AMA - Practice startups and early retirement

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So I now work 4 days (M-Th)a week at my 3rd office, which is 90% pedo patients (im a GP), with a heavy hygiene program. The other 10% are the parents of the pedo patients.

What does "heavy hygiene program" mean and do you see a high volume of patients/day (40-50) like most pediatric dentists do?

How is your 3rd office doing in cash flow compared to the ones you franchised (relatively, if you do not feel comfortable sharing the exact figures feel free not to do so)? Are the younger guys quite successful (i.e. do they find value staying with the franchise)?

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Off topic a bit, but what vehicles do you currently have right now?

If a dentist wanted to replicate your style (I like it so far, including the hours) would you recommend they start working on speed from the moment they get into school D1? Or just focus on learning and the speed will come with time?

I have a Lexus RX350, IS250, BMW i8, my first car (still! -Toyota Celica GT), and looking at the McLaren 650S right now. Maybe when I'm older I'll get an Aventador. One thing that's limiting me is garage space.... I have room for 2 in my primary garage and 2 in my gazebo. Was debating to buy the house next door or lot a few doors down to convert into a garage, but I'm not in that position yet :D

Unfortunately, getting through dental school is like going through the motions. If you stick to only what dental school teaches you, you'll be an unprofitable dentist. Use what you learn as the foundation to solve problems, not to view them as the only way to solve a clinical problem. Focus on passing, learning what you can to develop your clinical foundation, and speeding up afterwards. I would advocate that you finish your requirements as soon as possible so that you don't have to worry about doing them the dental school way after your requirements are done. Once you get your requirements, don't tout them to everyone, it'll put you on the radar (Don't want to be on faculty's radar). When you don't have to worry about graduation requirements, you're pretty much in AEGD/private practice training already. Use it to your advantage. Work with instructors that would let you have free reign unless you really need the handholding. If you don't train in speed at all, you'll be ill-prepared for the real world. Pre-clinic, I'll probably say take your time. Those ivorine teeth are nothing like real teeth, so the speed training isn't as important. Neither is the lab work, a productive dentist would not do their own lab work. To get even faster, start double booking patients in clinic. It will force you to work faster and if you can't finish one treatment, you'll be stressed with 2 ops running at the same time. Eventually, you'll either break down or learn to work through it. Trial by fire, I suppose.

As I mentioned before, the best trick is to do pulpectomies to the standard of an unobturated root canal with the speed of the endodontist. Why pulpectomies, you say? It'll teach you access, reading the pulpal floor for the orifices, biomechanical instrumentation, and pretty much everything till the final step, without having to go through the tedium of the WHOLE series of radiographs. just need pre-op, length check, cone check w/o radiograph (if WL = cone length, you're golden), and final. I'd leave the cone out, CaOH/IRM, and give the case to colleagues that needed the endo but don't plan to ever touch an endo file. Voila, you helped a friend in need, you got your training, and you didn't have to screw anyone over by hogging all procedures.

Buy your own equipment. Your school will usually make you buy a bunch of useless equipment (not all are useless though, find the ones that are useful and buy them off the ones that are specializing for dirtcheap). Dental supplies companies won't sell to you? eBay or sometimes there's vendor meetings that students can attend (and order from... they won't ask for a license number and academic discounts!).

Anyway, I hope this sets the tone for your D1 mindset. People either hated me or loved me for this mindset. You can guess which types hate me (see reply below).

Do you contribute to charity at all?

I'm gonna bite because I think you're trolling (and I enjoy feeding the trolls) and any response I give is going to be met with skepticism. Yes, I do. Now, answer one of mine: are you a pre-dent, dental student, dental faculty, dental aux, or dentist? Your name is studentdent, but I wonder which stage of the dental profession you're in.
 
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Anyway, I hope this sets the tone for your D1 mindset.

Would shadowing in the specialty clinics at my school be worth it as a D1 or just a waste of time?

"To get even faster, start double booking patients in clinic. It will force you to work faster and if you can't finish one treatment, you'll be stressed with 2 ops running at the same time. Eventually, you'll either break down or learn to work through it. Trial by fire, I suppose."

If speed is a key aspect of clinic, what would be lengths of time you'd allocate to different types of procedures in the clinic years? Would it 1.5 times as much as you'd take now? Like what's "faster"?
 
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Also, anything you'd recommend doing during the summers after D1, D2, and D3?
 
I opened 3 offices from scratch, franchised 2 of them to younger guys who are highly motivated. I'm also their landlord (I own the buildings), so they pay franchise fee (for equipment and charts) + 5 years leases (that way they are locked as tenants for longer as oppose to associates from year to year). The cash flow from rent and franchise fee per office is about $100k a year per office, so 5 year lease means $500k per office. Renewal options would be higher, so essentially I'm hands off and I just let those offices pay for the building mortgages, which should be paid off at the end of their first renewal term.

Like most offices, I had bad experience with keeping associates. They would ask for higher pay after 1 year contracts and then would slack off after they feel too comfortable or start to get ideas of starting their own practices (I don't blame them).

So I now work 4 days (M-Th)a week at my 3rd office, which is 90% pedo patients (im a GP), with a heavy hygiene program. The other 10% are the parents of the pedo patients.

I manage the buildings on Fridays. Say hello to the tenants and such. I procrastinate on weekends... watching soccer, adding features to Amazon echo, stop my parents place, and wife dates.

It took me 6-7 years to get here after d school graduation. I'm done with new ventures and all the things people say about doing more in life. I'm in my late 30s now, will max out my 401k ($73k a year; joint with my wife), and let the compounding interest take it to $6-8M in 20-25 years. At age 65, I have the chance to do more philanthropy and just use 5% of my savings between real estate, practices and retirement accounts, with zero debt. I will be happy to report back here in 20 years or so.

Interesting, so you're total compensation from the franchised practices is 100k each? Couldn't you increase compensation by making it a satellite and paying the associates a percentage or set income and keeping the leftover? Maybe I'm misunderstanding.
 
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I have a Lexus RX350, IS250, BMW i8, my first car (still! -Toyota Celica GT), and looking at the McLaren 650S right now. Maybe when I'm older I'll get an Aventador. One thing that's limiting me is garage space.... I have room for 2 in my primary garage and 2 in my gazebo. Was debating to buy the house next door or lot a few doors down to convert into a garage, but I'm not in that position yet :D

Unfortunately, getting through dental school is like going through the motions. If you stick to only what dental school teaches you, you'll be an unprofitable dentist. Use what you learn as the foundation to solve problems, not to view them as the only way to solve a clinical problem. Focus on passing, learning what you can to develop your clinical foundation, and speeding up afterwards. I would advocate that you finish your requirements as soon as possible so that you don't have to worry about doing them the dental school way after your requirements are done. Once you get your requirements, don't tout them to everyone, it'll put you on the radar (Don't want to be on faculty's radar). When you don't have to worry about graduation requirements, you're pretty much in AEGD/private practice training already. Use it to your advantage. Work with instructors that would let you have free reign unless you really need the handholding. If you don't train in speed at all, you'll be ill-prepared for the real world. Pre-clinic, I'll probably say take your time. Those ivorine teeth are nothing like real teeth, so the speed training isn't as important. Neither is the lab work, a productive dentist would not do their own lab work. To get even faster, start double booking patients in clinic. It will force you to work faster and if you can't finish one treatment, you'll be stressed with 2 ops running at the same time. Eventually, you'll either break down or learn to work through it. Trial by fire, I suppose.

As I mentioned before, the best trick is to do pulpectomies to the standard of an unobturated root canal with the speed of the endodontist. Why pulpectomies, you say? It'll teach you access, reading the pulpal floor for the orifices, biomechanical instrumentation, and pretty much everything till the final step, without having to go through the tedium of the WHOLE series of radiographs. just need pre-op, length check, cone check w/o radiograph (if WL = cone length, you're golden), and final. I'd leave the cone out, CaOH/IRM, and give the case to colleagues that needed the endo but don't plan to ever touch an endo file. Voila, you helped a friend in need, you got your training, and you didn't have to screw anyone over by hogging all procedures.

Buy your own equipment. Your school will usually make you buy a bunch of useless equipment (not all are useless though, find the ones that are useful and buy them off the ones that are specializing for dirtcheap). Dental supplies companies won't sell to you? eBay or sometimes there's vendor meetings that students can attend (and order from... they won't ask for a license number and academic discounts!).

Anyway, I hope this sets the tone for your D1 mindset. People either hated me or loved me for this mindset. You can guess which types hate me (see reply below).



I'm gonna bite because I think you're trolling (and I enjoy feeding the trolls) and any response I give is going to be met with skepticism. Yes, I do. Now, answer one of mine: are you a pre-dent, dental student, dental faculty, dental aux, or dentist? Your name is studentdent, but I wonder which stage of the dental profession you're in.

My school is going to rent out equipment, would you still advice us to buy the things we would actually need in practice? Also when should we get loupes? I was wondering if getting then early makes a difference long term.

How possible do you think it is to actually double book patients in clinical years? I have always thought seeing two a day was very slow and you're the first person who has brought up seeing more than that.
 
I have a Lexus RX350, IS250, BMW i8, my first car (still! -Toyota Celica GT), and looking at the McLaren 650S right now. Maybe when I'm older I'll get an Aventador. One thing that's limiting me is garage space.... I have room for 2 in my primary garage and 2 in my gazebo. Was debating to buy the house next door or lot a few doors down to convert into a garage, but I'm not in that position yet :D

Unfortunately, getting through dental school is like going through the motions. If you stick to only what dental school teaches you, you'll be an unprofitable dentist. Use what you learn as the foundation to solve problems, not to view them as the only way to solve a clinical problem. Focus on passing, learning what you can to develop your clinical foundation, and speeding up afterwards. I would advocate that you finish your requirements as soon as possible so that you don't have to worry about doing them the dental school way after your requirements are done. Once you get your requirements, don't tout them to everyone, it'll put you on the radar (Don't want to be on faculty's radar). When you don't have to worry about graduation requirements, you're pretty much in AEGD/private practice training already. Use it to your advantage. Work with instructors that would let you have free reign unless you really need the handholding. If you don't train in speed at all, you'll be ill-prepared for the real world. Pre-clinic, I'll probably say take your time. Those ivorine teeth are nothing like real teeth, so the speed training isn't as important. Neither is the lab work, a productive dentist would not do their own lab work. To get even faster, start double booking patients in clinic. It will force you to work faster and if you can't finish one treatment, you'll be stressed with 2 ops running at the same time. Eventually, you'll either break down or learn to work through it. Trial by fire, I suppose.

As I mentioned before, the best trick is to do pulpectomies to the standard of an unobturated root canal with the speed of the endodontist. Why pulpectomies, you say? It'll teach you access, reading the pulpal floor for the orifices, biomechanical instrumentation, and pretty much everything till the final step, without having to go through the tedium of the WHOLE series of radiographs. just need pre-op, length check, cone check w/o radiograph (if WL = cone length, you're golden), and final. I'd leave the cone out, CaOH/IRM, and give the case to colleagues that needed the endo but don't plan to ever touch an endo file. Voila, you helped a friend in need, you got your training, and you didn't have to screw anyone over by hogging all procedures.

Buy your own equipment. Your school will usually make you buy a bunch of useless equipment (not all are useless though, find the ones that are useful and buy them off the ones that are specializing for dirtcheap). Dental supplies companies won't sell to you? eBay or sometimes there's vendor meetings that students can attend (and order from... they won't ask for a license number and academic discounts!).

Anyway, I hope this sets the tone for your D1 mindset. People either hated me or loved me for this mindset. You can guess which types hate me (see reply below).



I'm gonna bite because I think you're trolling (and I enjoy feeding the trolls) and any response I give is going to be met with skepticism. Yes, I do. Now, answer one of mine: are you a pre-dent, dental student, dental faculty, dental aux, or dentist? Your name is studentdent, but I wonder which stage of the dental profession you're in.
Regarding the i8, it looks like a sweet car but I've read it only gets like 15 miles per charge. Is this true?
 
Would shadowing in the specialty clinics at my school be worth it as a D1 or just a waste of time?

"To get even faster, start double booking patients in clinic. It will force you to work faster and if you can't finish one treatment, you'll be stressed with 2 ops running at the same time. Eventually, you'll either break down or learn to work through it. Trial by fire, I suppose."

If speed is a key aspect of clinic, what would be lengths of time you'd allocate to different types of procedures in the clinic years? Would it 1.5 times as much as you'd take now? Like what's "faster"?

Shadow only if you want to be a specialist. I think its pretty useless unless you're trying to pickup pointers on gum surgery, root canals, or 3rd's. Now if you can assist them, you'll probably gain more insight.

I think at the end of my time there, I was able to do 6-8 interproximal fills in a 2 hour session (still slow by private practice standards). I posted how to speed up your complete dentures (in dental school) somewhere in the earlier posts. I bought my own piezo unit in dental school for more efficient plaque removal and faster prophies/srps. I don't remember the times, I just remember juggling sometimes. I probably should not give examples of how to doublebook since dental students are usually self-destructive of each other and will rat each other out. They'll probably just tell their admins. Another speedtip: use septocaine. Use marcaine for longer procedures.

So... keep a low profile and just go do it! I remember seeing patients when I was supposed to be in class. Could have been suspended, but never got in trouble. Shows you how useless most classes in dental school are.

Also, anything you'd recommend doing during the summers after D1, D2, and D3?

Clinical practice if its available. Goal is to finish early for aforementioned reasons

My school is going to rent out equipment, would you still advice us to buy the things we would actually need in practice? Also when should we get loupes? I was wondering if getting then early makes a difference long term.

How possible do you think it is to actually double book patients in clinical years? I have always thought seeing two a day was very slow and you're the first person who has brought up seeing more than that.

Yes, you should buy things you need in practice. How do you know what's good and not good without trying them out. Just don't tell your instructor what materials you're using or they might have a fit. There's instructions and DFU(directions for use) on the materials, we can all read (I hope). I remember back then I was testing out 7th generation bonding agents (no etch, no prime, no bond); how would they know what I'm using? or... H&H technique on impressions, easy no cord impressions. Just ask for extra die spacer and don't use too much light body. Those are some of the things that I remember. Get loupes asap. You should always practice with your loupes.

Double booking can be tricky. You can get in a lot of trouble if its against their policies and catch you. Again, I will not give examples publicly because rest assured, someone's gonna rat you out. Assume that of most of your future colleagues. It happened with the class above us. A high and mighty individual who thinks they are taking the moral high ground - there's plenty of them in dental school, and do not see that they are not making the system better, but worse for everyone else. Again, I'm very vague about this because I don't want you guys to lose your opportunities to use my ideas (although they are not provided in detail).

Regarding the i8, it looks like a sweet car but I've read it only gets like 15 miles per charge. Is this true?

Only if you go on electric only, but it has gas and electric. On both, I think max range is 310 miles.
 
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"DS3, I finished my requirements early so I didn't have to worry about the requirement aspects of school - I got to focus on what mattered most, succeeding in clinical practice"

What did you focus on? I know you said molar endo was a focus, but what else?

I am guessing you also stayed very low-key in dental school. Would you recommend staying low-key and I guess... how does one stay/maintain low-key?
 
"DS3, I finished my requirements early so I didn't have to worry about the requirement aspects of school - I got to focus on what mattered most, succeeding in clinical practice"

What did you focus on? I know you said molar endo was a focus, but what else?

I am guessing you also stayed very low-key in dental school. Would you recommend staying low-key and I guess... how does one stay/maintain low-key?

I think molar endo is the biggest thing. Extractions at lower income sites (sometimes there's dental missions that you can join to do more extractions).I think crowns and fillings become redundant. You can only do so much until you gain nothing more while still being stuck in a restrictive dental school setting. I may even propose that if you do them too much, you won't be able to see beyond the dental school context of fillings/crowns.

One thing I was not able to do in dental school, and if you are able to figure out if you can do it, would be RCT, b/u, crown in one appt.

How to stay low-key: Don't socialize too much with your peers. Interact primarily in a business/transactional matter. Don't get political, do too many events, or things that expose your name. (Don't listen to any of this advice if you're going to specialize)
 
I'm gonna bite because I think you're trolling (and I enjoy feeding the trolls) and any response I give is going to be met with skepticism. Yes, I do. Now, answer one of mine: are you a pre-dent, dental student, dental faculty, dental aux, or dentist? Your name is studentdent, but I wonder which stage of the dental profession you're in.
I don't think the dude is trolling you. He legit started a thread titled "morality of "being in it for $$$"

He's just one of those...
 
What does "heavy hygiene program" mean and do you see a high volume of patients/day (40-50) like most pediatric dentists do?

How is your 3rd office doing in cash flow compared to the ones you franchised (relatively, if you do not feel comfortable sharing the exact figures feel free not to do so)? Are the younger guys quite successful (i.e. do they find value staying with the franchise)?
Heavy hygiene = high new patients + high active recalls.

We see about 30-40 hygiene patients a day. I have 1 full time hygienist and 2 coronal polishers (they also do sealants). We have 3 hygiene blocks schedules with upto 12 patients each. I designed and built the office for pedo population, and opened the practice across the street from a big national pedo chain called Small Smiles 3 years ago. Small Smiles closed 6 months after I opened my pedo heavy clinic, which gave my office the boost of new and recall patients. I have a dedicated front desk staff who schedules recall patients, her goals is to schedule 30 recall appointments a day.

My 3rd office is in much more busier location than the other 2 offices. It hit 7 figure collection within 2 years, with 40% overhead (hence it's mostly pedo hygiene). The other 2 offices are adult based offices and the doctors who franchised those offices were working there as associates for couple of years before they became franchisee tenants. I was going to lose them if I didn't give them the franchise option, and they would have to give up the patients they have been seeeing at those offices if they had left (there was a 5 mile non compete clause for 3 years, the city has 10-15 miles radius, so they would be blocked from the most affluent part of the city for few years if they had left). So the value in staying was to increase their income and have full control of the practice. They created their own LLC as franchisee tenants, with their own staff and so on. It's a concept I haven't seen anywhere else, but seems to be working fine for me so far, because it's the best way to retain associate dentists.
 
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Interesting, so you're total compensation from the franchised practices is 100k each? Couldn't you increase compensation by making it a satellite and paying the associates a percentage or set income and keeping the leftover? Maybe I'm misunderstanding.
I could do that. But that would probably require 10x the effort and time to do that. I did try the conventional collection based compensation with associates, but they would be employees and I would have to pay payroll taxes and mange the staff for those associates through an office manager, the buck still ends with me. That's a lot of moving parts. Yes I would make maybe 3x the money, but I just didn't see myself doing that for additional $200k a year from each satellite office for the level of effort that I would have to put into it. Can I do it? Yes. Should I? No.

Again, I make good income and have set myself up for a good quality of life and a great income "balance". Everyone has their ratio on this, and as you increase one, the other side goes down. Quality of life should be as important, if not
more important that an income. There are folks who are extremely happy and have great quality of life with an income less than what most dentists make. This should be a goal on its own. The fear of debt has changed the race to make more money to higher levels.

So, take that YOLO reality seriously.
 
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I have a Lexus RX350, IS250, BMW i8, my first car (still! -Toyota Celica GT), and looking at the McLaren 650S right now.
A car can say a lot about it's owner. I have a friend and neighbor who has a similar collection, and I just pictured him when I was reading your line-up.

I could never own more than 1, at the most 2, depreciating cars at a time. You couldn't get me to do that, and this is coming from someone who owned M3, Audi S5, Macan Turbo and now a Targa GTS. If I do anything more, I would stand out as a sore thumb in my community or city. My accountant would have a fit too. I backed out from Mercedes GTC for these reasons. Anyways, first world problems.
 
I don't think the dude is trolling you. He legit started a thread titled "morality of "being in it for $$$"

He's just one of those...

LOL, yeah. Prime example of who not to become friends with in dental school. I read that thread. It's really funny that some people are really like that. Interesting he/she never answered my question.

I could do that. But that would probably require 10x the effort and time to do that. I did try the conventional collection based compensation with associates, but they would be employees and I would have to pay payroll taxes and mange the staff for those associates through an office manager, the buck still ends with me. That's a lot of moving parts. Yes I would make maybe 3x the money, but I just didn't see myself doing that for additional $200k a year from each satellite office for the level of effort that I would have to put into it. Can I do it? Yes. Should I? No.

Again, I make good income and have set myself up for a good quality of life and a great income "balance". Everyone has their ratio on this, and as you increase one, the other side goes down. Quality of life should be as important, if not
more important that an income. There are folks who are extremely happy and have great quality of life with an income less than what most dentists make. This should be a goal on its own. The fear of debt has changed the race to make more money to higher levels.

So, take that YOLO reality seriously.

Even though we have different practice philosophies, I agree with him on this one.... however, I would like to add: You only live YOUNG once. Enjoy your life when you're still young. Don't spend your entire life working your butt off then wake up someday to realize that you are old and can't enjoy your money as much as if you were younger. Worst part is if you work your entire life, build wealth, then have ungrateful children who are disappointments in life. I've seen lots of these examples and its just sad to see in retrospect.

A car can say a lot about it's owner. I have a friend and neighbor who has a similar collection, and I just pictured him when I was reading your line-up.

I could never own more than 1, at the most 2, depreciating cars at a time. You couldn't get me to do that, and this is coming from someone who owned M3, Audi S5, Macan Turbo and now a Targa GTS. If I do anything more, I would stand out as a sore thumb in my community or city. My accountant would have a fit too. I backed out from Mercedes GTC for these reasons. Anyways, first world problems.

I assume that whatever I spent on the vehicles, I'm never getting back again and the value of my vehicle is essentially 0 since I have no intention of selling or liquidating them (drive till they burn down on the side of the road and hopefully while I'm not in it. Essentially, I'll buy a car if I have disposable income for it. The good thing about my city, most physicians are in nice cars and I'm not in any social/religious circles in my community, so I don't really care what people say or think. You're right though... first world problems, haha.
 
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Under 40.

So you graduated dental school at 26, and you intend to practice for 3 more years which means you will practice for 8 years total and retire from dentistry at age 34. Is this correct or am I off?
 
Also, what population to dentist ratio would be the minimum for a startup or a practice acquisition?
 
How will you spend your days after you retire? Have you figured that part out?

Traveling, doing what I want to do. Sleeping in everyday... whatever floats my boat that day, week, month. Just to have the freedom of doing what I want without having to think about working.

Also, what population to dentist ratio would be the minimum for a startup or a practice acquisition?

I hear 2000:1, but I don't think I can give you a reliable answer. I think it's not just the population, but also the type and quality of the patients that come along with the area. Certain demographics are more difficult than others to deal with (more effort) and have different yields (prod/pt). 2000:1 in one location is drastically different from 2000:1 in another. Now, in terms of valuation, 2000:1 may actually be worth less than 1500:1 in another, depending on some variables that may be considered not PC. So, I think going solely by the numbers maybe misleading, you need to look at your demographics as well and factor that in. If your 2000:1 was comprised of mostly fixed income low savings senior citizens, you're in bad shape, or if its 2000:1 or lower income patients with no medicaid or the state medicaid benefits are not great. Now, if you got the same ratio with middle/upper-middle class with higher disposable incomes, that would be more desirable.

Again, this is probably controversial to some people, but I hope this provides some insight on how to look at this question. The important part is that you are asking the right questions and not irrelevant questions.
 
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What are you thoughts on how long one should work as an associate before starting their own practice?

Please critique these strategies:

1. Sign a one year contract to associate when I graduate with a corporate entity or a decent PP, then apply for a loan 3 months in for a startup, hopefully finish construction in the next 6 months (assuming there aren't any delays, but that's just wishful thinking), then work part time while keeping my associate job until I can go full force.

2. Apply for an SBA loan or some other funding source within the next couple months, for ~$150K, hopefully get some TI monies. Before I graduate, construct a "too small to fail" startup with 2-3 chairs or however many I can afford and fit, and run it bare bones with one assistant/front desk. I'll be doing the hygiene and the dentistry until I can afford to hire new people.

Con: I never worked in a private practice environment
 
Under 40.
No one can define "young". It's a state of mind.

Besides, most of my friends are 50-70 years old (my neighbors, my contractors, my dental specialist friends, my realtors, my tenants, my vendors, etc), and I'm in my late 30's. Am I young by the company I keep? Or where I live? Or what I do after work hours?

I suppose we are all young until someone's feelings are hurt.
 
@Cold Front

In hindsight, do you have any regrets about the way you approached your career? Anything you'd advise a younger version of yourself to do/not do? How about perspective - in hindsight, any aspect of your younger perspectives that you would have wanted to change or know are wrong/naive now?
 
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What are you thoughts on how long one should work as an associate before starting their own practice?

Please critique these strategies:

1. Sign a one year contract to associate when I graduate with a corporate entity or a decent PP, then apply for a loan 3 months in for a startup, hopefully finish construction in the next 6 months (assuming there aren't any delays, but that's just wishful thinking), then work part time while keeping my associate job until I can go full force.

2. Apply for an SBA loan or some other funding source within the next couple months, for ~$150K, hopefully get some TI monies. Before I graduate, construct a "too small to fail" startup with 2-3 chairs or however many I can afford and fit, and run it bare bones with one assistant/front desk. I'll be doing the hygiene and the dentistry until I can afford to hire new people.

Con: I never worked in a private practice environment

1. Try and get a large sign on bonus. If they terminate you before then, you get to keep it. If you quit, you have to give it back (read contract carefully, but that was my experiences at least). Business loans from banks are some of the worst in terms of the things they make you do... Sometimes they'll make you work x days per week somewhere else, force ("encourage" you to buy from expensive vendors, give them reports of hygiene and other things. They usually want a certain amount of work experience too. It would be better to just pay for it in cash if you can.

2. I don't know too much about SBA; I know that they have some rules for properties, owner-occupied, and some other restrictions. I don't know too much about it, you'll have to ask someone who went the SBA route. I think the too small to fail is a conservative way of going about it, but I wouldn't want it to be a money pit. A small office can also be a money pit. You could do barebones, but I say, start midsize with room to go big. Doing your own hygiene is good until you have enough to justify a hygienist. Do one front, two assistants, and one billing/front. Otherwise, you may end up having an administrative and clinical bottleneck in your operations

About being young... the answer pertains to physical well-being. As bad as it is... we're not as strong as we were in our 20's, 30's, is different, 40's our body starts to deteriorate a bit. So... when I say enjoy life when you're still young, enjoy life when you are able to physically enjoy it to the max. When you're in your 40's and 50's, you won't be able to eat as much as you can, drink as much as you can, or party as hard. Enjoy your youth. I'm just grateful I can eat whatever I want still and not gain weight or worry about cholesterol or other things. I'll be sad the day I can't do that anymore, but I understand it is inevitable.
 
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What about buying a percentage off a clinic? The chances of failure won't be anywhere near the chances of starting a new business. It also won't cost as much.
 
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About being young... the answer pertains to physical well-being. As bad as it is... we're not as strong as we were in our 20's, 30's, is different, 40's our body starts to deteriorate a bit. So... when I say enjoy life when you're still young, enjoy life when you are able to physically enjoy it to the max. When you're in your 40's and 50's, you won't be able to eat as much as you can, drink as much as you can, or party as hard. Enjoy your youth. I'm just grateful I can eat whatever I want still and not gain weight or worry about cholesterol or other things. I'll be sad the day I can't do that anymore, but I understand it is inevitable.
Actually, the best years in life are in the 40's and beyond (in my opinion). You may be physically slowing down, but your life and character becomes more refined like an aged wine. You appreciate life more, and stability leads to enjoying life more responsibly. Yes it's fun not watching for your diet and not caring about what happens to your body because you are going to leave the worries to later decades in your life. Ofcourse that sounds cool, but how many older patients do you see having regrets about younger days and their oral health (and whatever else they didn't disclose). I'm just saying you don't have to prioritize the best part of young body being put into use by focusing on booze and chasing skirts or doing something crazy, that happens by default to most young people anyways, but doesn't mean the physical body starts to slip away as a deadline when you turn 40 (which it does), but once again, as a default, most people become more mindful about their body as they get older.

Life can be enjoyed at all ages, don't base it on the body or physical ability as the main factor. Unless you decide to be an athlete beyond 40, the average person doesn't have to worry as much. There are many older crazy folks behaving like young people still walking around.
 
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@Cold Front

In hindsight, do you have any regrets about the way you approached your career? Anything you'd advise a younger version of yourself to do/not do? How about perspective - in hindsight, any aspect of your younger perspectives that you would have wanted to change or know are wrong/naive now?
So far not many regrets. I would say maybe not hiring certain associates and staff, but that was critical to the learning curve. I don't believe in regrets, you walk away from any situation with a lesson which becomes an experience.

I would have told my younger self to get into dental school sooner. I started dental school when I was 28, but if I had started sooner I would have not had some critical life experiences I picked up before dental school, that helped me after I finished school and in the business side of dentistry.

We are all dealt with different cards in life, make the most out of them.
 
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So far not many regrets. I would say maybe not hiring certain associates and staff, but that was critical to the learning curve. I don't believe in regrets, you walk away from any situation with a lesson which becomes an experience.

I would have told my younger self to get into dental school sooner. I started dental school when I was 28, but if I had started sooner I would have not had some critical life experiences I picked up before dental school, that helped me after I finished school and in the business side of dentistry.

We are all dealt with different cards in life, make the most out of them.
THIS.
I didn't start dental school until my 30s.
 
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What about buying a percentage off a clinic? The chances of failure won't be anywhere near the chances of starting a new business. It also won't cost as much.

I'm not familiar with buying a percentage off an office. Would you have to work in it or would you purchase x% interest for x amount of money and just have it generate income for you or do you have to work there as well. Depends on the corporate charter, can you resell your shares, and all these other corporate bylaws and regulations regarding what you can and cant do with your share/interest. Also, what happens if your colleagues leave a mess...

Just some questions to ponder about. Failure of a practice is not limited by having a percentage, it just limits the amount you have to lose and limits your liability depending on your state's protections regarding your corporate structure.
 
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What about buying a percentage off a clinic? The chances of failure won't be anywhere near the chances of starting a new business. It also won't cost as much.

You could do this - think Pacific Dental Services (you purchase up to 49%). Issue is... how do you sell a percentage of a practice in the future? Not many people would buy that... a) you don't even get the most say in the practice, b) it's not a full practice
 
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No, you have better things to do with your capital than buy a building/land and break ground. Commercial real estate can make you extra money, but you're in the business of dentistry, not being a landlord. You could generate an amount on commercial real estate development, but when you're capital hungry, bad idea, especially when your primary source of income is dentistry. Rent is cheap, I'd rather pay the rent, free up my obligations, and I'm getting free water/trash. On paper, it sounds like a great investment, but I'm adverse to it in my area due to high vacancy rates in commercial real estate. That gives me as a tenant more negotiating power. Areas that have high occupancy rates typically have lower CAP rates and less profitable as a buy and hold.

One thing I forgot to say is negotiating with landlords... Try not to go with large corporation owned strips. There's so much BS and restrictions with those landlords and I got lucky in that mine was very informal, no BS, pay rent and no problems.

Edit: RE is slow and steady money as a buy and hold strategy. I want to retire fast, so I don't dabble in real estate holdings, only hard money lending.

Where/what type of market are you serving to? Are you located in a urbanized area, or is it more rural/suburban? What state, or are not able to disclose that? I would assume the risk factors to starting the way you started wouldn't be very applicable in more densely populated areas such as NYC,LA,CHI,PHI etc.
 
Yeah.... not unless I have nothing else to do with my money.
When I evaluated real estate as a potential investment, I look at the following factors:
1. Am I building equity, cash flow, or both? If I'm building equity, how much, how fast, and how liquid is it?
2. What percentage of my income is taken by debt servicing, property taxes, maintenance, etc...
3. Risk factors for STNL/MTNL's since we're talking about commercial real estate. CAP rates just aren't that great for a buy and hold strategy, and flipping + 1031's are something I don't really want to do.
4. Passive income for absolute triple nets, but you need to factor in vacancy rates as well. If you're not in a absolute triple net, it's not absolutely passive (double nets, triple net still carry some maintenance costs)
5. Long term v short term. Your strategy works if you're going to do this for a long time. Wtf would I want to buy a building that I have no intention in staying in for the long term. I'm just gonna have an empty 4500 sq ft facility that's going to cost me money if I can't get anyone to rent or buy my office. A lot of these speculative/pro forma returns are factored into the purchasing price already.
6. Depreciation of a property does have tax benefits.

There's multiple sides to this, for most people going through the traditional route, this makes sense. If you're in a rush, this is probably not the best way to accumulate wealth

S-corps do have a higher chance of getting audited, I'll give him that, but I have my reasons on starting as an S-corp.

Anyway, I'm still at work, but I had some downtime. I'm just going to say this, 500k/yr is not much, especially if its not net income. (i'll assume that your debt servicing is not part of the net income equation due to building equity, but part of it is interest). Buying your building can make sense if its cash flow positive, building equity, you have nothing better to do with your capital and you're going to stay there for awhile, but its not as glamorous as the above poster made it. My strategy requires significant liquidity and its hard to get that especially if you're heavily leveraged on a property already., i.e 1mm down on a 10mm property...

Ill try and go more into detail later.

Depends on where you invest. Save money, buy property in premium neighborhoods, outside big metro areas. Demand for that almost never goes away, you will be guaranteed a tenant 95% of the time, depreciation rarely hits these properties since their always in demand.
 
Hey TanMan.

Thanks for starting this thread. Just out of curiosity, would you recommend doing an AEGD or GPR out of dental school? I think my dental school sufficiently prepares people to be good clinicians, but a lot of jobs that are higher paying for more recent graduates want either a residency or 3-ish years of experience before they hire someone. I wasn't sure if it is worth it, in your opinion for someone wanting to get to the place/type of practice you have, to take the time to do an AEGD or GPR or just try to get the experience needed through any job available they can get (corporate etc.)

Also, you talk a lot about steering away from more surgical procedures (implant placements, 3rd molar extractions etc.) because the liability/overhead isn't worth it and you can make up the difference. Do you think if those are procedures someone is interested in doing as a general dentist they should do a GPR or AEGD or do you think a dentist could get that kind of experience/training on their own through CE courses?
 
Where/what type of market are you serving to? Are you located in a urbanized area, or is it more rural/suburban? What state, or are not able to disclose that? I would assume the risk factors to starting the way you started wouldn't be very applicable in more densely populated areas such as NYC,LA,CHI,PHI etc.

Suburban area, texas. Slower growth in more densely populated areas because there's more dentists. More capital needed to make sure that you can survive the first few months while trying to break even against more competition.

Hey TanMan.

Thanks for starting this thread. Just out of curiosity, would you recommend doing an AEGD or GPR out of dental school? I think my dental school sufficiently prepares people to be good clinicians, but a lot of jobs that are higher paying for more recent graduates want either a residency or 3-ish years of experience before they hire someone. I wasn't sure if it is worth it, in your opinion for someone wanting to get to the place/type of practice you have, to take the time to do an AEGD or GPR or just try to get the experience needed through any job available they can get (corporate etc.)

Also, you talk a lot about steering away from more surgical procedures (implant placements, 3rd molar extractions etc.) because the liability/overhead isn't worth it and you can make up the difference. Do you think if those are procedures someone is interested in doing as a general dentist they should do a GPR or AEGD or do you think a dentist could get that kind of experience/training on their own through CE courses?

I don't recommend AEGD/GPR. Just seems like more school - you're losing 1-2 years of production as a result. Take a job that pays you based on production and make sure you can produce. Get a job through corporate that will let you make as much money as you produce with a guaranteed minimum. When you're done with them, leave.

I still wouldn't recommend doing AEGD/GPR. Work as a GP, take CE courses (and maybe even have your company pay for them), you'll come out ahead financially. I think there's some implant and surgical crash courses you can take in another country in the bahamas or south america where you don't have to worry about licensure or professional liability, that will give you implant proficiency in a crash course style setting. The only thing that you may need to do an actual course/program would be IV sedation (depends on the state), but that's if you really really want to.
 
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When you worked at a corporate office, were you on production or collection? And did they offer you a minimum salary?
 
I worked for two, first one was minimum w/ production, second one was no minimum, collection only.
When you started at your second job (collection, no salary), did you have your goal in mind (retiring early) or did you go there because that was the only job available? Also, I assist at a place where doctors get paid based on collection, I don't see one positive thing about it because the dentist should focus on his clinical work not go after patients and make sure they pay for the service.
 
When you started at your second job (collection, no salary), did you have your goal in mind (retiring early) or did you go there because that was the only job available? Also, I assist at a place where doctors get paid based on collection, I don't see one positive thing about it because the dentist should focus on his clinical work not go after patients and make sure they pay for the service.

I took the job since they had more volume. I left the first job because of more money potential. It was a medicaid mill when medicaid was great.
 
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Hey TanMan, great thread you have going on here.
Just a little question, I'm in the process of applying for my license (finally) and will have to start looking for jobs pretty soon. What was it like when you got your first job? Did they respect the fact that you were a dental newbie and helped you start getting comfortable out in the "real world"? What do you think are important things to look for or ask for when looking at options for my first work-places (work and pay related)? Thanks a lot.
 
Hey TanMan, great thread you have going on here.
Just a little question, I'm in the process of applying for my license (finally) and will have to start looking for jobs pretty soon. What was it like when you got your first job? Did they respect the fact that you were a dental newbie and helped you start getting comfortable out in the "real world"? What do you think are important things to look for or ask for when looking at options for my first work-places (work and pay related)? Thanks a lot.

First job was busy, although they let slow doctors work at their own pace too. They don't respect you for being a newbie, and having a dds/dmd means nothing. If you want respect, you have to prove you can keep up with the bigboys (experienced, fast dentists) and not be an uptight a--hole either.

I was very upfront with offers. I told them I want to make as much money as possible, I'm not afraid to work hard, and I'll do what has to be done. If they were going to bait and switch and play games with me, I'll walk off that day. That weeded out the BSers. I want to make money, they want to make money, don't send me to a slow office. (and yes... I told the potential offices this information)

Things to look for when you observe is patient volume, staff happiness and expediency, and whether other docs are just sitting around or no time to talk. If you see low patient volumes, staff is lethargic and lazy, or the docs are doing nothing... steer away. Also, if they let you tour the office, ask to see their schedules. Pay related, production is ideal over collections; collections is only good if the staff is good at collecting. Go for 30% minimum collections. In a corporate setting, make friends with the staff to make sure they give you more patients. If you prove that you can go fast, they'll give you more patients because they usually don't want to be stuck there afterhours.
 
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In your view, what do you think comes first- buying an office or buying a home/apt?

Or when it comes to wanting both, how have you planned this out financially?
 
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Hi there! Can you list the prices for the procedures you do at your office? Normal cleaning, molar endo, crown prep, etc... if you don't mind. Also, when you started your office, based on what did you come up with the prices for the procedures?
 
Hi there! Can you list the prices for the procedures you do at your office? Normal cleaning, molar endo, crown prep, etc... if you don't mind. Also, when you started your office, based on what did you come up with the prices for the procedures?

I do not want to share my price for all the procedures at this time. I charge 1k for RCT, 1k for crown. Prices are based on some area price list that I purchased, and I pegged my fees at 85-90th percentile. Not the cheapest, but the price you pay for convenience.
 
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I do not want to share my price for all the procedures at this time. I charge 1k for RCT, 1k for crown. Prices are based on some area price list that I purchased, and I pegged my fees at 85-90th percentile. Not the cheapest, but the price you pay for convenience.
Okay, so if I start a clinic at a "rich neighborhood" should I use the prices that are common in that area or a little less to win over patients?
 
Okay, so if I start a clinic at a "rich neighborhood" should I use the prices that are common in that area or a little less to win over patients?

Yes, I'd say so based on my own experience. Rich people tend to be more stingy with their money and demanding at the same time. That's why I don't target them. They can go to the dentist that's going to try and kiss their.... for hopes of more money. Unfortunately, in my region, rich people are entitled. I tend to be less friendly and strict with them if they are demanding, entitled, and with an attitude, so I don't see them back very often. How you treat your patients will dictate which ones you keep, and which ones you drive out of your office. This is important to keep in mind in that if you're ubernice to the ones that you don't want to keep, they'll keep coming back.

However, if you frame yourself as an emergency dentist, usually their barriers to being cheap go down if they are in severe pain and you can charge at the highest percentiles; cheapskates will just end up getting a script so they can see their dentist on Monday or the following day. However, certain demographics are much worse than others, and that's for you to figure out which demographics are good and bad as it may be considered un-PC to openly discuss. Not all income demographics are the same, there's age, race, cultural values to factor in as well. Example, if in a certain culture, the woman decides all the family decisions, who do you target? The one who makes the decisions. Someone might say... oh, that's sexist, racist, etc... No, its understanding the cultural value systems (and associated demographics) and figuring out how to get the one that decides to go to your office and have them drag their family with them too. Understand the people and regional culture you're going to work on and how you'll advertise to get them into your office. This will lead to larger returns on advertising.

There is no straightforward answer here, only the way that you may want to practice dentistry with the price levels that you want. Either the price levels will dictate your business model, or your business model will dictate the pricing that you want/could set. I have provided two possible options. Set them as average, you'll attract more, but the problems with upper class patients still persist. Set them high, you'll see more attrition with the upper class, but you'll get more emergencies if you open when no one else is open. Aim for middle, upper-middle. My business model agrees with the middle and upper-middle class.
 
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After PMing for awhile with another member regarding startups, I decided to answer any questions you may have regarding starting your own office and retiring early (yes, they are connected). I started my office a over 3 years ago and have been practicing for 5years. I love dentistry, but it takes it toll on you and life's too short to work for the rest of your life. If given the decision to do a startup or buy an office again, I'd choose a startup everytime unless the office was supercheap, but superprofitable.


This is not dental related at all, but do you have a Roth IRA? Would you recommend dental students to get one?

I set one up when I was 18, and as of now, I will be really well off if I make it to 65.
 
This is not dental related at all, but do you have a Roth IRA? Would you recommend dental students to get one?

I set one up when I was 18, and as of now, I will be really well off if I make it to 65.

No. If you are seeking early retirement, retirement accounts are of limited use because of the low amounts you can put in, and the age restrictions on use/withdrawal. Save your money to open an office instead. You'll make way more than having it in a retirement account.
 
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