. Fell apart a bit throughout the day. Note the longer appointments, those are the ones that "must" get everything done before the year's end.

 

[drseplo]

Usually 7 hours (8 hours on Saturday, but my staff is good at pushing up patients so that we get out in 7), and 5 hours for my half day. 5 mins writing a note for every patients - too long. I have autonotes. I dictate the fill in the blank parts of my autonotes and I review at the end of the day. My exams tend to be quick since a lot of times, I've reviewed the radiographs before going in already and have determined treatment(s) before I even walk in.

Here was my schedule for today. Blurred for privacy. Fell apart a bit throughout the day. Note the longer appointments, those are the ones that "must" get everything done before the year's end.

View attachment 290833

what system do you use to dictate notes?

 

[Cold Front]

It finally happened, the shop next door is closing up and I have dibs on getting an additional 1500 square feet for the office.

Now, my question to you guys would be, would you take an additional 1500 square feet for your office given my circumstances? I currently have 13 rooms as a solo GP and my main hesistation is whether I would be able to do 20 rooms solo (assume I can put 7 more rooms in 1500 sq feet, I can cram more, but I assume I need additional storage/bathroom). I've thought of the various scenarios of what I could do if I were to acquire the space, or should I just leave the space and not expand any further. I would like to retire soon but the one thing that gets to me is that I feel the need to challenge myself further to see if I can go beyond the 13 rooms or is this my true limitation. However, I don't want to have underutilized space either in the case that I would not be able to handle all 20 rooms simultaneously. Other question would be if I could sell a larger office with 20 rooms more easily or would it be more difficult?

One alternative is expand and hire a specialist to do procedures that I don't want to do such as peds or sleep apnea (I was thinking of doing a smile direct club style of sleep apnea, maybe call it sleep direct club). I'm not looking into ortho since I get a ton of referrals of cash patients from ortho. If I were to introduce a specialty, I would not connect it to my existing office (branding) so I don't have to be responsible for postops. Another option is 3rds, but increased regulatory requirements for IV sedation facilities make it less appealing, and 3rds would not be worth it without IV sedation. Last option is either a higher end version of my office or a lower end version of my office (Medicaid dental, denture mill, clearchoice style, or dental spa).

Another option is not to go into dentistry altogether and go into a different industry. Some things that seem in demand here right now are daycare, smoke shops, and payday loans.

I'd like to hear what you guys think, maybe I'm missing something in my analysis.

Why don’t you just buy the building? Is that an option?

For that level of success for your practice, the tax benefits of the real estate ownership would be no brainer and long term too.


Sent from my iPhone using SDN mobile

 

[AONLINE]

Usually 7 hours (8 hours on Saturday, but my staff is good at pushing up patients so that we get out in 7), and 5 hours for my half day. 5 mins writing a note for every patients - too long. I have autonotes. I dictate the fill in the blank parts of my autonotes and I review at the end of the day. My exams tend to be quick since a lot of times, I've reviewed the radiographs before going in already and have determined treatment(s) before I even walk in.

Here was my schedule for today. Blurred for privacy. Fell apart a bit throughout the day. Note the longer appointments, those are the ones that "must" get everything done before the year's end.

View attachment 290833

Is your office opened 6 days a week?

 

[TanMan]

what system do you use to dictate notes?

Not really a system, I tell my assistants what to write, they write it for me in real time. They've learned to type real fast and have my autonotes assist in filling in the blanks/narratives.

Why don’t you just buy the building? Is that an option?

For that level of success for your practice, the tax benefits of the real estate ownership would be no brainer and long term too.


Sent from my iPhone using SDN mobile

It's an option later on, but I wouldn't want to purchase it right now. Supply of MTNL properties has grown drastically, but demand isn't all there yet. Occupancy rates are not good and some are set to potentially foreclose within 18-24 months. Even some STNL backed properties have foreclosed or have been on the market for >3 years. Too much speculative buying and overpriced for the market. I'll wait for a crash or market correction to happen before jumping in. 50-60% occupancy rates are not appealing to me right now and property prices have not decreased to reflect that. Also, I have other capital intensive projects to manage at this time, but I'll strike when the time is right.

Is your office opened 6 days a week?

5 days.

 

[ap_520]

Acquire and test out running 20 chairs. If it works out, great, if not, hire an associate to take on the extra chairs + all the denture cases that you refer out to other GPs. Your retirement is soon, so you could include a buy-out clause in the contract after the honeymoon period. You'd probably find an associate that is worthwhile if he/she knows they can/will have skin in the game.

Or just put a Firehouse Subs there...not sure if you do any franchising

 

[P7898]

Acquire and test out running 20 chairs. If it works out, great, if not, hire an associate to take on the extra chairs + all the denture cases that you refer out to other GPs. Your retirement is soon, so you could include a buy-out clause in the contract after the honeymoon period. You'd probably find an associate that is worthwhile if he/she knows they can/will have skin in the game.

Or just put a Firehouse Subs there...not sure if you do any franchising

I like the last idea. Get a national tenant if it’s a retail space.

 

[monkeykey]

Put tanning beds in the extra space and become the ultimate Tanman.

 

[TanMan]

Looks like it's official, we're expanding to meet extra demand. Done with the demo and framing already. This virus ordeal has been a blessing in disguise. We've learned to process and triage patients a lot more efficiently and hired a 4th hygienist as a stopgap measure to meet excess demand. So far, the rooms are planned for +5 ops/hyg, +2 hygiene rooms (total of +7). Going to hire another hygienist and focus on alternative procedures such as same day bridges, same day implant crowns, snoring treatment, lanap, etc... for the other side. I've been experimenting on the systems to make sure that we can crank out these procedures quickly and efficiently. We're getting close to the 4MM mark, just a little more should do it.

 

[wannagiveup]

Looks like it's official, we're expanding to meet extra demand. Done with the demo and framing already. This virus ordeal has been a blessing in disguise. We've learned to process and triage patients a lot more efficiently and hired a 4th hygienist as a stopgap measure to meet excess demand. So far, the rooms are planned for +5 ops/hyg, +2 hygiene rooms (total of +7). Going to hire another hygienist and focus on alternative procedures such as same day bridges, same day implant crowns, snoring treatment, lanap, etc... for the other side. I've been experimenting on the systems to make sure that we can crank out these procedures quickly and efficiently. We're getting close to the 4MM mark, just a little more should do it.

I am curious how you are managing all these hygienists? Do you have an office manager?

 

[TanMan]

I am curious how you are managing all these hygienists? Do you have an office manager?

My hygienists are fairly independent and do the main things they were designed to do... sell and clean. I don't need to hold their hand (and neither should any dentist) to perform those two tasks. Thankfully I don't have high maintenance divas on my team. I have an office manager who acts like the lubricant to all the parts of the office.

 

[wannagiveup]

My hygienists are fairly independent and do the main things they were designed to do... sell and clean. I don't need to hold their hand (and neither should any dentist) to perform those two tasks. Thankfully I don't have high maintenance divas on my team. I have an office manager who acts like the lubricant to all the parts of the office.

How do you hire the right people for your team? Any tips? Do you only hire experienced staff? I've heard a lot of the "hire for the personality" mantra especially for front office and DAs. On the other hand, some argue you get what you pay for (sort of like the Buffett mantra of "buy a great company at a fair price rather than a fair company at a great price"). Any truth to this when it comes to associates and hygienists (ie less experienced but good personality vs seasoned but less congenial)?

Also your office manager must be making some big bucks in an office doing close to four million. Wow!

 

[P7898]

Looks like it's official, we're expanding to meet extra demand. Done with the demo and framing already. This virus ordeal has been a blessing in disguise. We've learned to process and triage patients a lot more efficiently and hired a 4th hygienist as a stopgap measure to meet excess demand. So far, the rooms are planned for +5 ops/hyg, +2 hygiene rooms (total of +7). Going to hire another hygienist and focus on alternative procedures such as same day bridges, same day implant crowns, snoring treatment, lanap, etc... for the other side. I've been experimenting on the systems to make sure that we can crank out these procedures quickly and efficiently. We're getting close to the 4MM mark, just a little more should do it.

Single doc office still?

 

[ToothJockey]

Single doc office still?

To be fair I think TanMan counts as 3 docs by himself lol

 

[P7898]

To be fair I think TanMan counts as 3 docs by himself lol

haha I mean I know some guys that do 10 min crown preps, 20 min bridge preps, and 45 mins molar endo in my area. The fact is that if you can do that and still keep good quality, you can be as many docs as you want to be lol

 

[ToothJockey]

haha I mean I know some guys that do 10 min crown preps, 20 min bridge preps, and 45 mins molar endo in my area. The fact is that if you can do that and still keep good quality, you can be as many docs as you want to be lol

This actually got me thinking now, when we see these huge discrepancies when it comes to dentist incomes, is it mostly due to how fast a dentist works?

I always thought it was based on # of patients, but maybe speed is a bigger factor?

 

[TanMan]

How do you hire the right people for your team? Any tips? Do you only hire experienced staff? I've heard a lot of the "hire for the personality" mantra especially for front office and DAs. On the other hand, some argue you get what you pay for (sort of like the Buffett mantra of "buy a great company at a fair price rather than a fair company at a great price"). Any truth to this when it comes to associates and hygienists (ie less experienced but good personality vs seasoned but less congenial)?

Also your office manager must be making some big bucks in an office doing close to four million. Wow!

Have to pay a little more for the right people. We go through a good amount of applicants to find the right fit. Know what keywords and trends to look for in resumes that would indicate a potential troublemaker for the office. I can't go over those in too much detail because it may not be seen as PC. In terms of paying, there are some people who overvalue themselves, and pay is relative to what others in your office are making. People who think too highly of themselves and overvalue their abilities should not be hired. I try to go for staff that have 1-3 years of experience. Years 0-1 tend to take a little longer to train. Beyond 3 years, bad habits start to become established. More experience is not better, as undoing their previous experience (the bad parts) can be annoying.

Single doc office still?

Yep, still solo practice.

 

[P7898]

This actually got me thinking now, when we see these huge discrepancies when it comes to dentist incomes, is it mostly due to how fast a dentist works?

I always thought it was based on # of patients, but maybe speed is a bigger factor?

Speed is a HUGE factor. Then you schedule based on time per procedure. For example, if you can prep a crown in 10 minutes and have a CEREC machine to scan the prep to create the definitive restoration, then really you have maybe 15 minutes of chair time. So I would schedule 30 mins tops of chair time which would include the crown fit and whatnot.

The most successful guys I know schedule based on chair time only. So prep, scan, leave. 30 mins for a $1100 crown in my neck of the woods is a good deal as a GP. Then you can add whatever you want - considering you are balancing hygiene. But I am a big proponent on scheduling based on chair time only. There is always time for conversation during the procedure.

 

[ToothJockey]

Speed is a HUGE factor. Then you schedule based on time per procedure. For example, if you can prep a crown in 10 minutes and have a CEREC machine to scan the prep to create the definitive restoration, then really you have maybe 15 minutes of chair time. So I would schedule 30 mins tops of chair time which would include the crown fit and whatnot.

The most successful guys I know schedule based on chair time only. So prep, scan, leave. 30 mins for a $1100 crown in my neck of the woods is a good deal as a GP. Then you can add whatever you want - considering you are balancing hygiene. But I am a big proponent on scheduling based on chair time only. There is always time for conversation during the procedure.

Gotcha, that's how I would want to practice eventually, with efficiency. Sitting around doing nothing is wasted time.

Quick question, how does rural vs urban play into this. Say we are talking about a practice owner, why exactly do rural dentists make more? Theoretically the faster dentist should be making more regardless of where he practices, but do rural dentists have some other advantage (higher fees maybe?)

 

[TanMan]

This actually got me thinking now, when we see these huge discrepancies when it comes to dentist incomes, is it mostly due to how fast a dentist works?

I always thought it was based on # of patients, but maybe speed is a bigger factor?

Either one can be a bottleneck. You can be fast, but if you don't have the patients, then your speed will serve to reduce your operating costs assuming you close for the rest of the day when you're done... or on the flipside, you can have a bunch of patients, but if you can only process x amount of patients per day, then that is the inherent limitation of the dentist.

Speed is a HUGE factor. Then you schedule based on time per procedure. For example, if you can prep a crown in 10 minutes and have a CEREC machine to scan the prep to create the definitive restoration, then really you have maybe 15 minutes of chair time. So I would schedule 30 mins tops of chair time which would include the crown fit and whatnot.

The most successful guys I know schedule based on chair time only. So prep, scan, leave. 30 mins for a $1100 crown in my neck of the woods is a good deal as a GP. Then you can add whatever you want - considering you are balancing hygiene. But I am a big proponent on scheduling based on chair time only. There is always time for conversation during the procedure.

And this is why every minute counts. 2-3 minutes of time savings in any given procedure is potential allocation to another procedure. Unfortunately, our bottleneck right now is chair availability. We're hoping the addition of chairs will solve this bottleneck and push my limitations further. In an ideal world, if I had 6 crown patients in an hour, I could stagger them every 10 minutes and have all the mills running simultaneously. Although the RCT aspect tends to throw a wrench in that type of assembly line.

Gotcha, that's how I would want to practice eventually, with efficiency. Sitting around doing nothing is wasted time.

Quick question, how does rural vs urban play into this. Say we are talking about a practice owner, why exactly do rural dentists make more? Theoretically the faster dentist should be making more regardless of where he practices, but do rural dentists have some other advantage (higher fees maybe?)

Rural dentists have the advantage of lower supply/higher relative demand. COL is lower in many rural areas, so disposable income towards elective dental work tends to be higher. The downside of rural is that the dilution effect is a lot stronger. Lets say, for example, you have 2000 people in your town and you're the only dentist, you got a respectable 1:2000 ratio. Someone comes in (or 2), the ratio goes down to 1:1000 or 1:667 v. if you were in a town of 200000 (and hypothetically, there were only 100 dentists (w/ a 1:2000 ratio). Add one more dentist and it's still a 1:1980 ratio. FWIW, I am not in a rural area.

 

[charlestweed]

This actually got me thinking now, when we see these huge discrepancies when it comes to dentist incomes, is it mostly due to how fast a dentist works?

I always thought it was based on # of patients, but maybe speed is a bigger factor?

You need both: speed and # of patients. In less competitive rural areas, it's easier to attract more patients to come to your office and to keep your appointment book full. And if you are fast like Tanman, you will be a very rich man.

In more competitive areas like SoCal and NYC, it's much harder to get enough patients to fill your appt book. To earn comparable income in these saturated areas, you will have to travel to more than one office....so you can get the high # of patients that you want. Most specialists travel but I know plenty of GPs who travel as well. My sister is a GP. When she started her own office, she didn't have enough patients. She worked 4 days/wk at a corp and 3 days/week at her own office. The managing GP, who works at the same corp office with me, also has her own office. She only works 1 day/week (every saturday) at her own office because it doesn't have enough patients for 2 doctors (her husband is also a dentist). Every saturday at her own office is a high production day for her....implant placements, RCTs, crowns etc. She probably makes more money on one saturday than what a new grad GP can make working 5 days/week. She is good and fast. At the corp, she gets the award every year for being the top producing dentist.

The faster you are and the harder you work, the higher the income you will earn.

 

[ToothJockey]

Gotcha, thanks for the responses.

How exactly does a dentist become faster? Are there CE courses which focus on speed/efficiency, or is it just practice?

When I was shadowing I never really paid attention to speed. It's susprising to me that there are such large differences in speed among dentists, such that there are dentists that struggle to produce 500k, whereas other dentists like TanMan can produce millions by himself.

 

[TanMan]

Gotcha, thanks for the responses.

How exactly does a dentist become faster? Are there CE courses which focus on speed/efficiency, or is it just practice?

When I was shadowing I never really paid attention to speed. It's susprising to me that there are such large differences in speed among dentists, such that there are dentists that struggle to produce 500k, whereas other dentists like TanMan can produce millions by himself.

Practice and the mindset. Always strive to be better and understand how you can improve your procedural efficiency and workflow. There's always room for improvement and those that struggle to produce are usually in that situation due to location, personality (interpersonal interaction with patients), and/or stuck in a dental school mentality/mindset where they cannot go beyond what they learned - essentially, a tooth mechanic with little understanding and/or tenacity for risk to improve their processes.

In many instances, it is the person that's blocking themselves from achieving their maximum potential.