AMA - Practice startups and early retirement

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Essentially, one of the investments I'm advocating for is the use of market inefficiencies (i.e lending to companies/individuals that need money but can't get money from banks) to make a significantly larger profit. With respect to consumer loans, some states are starting to regulate payday loans, so it's not as profitable as it used to be.

I thought of the differences between our philosophies (practice, business, and investment-wise). We're very opposite, from the way we practice, the way we think about life and business, and the way we think of dentistry. My practice philosophy of opening when other dentists aren't open pretty much addresses a need that allowed me to ramp up my operations faster; seeing a good number of patients allows me to work harder in my prime and allow myself to exit faster. Pretty much, my investment philosophy lines up in a similar fashion. I look beyond the traditional investment vehicles because I'm looking for higher returns, faster money (albeit with more risk). This lines up with my life philosophy, enjoy it as much as I can and having enough resources without having to do this ever again.
Showing the readers our different philosophies is showing them different paths available to young dentists after they graduate. We are both fortunate to be where we are, and I say it with a good level of understanding of what it takes to grow a business and invest outside dentistry.

I am not big on letting a big junk of my $ sitting in a bank. My father always said before I became a dentist that it will lose value and not let me capture great investments today. However, I would never personally expose myself to higher risks outside the traditional investments, because the failure rates (as you know) are higher in general, and it would be crazy for all the stress and sweat that it took me to get that money to take a chance in high risk investments. I would settle for 10-20% ROI for all my hard earned money, and not roll the dice on 60-80% ROI, regardless on how well I understand the ups and downsides of high risk businesses. Like you said, the "I'm all in" approach is a big coin toss for many. If I was getting my money in other means with less stress and sweat, then I would be more open to higher risk vehicles. Essentially it comes down to not only how much you are willing to lose, but more importantly, on how much effort did it take for you to get there to make such a choice. A bird in my hand will always be worth 2 in the bush for most investments.

Yes, you are working harder while you are young, and before other dentists show up and open practices near you, nothing wrong with that approach. But that shouldn't be a reason to fast track yourself before the cavalry shows up. I can see the formula for your money to go to high returns is time sensitive, but you may be forcing yourself out of the best strategy in investing, "patience". I'm not saying you don't understand this concept, but you may not get the full benefit of patience in how you invest your hard earned money when you have big and short deadlines, as you said. There should be a big Disclaimer for any reader to not think this is how to get the gold in life.

As they say, fortune favors the bold... and you seem pretty bold, and I hope you find your fortune in the path you have chosen.

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I like what I'm learning from Senior and Practicing Dentists in this forum.
 
Doesn't have to be the types of financing that you named, there's alternative financing methods that are not as risky either. Essentially, one of the investments I'm advocating for is the use of market inefficiencies (i.e lending to companies/individuals that need money but can't get money from banks) to make a significantly larger profit. With respect to consumer loans, some states are starting to regulate payday loans, so it's not as profitable as it used to be.

I thought of the differences between our philosophies (practice, business, and investment-wise). We're very opposite, from the way we practice, the way we think about life and business, and the way we think of dentistry. My practice philosophy of opening when other dentists aren't open pretty much addresses a need that allowed me to ramp up my operations faster; seeing a good number of patients allows me to work harder in my prime and allow myself to exit faster. Pretty much, my investment philosophy lines up in a similar fashion. I look beyond the traditional investment vehicles because I'm looking for higher returns, faster money (albeit with more risk). This lines up with my life philosophy, enjoy it as much as I can and having enough resources without having to do this ever again.

Sounds like you should visit a hedge fund.
 
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I like what I'm learning from Senior and Practicing Dentists in this forum.
yea this thread will be absolute gold once many of us become D4s and are preparing to have our own practice/investing habits. Especially with 2 polarizing yet highly successful takes on life after d school (coldfront/tanman)
 
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Hello, Coldfront I have been a big fan of yours ever since I was first trying to get into dental school many years ago.
As a recent graduate, I'm paying back about 2k a month in school loans. Im currently looking at practice 30 minutes to an hour outside of a major metro where I live, and I am looking at purchasing rental properties in the near future. May I ask what you look for in a rental property since yours seem to be doing so well.
 
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As for now the dilemma boils down to this in my view: Is the extra % in return of investment worth the much greater proportional risk? (TanMan's strategy vs. long-term/conservative portfolio.)

Something we haven't talked about is how much time is actually dedicated investing TanMan's style. Index funds, most of real estate's time committment is virtually negligible. Other investments require lots and lots of research and analysis no?
 
Hello, Coldfront I have been a big fan of yours ever since I was first trying to get into dental school many years ago.
As a recent graduate, I'm paying back about 2k a month in school loans. Im currently looking at practice 30 minutes to an hour outside of a major metro where I live, and I am looking at purchasing rental properties in the near future. May I ask what you look for in a rental property since yours seem to be doing so well.
I have only done 2 commercial properties, not residential yet.

My first commercial property was through the purchase of an outparcel land in front of my first practice. After my 5 years lease was over inside the larger anchor strip center, I had the option to either renew my lease or build a new building on the adjacent outparcel. This was a better route; A) I can build a building for my practice, and a space for 1 additional tenant, and let the tenant pay the mortgage, B) The commercial building investment would help me depreciate for 39.5 years against my income taxes, C) I have more exposure to the street traffic through a large and more visible monument sign, D) I manage the buildings so I control my CAM and collect management fee income from the other tenant, etc.

Second building was an acquisition. I bought out the landlord after he filled all 5 spaces (including my 2nd office) with national tenants. For the same reason as my other building, tenants pay the mortgage and I make income from managing the building too. Also Tax depreciation here too.

Both buildings was done with 0 downpayment through SBA program for dentists. I didn't put a penny of my money in the building purchases, and I created a separate LLC for each building. Rates were 4.0% on both, and the banks liked my cash flow at the time to do the deal. It's all about the cash flow to qualify for these loans, the 1.25x income to debt ratio is the deal breaker for the underwrites (and the 51% occupancy rule). I should expand on all this, but just wanted to give you a snap shot of what happened.
 
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Interesting update and a lead I wanted to share with you guys on another potential investment. Recently, I received two offers on undeveloped land (one in a major city, one in a growing suburban area, both zoned for commercial) . They both came from individuals who are terminally ill or at least think they are going to die soon. Pretty much its a firesale, being offered at about 40% of comparables and assessed value. This might be something for you guys to pursue if you wanted to pursue real estate investments. I'm doing a due diligence and assessment whether I could move the property quickly or develop and sell/rent out afterwards. I wonder if this type of demographic is typically willing to let go of property at these prices, and if so, how can I find more of this demographic.
 
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As for now the dilemma boils down to this in my view: Is the extra % in return of investment worth the much greater proportional risk? (TanMan's strategy vs. long-term/conservative portfolio.)

Something we haven't talked about is how much time is actually dedicated investing TanMan's style. Index funds, most of real estate's time committment is virtually negligible. Other investments require lots and lots of research and analysis no?

With ANY investment, you should always do your due diligence. I don't dedicate as much time as I am not involved as much in the operations, BUT I have it set up so that I can take control of the entire operations if I have to. I am on the financial side though, so my role is more financial than anything else.

I enjoy what I do when it comes to analyzing businesses and profit models/proposals. I have my own metrics and questions that I ask whenever I look into a new investment. It doesn't feel like work because I like what I'm doing outside of dentistry. So yes, it does take a bit more time, but you should dedicate a good chunk of time with anything you pursue, even if its as "harmless/passive" as an index fund all the way to a hostile takeover of a privately held company (especially if its a family owned company that's split and fractured among siblings, you should have a concealed carry for your protection if you're trying to take over an emotionally charged/vested takeover).

Anyway, important point: study EVERY investment before you invest, minimize your managerial activities but have checks and balances that allow you to seize control especially if the money is coming mostly from you. In my opinion, 60%+ returns are worth it if you're looking to grow fast v. 8-10%.
 
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Interesting update and a lead I wanted to share with you guys on another potential investment. Recently, I received two offers on undeveloped land (one in a major city, one in a growing suburban area, both zoned for commercial) . They both came from individuals who are terminally ill or at least think they are going to die soon. Pretty much its a firesale, being offered at about 40% of comparables and assessed value. This might be something for you guys to pursue if you wanted to pursue real estate investments. I'm doing a due diligence and assessment whether I could move the property quickly or develop and sell/rent out afterwards. I wonder if this type of demographic is typically willing to let go of property at these prices, and if so, how can I find more of this demographic.
Look who is into/considering a real estate investment now. :whistle:

There will be a huge asset and wealth transfer from the oldest retired generation to their families (and some to the public and private investors) over the next decade or so. I can see this benefiting those who have been waiting for their big move in investing in real estate.
 
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Anyway, important point: study EVERY investment before you invest, minimize your managerial activities but have checks and balances that allow you to seize control especially if the money is coming mostly from you.
I agree 100% with you here.

I have started (and probably mentioned in a previous post) a business concept 8 months ago. The state I live in is landlocked, and my city specifically is a big artery for trucking business. A lot of retail and manufacturing businesses. Unfortunately, due to City zoning issues and limited supply of infrastructure (which is also the case across the country) for truck parking, I did a lease to own deal on a paved, fenced, gatef and electrically powered for truck drivers to come park their trucks when they visit their families on the weekends (and sometimes during the week). I was able to fit 70 parking spaces into this 3.5 acre lot, which is a walking distance to food and restaurant businesses, which is convenient for customers in case some of the out of town truckers wanted a place to eat and use bathroom. I did very minimum investment, since the lot was already paved and fenced, all I did was paint the ground for the parking spaces.

Anyways... 8 months later, the place is full, and now considering to purchase the lot if this full occupancy holds the next 6 months. I'm also looking at 2 other similar sized locations in town now, with the hope to expand more in the future if this business grows.

In case you are wondering what these truckers pay for parking, it's $150 a month, or $20 a night. 90% of the customers are local and pay monthly. The place can bring in $10-11k a month at full occupancy. I hired a guy to manage the customers, and look after the lot couple of hours a day. Overhead is about 30% (only utility bill is electric, and use energy saving lights which bring down my bill to an average of about $50 a month). I am never there.

Who knew! high ROI. I might actually retire sooner than I expected.
 
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I agree 100% with you here.

I have started (and probably mentioned in a previous post) a business concept 8 months ago. The state I live in is landlocked, and my city specifically is a big artery for trucking business. A lot of retail and manufacturing businesses. Unfortunately, due to City zoning issues and limited supply of infrastructure (which is also the case across the country) for truck parking, I did a lease to own deal on a paved, fenced, gatef and electrically powered for truck drivers to come park their trucks when they visit their families on the weekends (and sometimes during the week). I was able to fit 70 parking spaces into this 3.5 acre lot, which is a walking distance to food and restaurant businesses, which is convenient for customers in case some of the out of town truckers wanted a place to eat and use bathroom. I did very minimum investment, since the lot was already paved and fenced, all I did was paint the ground for the parking spaces.

Anyways... 8 months later, the place is full, and now considering to purchase the lot if this full occupancy holds the next 6 months. I'm also looking at 2 other similar sized locations in town now, with the hope to expand more in the future if this business grows.

In case you are wondering what these truckers pay for parking, it's $150 a month, or $20 a night. 90% of the customers are local and pay monthly. The place can bring in $10-11k a month at full occupancy. I hired a guy to manage the customers, and look after the lot couple of hours a day. Overhead is about 30% (only utility bill is electric, and use energy saving lights which bring down my bill to an average of about $50 a month). I am never there.

Who knew! high ROI. I might actually retire sooner than I expected.
This is genius
 
Look who is into/considering a real estate investment now. :whistle:

There will be a huge asset and wealth transfer from the oldest retired generation to their families (and some to the public and private investors) over the next decade or so. I can see this benefiting those who have been waiting for their big move in investing in real estate.

LOL, I keep an open mind when opportunities arise. That's the key to doing well is not to be close minded, but also identify opportunities when they come. It was just that the traditional approach to real estate (your method), was not for me, but when opportunities come at a good price, why would I be resistant to it if I had the extra capital.

Edit: A lot of what you see on the market already has the rental income priced in, that's why I am hesitant overall. If I can get property at low low prices, I would definitely jump on it. Especially if I can flip the property for double or 10x more after a quick development. I just wouldn't want to buy a property and get stuck with it (along with my capital), unless I can draw equity out of it as needed. The threat of death changes people's prioritizes pretty quickly.
 
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Gotta ask, what's your educational background pre-DS? No way you learned all the business side on the go. Judging by the sub 250k student load debt, I'm assuming your parents footed some of the tuition bills? i.e. professionals or possibly business executive parents?

On a side note, @charlestweed @TanMan @Cold Front what are your thoughts on the following plan if one is aiming for retirement by 35 after graduation from DS at 26?

get into a 2yr ortho residency and moonlight -> start up upon graduation and concomitantly work in chains to ensure full-time employment-> work 6d/wk w/ minimal vacation time and open up a 2nd office when the time comes -> invest aggressively via both traditional and non-traditional investment vehicles (stock funds and private investments)

So would ortho production in a current market condition from about seven years in practice combined with an aggressive investment strategy (not splurging and putting everything besides fixed expenses into retirement) yield about 5m+ in portfolio value by 35? This is also assuming purchasing a house and starting a family would be on hold until retirement at 35.

For example, if I assume 5k/case and 400 new patients/yr that's about 2m annual production. Assuming 50% overhead, that would be 1m gross. After taxes, I'm assuming 700k take home, from which 650k would go straight into investment. Assuming 15% annual ROI compounded annually for seven years, that would yield around 7m by the end of year seven. So I guess my question is how likely is it to achieve 400 new patients/year in ortho and how likely is it that all patients will pay 5k upfront?
How about you first get into dental school before you start planning out your life?
 
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Gotta ask, what's your educational background pre-DS? No way you learned all the business side on the go. Judging by the sub 250k student load debt, I'm assuming your parents footed some of the tuition bills? i.e. professionals or possibly business executive parents?

On a side note, @charlestweed @TanMan @Cold Front what are your thoughts on the following plan if one is aiming for retirement by 35 after graduation from DS at 26?

get into a 2yr ortho residency and moonlight -> start up upon graduation and concomitantly work in chains to ensure full-time employment-> work 6d/wk w/ minimal vacation time and open up a 2nd office when the time comes -> invest aggressively via both traditional and non-traditional investment vehicles (stock funds and private investments)

So would ortho production in a current market condition from about seven years in practice combined with an aggressive investment strategy (not splurging and putting everything besides fixed expenses into retirement) yield about 5m+ in portfolio value by 35? This is also assuming purchasing a house and starting a family would be on hold until retirement at 35.

For example, if I assume 5k/case and 400 new patients/yr that's about 2m annual production. Assuming 50% overhead, that would be 1m gross. After taxes, I'm assuming 700k take home, from which 650k would go straight into investment. Assuming 15% annual ROI compounded annually for seven years, that would yield around 7m by the end of year seven. So I guess my question is how likely is it to achieve 400 new patients/year in ortho and how likely is it that all patients will pay 5k upfront?

My parents did not help with my tuition. I got a free ride in undergrad, and tuition/expenses were cheaper back then. My parents are small business owners. That's where I learned a lot of what I know now. I don't have any formal business education, although I did take an accounting course in undergrad for a gpa booster. I read books/literature on business, etc..., but I think its a compilation of my background and the information I acquire over the years.

I haven't studied the mechanics of the orthodontics business, so I can't give you a thorough case analysis. Plan makes sense if the numbers fit. Someone with more handson experience would be able to tell you if those numbers sound realistic.
 
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How about you first get into dental school before you start planning out your life?
If you plan on going 400k in debt, you better start thinking of plans on how to pay them back.
 
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If you plan on going 400k in debt, you better start thinking of plans on how to pay them back.


That is true. You should always have the end goal in mind with multiple strategies in mind. Think of it like a war, variables change, you need to have an adaptive doctrine of financial growth. On the flip side, getting into dental school is the most important goal, but at least you have a vision of where to go from there. You can't always predict what you'll be doing after dental school, or if you have to be a gunner to get into residency.
 
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That is true. You should always have the end goal in mind with multiple strategies in mind. Think of it like a war, variables change, you need to have an adaptive doctrine of financial growth. On the flip side, getting into dental school is the most important goal, but at least you have a vision of where to go from there. You can't always predict what you'll be doing after dental school, or if you have to be a gunner to get into residency.
Books, websites, blogs, podcasts, etc. to recommend for business/financial mastery TanMan?
Do you excercise? What's your diet like?
What's been your most effective strategy for case acceptance?
What are your plans for after you retire?
What is your tx planning philosophy?
Are you planning to sell your practice to a DSO?
 
Books, websites, blogs, podcasts, etc. to recommend for business/financial mastery TanMan?
Do you excercise? What's your diet like?
What's been your most effective strategy for case acceptance?
What are your plans for after you retire?
What is your tx planning philosophy?
Are you planning to sell your practice to a DSO?

1. I get that question a lot about what I read. I need to dig up books and literature and post it on here.
2. Exercise? Not too often. I just go in the pool and swim a few laps every now and then. I'll exercise more when I start gaining weight. Diet: 1 meal a day (dinner) on workdays. On days off, eat whatever I want (lots of snacking).
3. Most effective strategy? If you give your staff financial incentive and stake, they'll do all the selling for you.
4. After retirement? Relax, enjoy the world, travel everywhere, seek new entrepreneurial pursuits. Pretty much freedom to do what I want on a whim. Life's a journey, we'll see where it takes me. The most important thing is that I don't have to worry about money after retirement
5. I'm pretty conservative. If you don't have to drill onto tooth structure, don't do it. My priorities are pretty much:
Address pain first, then potential pain, then the foundation (perio), then everything else. Sometimes, the patient's priorities are different, and most of the time, we have to respect their priorities unless you're going to cause them harm by prioritizing what they want (i.e veneers on abscessed teeth without doing an RCT or addressing underlying pathology)
6. Selling... My financial plans are based without selling the practice in mind (pretty much if I have to walk away from it, I can, from a financial perspective). Depends who's willing to buy it. I'll sell to anyone who has money. However, I don't want a "tutorial period for the buyer, where I stay on for months or a year". Buy it as is, and good luck!
 
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1. I get that question a lot about what I read. I need to dig up books and literature and post it on here.
2. Exercise? Not too often. I just go in the pool and swim a few laps every now and then. I'll exercise more when I start gaining weight. Diet: 1 meal a day (dinner) on workdays. On days off, eat whatever I want (lots of snacking).
3. Most effective strategy? If you give your staff financial incentive and stake, they'll do all the selling for you.
4. After retirement? Relax, enjoy the world, travel everywhere, seek new entrepreneurial pursuits. Pretty much freedom to do what I want on a whim. Life's a journey, we'll see where it takes me. The most important thing is that I don't have to worry about money after retirement
5. I'm pretty conservative. If you don't have to drill onto tooth structure, don't do it. My priorities are pretty much:
Address pain first, then potential pain, then the foundation (perio), then everything else. Sometimes, the patient's priorities are different, and most of the time, we have to respect their priorities unless you're going to cause them harm by prioritizing what they want (i.e veneers on abscessed teeth without doing an RCT or addressing underlying pathology)
6. Selling... My financial plans are based without selling the practice in mind (pretty much if I have to walk away from it, I can, from a financial perspective). Depends who's willing to buy it. I'll sell to anyone who has money. However, I don't want a "tutorial period for the buyer, where I stay on for months or a year". Buy it as is, and good luck!
How many other dentists collecting similar to you do you know?
Average Class II composite time? Crown? Partially impacted third molar ext?
How many languages do you speak? Does being bi/tri-lingual significantly increase total active patients in your opinion?
How do you choose your referring specialists?
 
3. Most effective strategy? If you give your staff financial incentive and stake, they'll do all the selling for you.
And how are you accomplishing this? What's the incentive model you are offering them?

(based on how much the whole office is producing, or just patients they've seen, etc.).

and what's your staff turnover rate looking at about now
 
How many other dentists collecting similar to you do you know?
Average Class II composite time? Crown? Partially impacted third molar ext?
How many languages do you speak? Does being bi/tri-lingual significantly increase total active patients in your opinion?
How do you choose your referring specialists?

1. Those that have 2-3 doctors in their office or two offices collect about the same. Haven't seen a solo office with similar collections, but then again, a lot of dentists in my area don't like me.
2. 7-10 minutes, depends, but 4 back to back, i.e MO,MOD,MOD,DO would take about 25-30 minutes. I don't do partial bony thirds
3. 2 Fluent, 1 not that great. Does not increase total active patients by a large margin
4. Screen them out personally, interview, get to know them, try them out a few times, if patients are happy, clinically good results, keep referring. If there's complaints, we switch them out.

And how are you accomplishing this? What's the incentive model you are offering them?

(based on how much the whole office is producing, or just patients they've seen, etc.).

and what's your staff turnover rate looking at about now

Incentive model: Profit sharing (I give a percentage of my gross production to the staff).

Staff turnover rate: Haven't lost a DA in 2+ yrs I think. One hygienist left because she didn't want to work Sundays. I was actually hoping she left since I had her replacement in line already.
 
What are your thoughts on expanded function dental assistants and hygienists? Why/ why not?
What is the best way to reduce liability/litigation possibility?
What type of lawyers and accountants do you use?
 
What are your thoughts on expanded function dental assistants and hygienists? Why/ why not?
What is the best way to reduce liability/litigation possibility?
What type of lawyers and accountants do you use?
1. Whatever you can delegate, delegate at a cheaper price point. Use them so you can do more procedures for less labor costs.
2. Best way to reduce liability and litigation, simply put, is to screen out patients that are most likely to sue you, and learn how to talk to patients. Your words don't cost you anything, but can sure as hell prevent a lot of headache later on.
3. A CPA? Also have asset protection lawyer, business lawyer, and lawyer for litigation if needed.

Were you planning on retiring early before going into dentistry?

Not as early as what I foresee now.
 
Why couldn't/didn't you start your own practice right after graduation? Were you not able to secure a practice loan? Also, many brokers seem to believe buying a practice is the financially better choice than a start up given 1) the guaranteed income from day one with existing patients especially if there's a "tutorial period" where the old doc stays in to show the ropes and deals with retreats, 2) experienced staff who know what they are doing (no need to re-train), and 3) you are essentially taking a competition off the market when you are buying. What's your retort to this? Lastly, what's your EBITDA?

1. Didn't have the money to start. Practice loan is more difficult, lots of paperwork, red tape, restrictions.
2. Brokers make their money by selling you an office. See my previous post of essentially working to pay off that practice. There was some simple equation I put there, look it up.
3. I've addressed the idea that experienced staff is not always the best.
4. You're not just taking a competition off the market, you're feeding it money too.
5. I don't know the EBITDA off the top of my head, nor do I really want to disclose that to you.

A lot of your questions have been answered in previous posts. I don't want to type it all out again. Still at work. Look it up.
 
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What's a good size piece of land for a stand-alone dental office + parking? Do you think 0.5-0.75 acre on a corner is sufficient?
 
What was your rationale behind relocating to Texas upon graduation?

Money, and later on, guns and freedom.

What's a good size piece of land for a stand-alone dental office + parking? Do you think 0.5-0.75 acre on a corner is sufficient?

I think its a hard question to answer, especially for a single tenant; it depends on the city's requirements for parking. You don't want it too big or else you might end up paying more in property taxes unless you plan to develop a multitenant shopping center or "mini-mall". I don't have enough first hand experience but my thought process would be along those lines.
 
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If you had to open up a practice in NYC as a GP right after graduation, what would have been your survival strategy in terms of hitting 3m in production/yr (which according to you is about the upper limit of what a single doc GP office can produce)? Specifically, what would be your thought process in terms of site selection, patient base target (FFS, HMO/PPO, medicare/medicaid, age group, upper class vs lower class), fee schedule/pricing strategy, marketing strategy, staffing, and office hours? Procedure-wise would you have expanded your skill sets in this case (IV sedation/full mouth rehab/surgical extractions/implant placement/ortho)? i.e. can your production number be replicated in NYC with just bread and butter dentistry with molar endos thrown in?

There's multiple factors going against you with respect to opening in NYC. Operating costs and competition would be the biggest hurdles. You'll definitely need more capital to weather the first few months of mounting operating costs v. intake of revenue. So... first strategy, save more money. Second, keep the same principles, build cheap, but good looking. Third, mapping the areas, see who's the most underserved in the region that can generate a profit. (I haven't studied this, so I can't really answer this right now). Next, advertising strategy and roll out. NYC is the biggest market and cost per point in the entire US (Second is LA). I would try and find out the hours that your demographic works and base it off that. Staff wise, I'd keep the same principles.

A lot of offices that are starving try to expand their skillset to offer more and pretty much milk more out of their patients (increase per patient production). I wouldn't know how to answer what skill sets to add unless I understood the market more, so from a difficulty perspective, I'd do invisalign in the very least. I don't do that right now because I make more money from orthodontist referrals and wouldn't want to burn any bridges.

You can reach the production number I stated with bread and butter dentistry. There are some ethically questionable things you'll have to do with respect to advertising, SEO, and procedures, but it can be done. As a previous poster mentioned, what's the point of mentioning it? Because there's a way, but it may violate TOS for this forum. If you really want to know, do your own research. Being able to sleep at night with peace of mind is most important for me.
 
I get enough exercise from dentistry. I do get a massage every now and then. I did have to go to a physical therapist one time since my forearm was hurting from too many extractions and root canals.

My own research and experiences (as life lessons). I did not have the luxury of a mentor.
 
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First off, thanks for starting this thread, I've really enjoyed it. I've got a few questions regarding what you recommend students do who's main goal is ownership. Many grads just go to corporate for the first few years to build confidence in their procedures, but for someone who is looking to make as much money as possible after graduation, do you feel like jumping into ownership right away with a dentist who would be willing to mentor and phase out over 6 months would be the most ideal. Do you think the opportunity cost in regards to building a patient family, building equity in your practice and the increased income from owning is enough to justify giving up the "1-2 year learning period" in corporate?
If you recommend the ownership right away route, what should a dental student be doing his last 2 years of school to expedite this process and when ideally should one start looking.
I know you've set up shop in/near a city with huge projected growth over the next few decades. How did you go about location selection in a city such as this. Did you just find a newly developed piece of commercial real estate in an area that you thought would soon see the huge population increase or did you fight the competition and set up in an already prime location. If you could do it over again, would you recommend startups in these cities or purchasing an existing practice, if so what current production numbers of the practices would be best to look at buying.

If these have already been asked let me know and I'll go back and search through the pages, once again thanks for your help.

(Also, @Cold Front , I'd like to hear your opinion as well. I've really enjoyed seeing both of your opinions to the questions as theyre usually coming from two completely different angles)
 
First off, thanks for starting this thread, I've really enjoyed it. I've got a few questions regarding what you recommend students do who's main goal is ownership. Many grads just go to corporate for the first few years to build confidence in their procedures, but for someone who is looking to make as much money as possible after graduation, do you feel like jumping into ownership right away with a dentist who would be willing to mentor and phase out over 6 months would be the most ideal. Do you think the opportunity cost in regards to building a patient family, building equity in your practice and the increased income from owning is enough to justify giving up the "1-2 year learning period" in corporate?
If you recommend the ownership right away route, what should a dental student be doing his last 2 years of school to expedite this process and when ideally should one start looking.
I know you've set up shop in/near a city with huge projected growth over the next few decades. How did you go about location selection in a city such as this. Did you just find a newly developed piece of commercial real estate in an area that you thought would soon see the huge population increase or did you fight the competition and set up in an already prime location. If you could do it over again, would you recommend startups in these cities or purchasing an existing practice, if so what current production numbers of the practices would be best to look at buying.

If these have already been asked let me know and I'll go back and search through the pages, once again thanks for your help.

(Also, @Cold Front , I'd like to hear your opinion as well. I've really enjoyed seeing both of your opinions to the questions as theyre usually coming from two completely different angles)

I think going to corporate could make you a faster and more confident dentist but the primary purpose of going to corporate is to raise enough capital to be able to start your own office. Unfortunately, there are people out there who never get any better and get stuck in corporate for the rest of their lives. If I had rich parents or enough capital, I probably would have started my own from the start. We are born into certain realities of life and we gotta make do with the cards we're dealt with. I think finding the right mentor would be key, if you are unable to come up with your own systems of efficiency. I don't like the way most dentists operate, so I'm not a fan of the whole mentor concept. You might just be led into becoming a slow and inefficient dentist.

In terms of location, I setup away from everyone else. I would never setup in a generic medical center unless I could have leeway on the size and flashy-ness of the sign. Identifying the "underserved with money or means to pay" is crucial when looking for a location. I don't really like the idea of buying an office unless it was extremely cheap with high production. For a single doctor solo practice, I'd aim for 2.5+. I am not in a prime location, I am about a mile or two away from the prime location. The reason for this is that prime real estate is expensive, high traffic areas are not always the best places, and usually suburban middle/upper middle income regions are a little off the prime areas as well.

To get ready for the real dentistry, you have to study how patient flows in a dental office, minimizing the wait times of everyone, knowing which procedures you can juggle, and being able to innovate beyond what dental school teaches you. When you understand how each procedure flows, you know when you can step out to do other things, and when chunks of time will be required that you can't go in and out.

So... how to prepare in dental school?
1. Learn from part time faculty that actually have their own offices and promote efficiency
2. Learn to juggle multiple patients and procedures at a time.
3. Endo + Crown... get fast. Once you meet your minimum requirements, just speed it up without getting kicked out of dental school. This is why I advocate an aggressive approach to finishing your requirements early. Nothing to lose as long as you remain under the radar.
4. Study each steps of the procedure time-wise, understand how to weave in and out of procedures.
5. Something I haven't noted here, get fast at reading radiographs and doing exams. (I think I took this for granted and forgot to mention this to everyone)
6. Learn to talk to patients efficiently with charisma. More time talking to them does not mean better. You can be efficient and make the patient feel appreciated at the same time. Words aren't expensive, time is.
7. Learn to identify difficult patients and refer those out (reduces liability and headache)
8. If you don't have the money and want to start right after dental school, look for people who will lend to you (banks are not a good option). Otherwise, go corporate.
9. Study the business of dentistry. The most limited resource you have is labor that only the dentist can perform. Study what you can legally delegate to your auxiliaries and delegate. Remember, your time is worth more than everyone else's unless you're not producing (but you should be!) There's many facets of dentistry such as advertising, patient flow, patient retention/rejection, FIFO, pleasing as many people as possible, exit strategy, human resources, etc...
10. Go go go!

This response is probably going to be very fragmented. I'm tired, if I didn't answer any of your questions, please ask them again. I was going down line by line on your questions, I may have missed something.
 
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I don't really like the idea of buying an office unless it was extremely cheap with high production. For a single doctor solo practice, I'd aim for 2.5+. I am not in a prime location, I am about a mile or two away from the prime location.

Thanks for the perspective, @TanMan. What did you mean by "2.5+"? From the context of the rest of your comments in this thread, it sounds like that refers to aiming for $2.5+ million in production when buying an office.
 
2.5+ million in terms of a fully functioning office, or in terms of production goal if you see an opportunity to turn around a poor performing office. However, 2.5MM+ is relative, depending on the price of the office.
 
Thanks, @TanMan.

From what I recall, your office has 7 hygiene chairs, with 6 that you can use as dentist operating stations ("ops"). How is the 7th hygiene, non-operating station different from the other six stations where you do operate? What's missing that prevents the hygiene station from being classified as an operating station?

Thanks, again, for all of your insight.

Edit: I just looked up your quote, here's what I was referring to:
No associates, 3 hygienists. 7 columns of hygiene, 6 ops (but utilize about 3-4 ops per hour on avg, rest is just spillover for hyg or walkin emergencies) --- (AMA - Practice startups and early retirement)
 
Every ops has its own supplies to do ops in, electric handpieces, and dual delivery systems. Hygiene does not have electric handpieces, just piezos, single delivery system, and everything needed to do hygiene.
 
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If you had to open up a practice in NYC as a GP right after graduation, what would have been your survival strategy in terms of hitting 3m in production/yr (which according to you is about the upper limit of what a single doc GP office can produce)? Specifically, what would be your thought process in terms of site selection, patient base target (FFS, HMO/PPO, medicare/medicaid, age group, upper class vs lower class), fee schedule/pricing strategy, marketing strategy, staffing, and office hours? Procedure-wise would you have expanded your skill sets in this case (IV sedation/full mouth rehab/surgical extractions/implant placement/ortho)? i.e. can your production number be replicated in NYC with just bread and butter dentistry with molar endos thrown in?

Dont.
 
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Every ops has its own supplies to do ops in, electric handpieces, and dual delivery systems. Hygiene does not have electric handpieces, just piezos, single delivery system, and everything needed to do hygiene.

Thanks, @TanMan. :)
 
First off, thanks for starting this thread, I've really enjoyed it. I've got a few questions regarding what you recommend students do who's main goal is ownership. Many grads just go to corporate for the first few years to build confidence in their procedures, but for someone who is looking to make as much money as possible after graduation, do you feel like jumping into ownership right away with a dentist who would be willing to mentor and phase out over 6 months would be the most ideal. Do you think the opportunity cost in regards to building a patient family, building equity in your practice and the increased income from owning is enough to justify giving up the "1-2 year learning period" in corporate?
If you recommend the ownership right away route, what should a dental student be doing his last 2 years of school to expedite this process and when ideally should one start looking.
I know you've set up shop in/near a city with huge projected growth over the next few decades. How did you go about location selection in a city such as this. Did you just find a newly developed piece of commercial real estate in an area that you thought would soon see the huge population increase or did you fight the competition and set up in an already prime location. If you could do it over again, would you recommend startups in these cities or purchasing an existing practice, if so what current production numbers of the practices would be best to look at buying.

If these have already been asked let me know and I'll go back and search through the pages, once again thanks for your help.

(Also, @Cold Front , I'd like to hear your opinion as well. I've really enjoyed seeing both of your opinions to the questions as theyre usually coming from two completely different angles)
If you have an a hour or so downtime, you can skim through my previous posts to find answers to your questions and more. If you still can't find specific answer, let me know, I can expand on it.

I am checking these forums once a week or 2 lately. So my replies might be delayed.
 
How hard was dental school for you? How much free time did you have D1-D4 years?
 
How hard was dental school for you? How much free time did you have D1-D4 years?

I think dental school was hard for the first few months since I went to every class. Then I realized that class was useless and not going made dental school a lot easier. For most classes, I could just study the week before finals and pass (or even top 10%). I think there's a difference between hard and time-wasters. After not going to classes, dental school just had a lot of time wasting activities such as preclinical lab work. There are some classes that have quizzes as a "attendance check", but usually we can just take the quiz and go about our day.

If you don't want to specialize, just do enough to pass and you will have plenty of time. Also, if you finish all your clinical requirements ahead of time, you can coast through your 4th year without really doing anything.

YMMV with each school. That's why I didn't want to go to UOP; quizzes and mandatory attendance back in the day (might still be applicable?) I'm glad it worked out in the end, and in retrospect, I'd go to a school that only has finals.

So... from a functional perspective, how does this apply to you? If you want to have an easy dental school life, look for the following:
1. Minimal requirements for graduation
2. Finals only (maybe midterms and quizzes if you really really have to)
3. Scout out the rooms that you have to be in. Is there an easy entry/exit? This matters because if you are going to skip after a quiz, you don't want to be spotted. Although, a strategy commonly used is to pretend to go to the bathroom and show up right before class ends to pick up your stuff. A lot of people end up doing labwork or clinical work during class time so that they don't have to stay later.
4. Live nearby. Nothing beats rolling out of bed and minimal commute time.
5. Physical paperwork as opposed to electronic... since its actually a lot easier than the bureaucracies of dental school electronic charting, signatures, etc...
6. Understand the bottlenecks and procedures of the system you're working with. Usually best to know if its easy or hard to get procedures before going to a specific dental school.
7. Avoid curriculum(s) that have a lot of small group w/ attendance requirements because these will drain your time.
8. Have a good group of people that can sign you in and take notes as needed.

These address how to select a dental school that you can get by easily, and how to avoid wasting time in dental school. I got a lot more, but they'll probably take my diploma back at this rate, lol. Also, talking to my friend since he was able to identify me based on these postings, he said that a lot of these things I'm saying would probably get people kicked out and I got lucky. So... if you're going to do these things, play it cool, play it smart, be aware and have an exit strategy if things go wrong. Don't get kicked out due to poor execution or interpretation of the rules.
 
What kind of equipment do you have in your office (CEREC, LAVA scanner etc.)?
If you do have any of this stuff, do you think its benefits have justified the increased overhead?
 
CEREC - YES, definitely worth it. Paid for itself within a few months, increased efficiency, less visits, less chairtime overall. . The sound of it is like printing money.
LANAP/Periolase - I'm iffy about this one, personally, I'm not a fan of it. Makes good money, but perio patients are difficult.
Er:YAG Laser - I bought it when it was 50% off. Definitely worth the endo capabilities (PIPS). Speeds up my endos and cleans the canals better. Got it for only 30k. I'd wait for AMD lasers to put it on sale again.
Electric handpieces - great investment, cuts faster, less chairtime

I can't think of anything else right now, let me know if you have any other questions about equipment.
 
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If you had to rank the profitability of each of the specialties, how would you rank them?
 
TanMan said:
8. If you don't have the money and want to start right after dental school, look for people who will lend to you (banks are not a good option).
People as in specific people, or some sort of business?
Would like to know more about this

And TanMan it sounds like you had a great clinical experience in dental school. I am not going to get too specific because I am still need to graduate, but it's damn hard to get anything done at school. I am learning more about how the school wants things done than how dentistry should be done.
 
If you had to rank the profitability of each of the specialties, how would you rank them?

It's hard to say, I'd probably say on average, OS/endo would be the top of my list of most profitable. Least profitable would probably be prosthodontics. If you are looking at it in terms of solo practice capabilities, I'd put OS/endo/ortho. Pediatrics is more scalable for multiple practice models, but regional pedo mills are popping up everywhere. I don't know anything about perio, so I wouldn't know where to put that in rankings.

People as in specific people, or some sort of business?
Would like to know more about this

And TanMan it sounds like you had a great clinical experience in dental school. I am not going to get too specific because I am still need to graduate, but it's damn hard to get anything done at school. I am learning more about how the school wants things done than how dentistry should be done.

Private lenders, alternative lending (very expensive, I would not recommend them for a startup), people who can lend you the money to start an office, etc... Those are just some examples. If I had networked more in dental school, I could have probably reached out to a financier.

The most important thing to remember in dental school is to be able to understand the fundamentals to the procedure, and being able to apply those principles any clinical situation; not as a step by step guide on how to do dentistry. If you get stuck in the dental school way, you'll never be a profitable dentist. If you can always keep in mind that you want to be the most profitable dentist, then you'll do what you have to do to pass. When they give you your diploma and pass the boards, you can ditch all that and focus on being a better clinician.
 
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It's hard to say, I'd probably say on average, OS/endo would be the top of my list of most profitable. Least profitable would probably be prosthodontics. If you are looking at it in terms of solo practice capabilities, I'd put OS/endo/ortho. Pediatrics is more scalable for multiple practice models, but regional pedo mills are popping up everywhere. I don't know anything about perio, so I wouldn't know where to put that in rankings.



Private lenders, alternative lending (very expensive, I would not recommend them for a startup), people who can lend you the money to start an office, etc... Those are just some examples. If I had networked more in dental school, I could have probably reached out to a financier.

The most important thing to remember in dental school is to be able to understand the fundamentals to the procedure, and being able to apply those principles any clinical situation; not as a step by step guide on how to do dentistry. If you get stuck in the dental school way, you'll never be a profitable dentist. If you can always keep in mind that you want to be the most profitable dentist, then you'll do what you have to do to pass. When they give you your diploma and pass the boards, you can ditch all that and focus on being a better clinician.

When you talk about profitability - to clarify, is this based on Dr time/hour?
Also, which type of specialist refers the most cases to you?
Last, what are your thoughts on a partnership in which 1 dentist works 7 days consecutively and the other the next 7 days and etc.? I.e. 7 on 7 off?
What about a partnership in which 1 dentist works 7 to 2 (no lunch) and the other works from 2 to 9, for example? Lower OH with 2 dentists, able to provide services at early morning and evening hours, etc.
 
When you talk about profitability - to clarify, is this based on Dr time/hour?
Also, which type of specialist refers the most cases to you?
Last, what are your thoughts on a partnership in which 1 dentist works 7 days consecutively and the other the next 7 days and etc.? I.e. 7 on 7 off?
What about a partnership in which 1 dentist works 7 to 2 (no lunch) and the other works from 2 to 9, for example? Lower OH with 2 dentists, able to provide services at early morning and evening hours, etc.

1. Profitability is Dr Time/hour, but there's different ways of looking at it. Either you're looking at it as a solo, group practice, or multiple practice model. I address more of a solo practitioner model.
2. Most of my referrals come from orthodontists. I am a higher volume office, I team up with the highest volume ortho offices in my area
3. You might end up having to clean up the messes and post-ops of the other dentist, and vice versa with a 7 on 7 off schedule. Also, some patients like seeing the same dentist for each visit, but on a pure volume basis, should not be much of an issue except for burnout and being rusty when it's your turn coming back from your 7 day off
4. 7-2, 2-9 works if both are ok, but you may have conflicts with respect to production (one may accuse the other of stacking appointments that are biased in the morning or afternoon), especially if there's a large difference between production levels.
 
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