Worked for corporate for 18 months, then bought a practice right before COVID. AMA.

[THS]

It's been a while since I've logged on to SDN, so I figured I would share some info as far as working as an associate in a corporate office, as well as the process of finding and buying a practice, and also the stress of closing down for 2 months only weeks after closing. I won't disclose what company I worked for, but it's easy to figure out if you know anything about them.

Graduated LSU in 2018. Found an open job at this particular office in my hometown, where I planned on moving back to anyway. Brand new office in a great part of town. It was a great opportunity. I worked there for 18 months before closing on my current practice, and stayed there part-time for a couple months while transitioning to full time at my current office. I can't say I learned all that much clinically from my associate position. I don't think I learned any new procedures there (though I did pay my own way to certain courses - like Misch implant institute). I learned a lot about talking to patients, talking about money, how insurance worked, etc. And most importantly, I got very fast and efficient.
I was paid well enough, though not nearly as much as I would have made at other offices. I got a $500/day guarantee for 6 months, then 25% of production. After a year, I was given a raise (to a whopping 26% of production). To me, the money was not super important. I was most interested in moving back to my hometown and biding my time until another opportunity presented itself. The contract that was initially presented to me included a 5 mile non-compete, which I was able to reduce to 2 miles.
Pros of working for a corporate office - you will get your reps in. You'll most likely have some guarantee of an income.
However, expect to have your treatment planning questioned by your office manager, your owner dentist, etc. You will be sent to meetings and courses put on by the company, full of a bunch of folks drinking the corporate kool-aid, telling you how the average doc makes $850k or something ridiculous like that. You will have your production/metrics compared to the rest of the docs in the company. I frequently had to defend myself for having an SRP diagnosis rate of ~35% instead of the company's average (around 70%).

Anyway, I digress. I'm much happier now. Bought a small practice from a 72 year old doc that was just done. I ended up starting there a few weeks before closing just because he wasn't even seeing emergencies anymore. Super loyal patient base, all with work to be done. Retired doc was just patching everything up with miracle mix. Patients are very understanding that they need work and don't need me to tell them twice. For the time being, I am reinvesting profits back into the business and living on a smaller salary than I was at my previous job. For dental students out there, 90% of you will have ****ty jobs coming out of school, but you'll learn and grow from those experiences.

Fire away if y'all have any questions about associateships or practice acquisitions. I'm by no means an expert, I can just speak from my personal experience.

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[frentist]

thank you for sharing your experience!

what was/is your transition plan business-wise going from being corp associate to now an owner?
as an associate did you establish a network with equipment and insurance reps?
when you graduated, how did you decide what CE courses you would take?
can you further elaborate about the challenges of being a recent grad both clinically and financially?
what type of practice are you running (FFS, in network or out of network)?
how did you negotiate to reduce your non compete clause?
what was your experience like finding and acquiring a practice?

 

[THS]

Great questions. After working in a fast paced environment, I have found that I don't do my best work when thinking about the 3 other patients that are waiting on me on other rooms. Right now, I am focusing on seeing one patient at a time (single column scheduling) in order to build that rapport with tmy new patients. These people are generally older and have been going to the same office for 20+ years, so relationships and trust are very important to them. After a year or so, I will start to schedule quick appointments in a second column. I am in network with 6 PPOs, mainly to attract some of my loyal patients from my previous job. I have a non-solicitation agreement in my contract, so I can't directly call these patients, but they often find out that I moved and follow me to the new office. Most of the old doc's patients don't have insurance and either pay cash or send a check every month.
I had a good relationship with my local Patterson reps even before graduating dental school. I reached out to them in my 3rd year so I could start looking for retiring docs in my area. I still use the same reps today. I am not doing any marketing other than a small ad in my church bulletin. The existing patient base has enough work that I don't really need new patients right now. My goals for this year are to set up firm financial arrangements (listen to Tarun Agarwal's podcasts on the subject). We are still sending out paper statements and letting patients send checks for $50 or $100 a month. This is expensive on our end, I would rather have a credit card on file and do recurring monthly charges. I have already upgraded from film to digital xrays, from paper charts to open dental, and paper insurance claims to e-claims. This was a big step for us.

When I was in dental school, I was a member of Spear Online, which was a fantastic resource, but also very expensive. I learned a lot about treatment planning and restorative, and that can in handy for the few FMR cases I have done. I knew I wanted to place implants, so after about a year in practice I started placing mini implants for overdentures, then eventually went to the Misch institute. Some of the CE I was going to do this year was cancelled due to Covid. But I plan on learning oral sedation soon, and taking some Endo courses. The retired doc didn't do any extractions or endo, so the patients appreciate that I can do most procedures in-house
I have no desire to do 3rd molars or comprehensive ortho.

Negotiating the non-compete wasn't a big deal, the regional manager for the company was hesitant to do so, but ultimately my owner dentist was easy to work with. She knew that I was born and raised in this city and that I wanted to own a practice here, so she agreed to make the non compete reasonable. 2 miles for 2 years.

Financially speaking, our main struggle was getting approved for a house loan. We bought a house in January of '19. Since I was only paid on production at that time, most banks need a 2-year work history. However, my wife's family had worked with a particular local bank for a long time and they made it work out for us. We had a similar problem securing a practice loan. Most banks wanted to do an SBA loan since I didn't have 2 years of work experience. This involved a lot of red tape, and in my case a large down payment that I couldn't afford at the time. Bank of America has their detractors, but they are very easy to work with to get 100% financing.

Clinically, my main struggles were under-reducing my preps for ceramic restorations, sensitivity after composites - which was due to total etching before using a self-etching primer (rookie mistake, once I read the label and used it properly I didn't have any issues).

I met with several retiring dentists in the area before moving forward with this office. I heard about it from the same Patterson rep I met in dental school.

 

[frentist]

Great questions. After working in a fast paced environment, I have found that I don't do my best work when thinking about the 3 other patients that are waiting on me on other rooms. Right now, I am focusing on seeing one patient at a time (single column scheduling) in order to build that rapport with tmy new patients. These people are generally older and have been going to the same office for 20+ years, so relationships and trust are very important to them. After a year or so, I will start to schedule quick appointments in a second column. I am in network with 6 PPOs, mainly to attract some of my loyal patients from my previous job. I have a non-solicitation agreement in my contract, so I can't directly call these patients, but they often find out that I moved and follow me to the new office. Most of the old doc's patients don't have insurance and either pay cash or send a check every month.
I had a good relationship with my local Patterson reps even before graduating dental school. I reached out to them in my 3rd year so I could start looking for retiring docs in my area. I still use the same reps today. I am not doing any marketing other than a small ad in my church bulletin. The existing patient base has enough work that I don't really need new patients right now. My goals for this year are to set up firm financial arrangements (listen to Tarun Agarwal's podcasts on the subject). We are still sending out paper statements and letting patients send checks for $50 or $100 a month. This is expensive on our end, I would rather have a credit card on file and do recurring monthly charges. I have already upgraded from film to digital xrays, from paper charts to open dental, and paper insurance claims to e-claims. This was a big step for us.

When I was in dental school, I was a member of Spear Online, which was a fantastic resource, but also very expensive. I learned a lot about treatment planning and restorative, and that can in handy for the few FMR cases I have done. I knew I wanted to place implants, so after about a year in practice I started placing mini implants for overdentures, then eventually went to the Misch institute. Some of the CE I was going to do this year was cancelled due to Covid. But I plan on learning oral sedation soon, and taking some Endo courses. The retired doc didn't do any extractions or endo, so the patients appreciate that I can do most procedures in-house
I have no desire to do 3rd molars or comprehensive ortho.

Negotiating the non-compete wasn't a big deal, the regional manager for the company was hesitant to do so, but ultimately my owner dentist was easy to work with. She knew that I was born and raised in this city and that I wanted to own a practice here, so she agreed to make the non compete reasonable. 2 miles for 2 years.

Financially speaking, our main struggle was getting approved for a house loan. We bought a house in January of '19. Since I was only paid on production at that time, most banks need a 2-year work history. However, my wife's family had worked with a particular local bank for a long time and they made it work out for us. We had a similar problem securing a practice loan. Most banks wanted to do an SBA loan since I didn't have 2 years of work experience. This involved a lot of red tape, and in my case a large down payment that I couldn't afford at the time. Bank of America has their detractors, but they are very easy to work with to get 100% financing.

Clinically, my main struggles were under-reducing my preps for ceramic restorations, sensitivity after composites - which was due to total etching before using a self-etching primer (rookie mistake, once I read the label and used it properly I didn't have any issues).

I met with several retiring dentists in the area before moving forward with this office. I heard about it from the same Patterson rep I met in dental school.

Thank you for your response, I am always looking to learn from other peoples experiences! Ill definitely stay in contact with the Patterson rep I currently know

did you have other non corp job offers coming out of dental school?
every school is different, but any tips on how make the most of the clinical experience as a dental student? (my goal is not to have to do a GPR or AEGD)
did you take out loans to finance your dental school education? if so, how are you tackling your student loan debt?

 

[yappy]

In your previous corp job what were your most common/frequent procedures. In your current job what are your most common/frequent procedures?

 

[THS]

In your previous corp job what were your most common/frequent procedures. In your current job what are your most common/frequent procedures?

That's a really good question, I hadn't thought about it much. I definitely did more new patient exams and limited/emergency exams than anything else. However my most common procedures were probably extractions and fillings.
At my new office, it's crowns, for sure. Like I mentioned in a previous post, the retired doc was "watching" a lot of problems get worse, and patching them up when they did. I had a a few pages of names when I got here of patients who definitely needed crowns right away, and that's not to mention the ones I diagnosed in hygiene. I do much fewer extractions and endo here than I did previously.

 

[THS]

Thank you for your response, I am always looking to learn from other peoples experiences! Ill definitely stay in contact with the Patterson rep I currently know

did you have other non corp job offers coming out of dental school?
every school is different, but any tips on how make the most of the clinical experience as a dental student? (my goal is not to have to do a GPR or AEGD)
did you take out loans to finance your dental school education? if so, how are you tackling your student loan debt?

I did not really pursue other private practice offers, because there weren't any in my home town. I considered buying 2 different practices upon graduation, but I'm glad I didn't go that route. I did get offers from two other corporate offices which I would have never considered - notoriously shady places.

 

[2TH MVR]

@THS
Just wanted to throw you some big props for getting your own private practice after 18 months of Corp. I still remember when I bought into a partnership (about 8 months after residency) and then purchased the entire ortho practice 18 months later. It's going to be a very exciting time for you. Nothing like putting energy into your own practice and reaping the rewards. Hopefully the new grads will follow your lead and stay away from a life time of working Corp.

 

[Cold Front]

I was paid well enough, though not nearly as much as I would have made at other offices. I got a $500/day guarantee for 6 months, then 25% of production. After a year, I was given a raise (to a whopping 26% of production).

You will be sent to meetings and courses put on by the company, full of a bunch of folks drinking the corporate kool-aid, telling you how the average doc makes $850k or something ridiculous like that. You will have your production/metrics compared to the rest of the docs in the company. I frequently had to defend myself for having an SRP diagnosis rate of ~35% instead of the company's average (around 70%).

This is probably (with high probability) Aspen Dental where you worked.

I’m seeing couple of offices this Friday where the dentists literally walked out of their office because they couldn’t handle their debt obligations. The lien holder/bank is trying to salvage the equipment and furniture for pennies to the dollar (for lack of better words). So more power to you for surviving the covid shutdown. You are lucky because your deal was an acquisition deal and not a scratch startup/brand new office, which would have been almost next to impossible to make it work.

Congrats and Good luck!

 

[Grinz]

My goals for this year are to set up firm financial arrangements (listen to Tarun Agarwal's podcasts on the subject). We are still sending out paper statements and letting patients send checks for $50 or $100 a month. This is expensive on our end, I would rather have a credit card on file and do recurring monthly charges. I have already upgraded from film to digital xrays, from paper charts to open dental, and paper insurance claims to e-claims. This was a big step for us.

Can you touch base a little bit more about this? What services are you using to do this? And which episode of Tarun's podcast specifically were you referring to? Thanks!

 

[THS]

This is probably (with high probability) Aspen Dental where you worked.

Surprisingly not! Aspen was one of the other offers I got, though.

 

[THS]

Can you touch base a little bit more about this? What services are you using to do this? And which episode of Tarun's podcast specifically were you referring to? Thanks!

I'll have to go through and look, but he talks about his "financial menu" quite often. Check his interviews on the DentalHacks podcast and Shared Practices podcast. I know for sure he talks about it on those.

The old dentist was using film radiographs and had an old Air Techniques developer that was on its last leg. I was quoted anywhere between $8,000-17,000 for two digital sensors. While an important investment, this was an expense I couldn't afford when I started. I found an Air Techniques ScanX phosphor plate scanner on eBay for $2,000 and bought a bunch of phosphor plates for around $20 each. Not only was this much more economical for me, but it's also a very easy transitions for the patients and staff. They feel just like film to the patient, and the process of "developing" the phosphor plates is similar to film for the staff. Also, instead of having to buy a digital pan, I bought a $200 pano phosphor plate and can still use the old film pano. Not the best image quality, but it does the job. I still plan on getting true digital sensors in the future, but this is working great for me for now.

They were previously mailing or faxing claims to insurance companies, which would take forever and they would get a lot of kickbacks because they didn't have enough information. So they would have to mail in the film radiographs, which they would never get back. Now, I am using EDS as my Clearinghouse to send electronic claims, and I can easily attach radiographs, intraoral images, narratives, etc.