I really like this post, and appreciate everything that you want in a practice. It is definitely fulfilling and rewarding to open a practice, build and design it exactly to the way that you envision it. Although, a concern when comparing opening a practice from scratch vs. taking over a practice for me would be the time that it would take to develop a patient pool. When, if you take over a practice, you already have those patients "handed over" to you. Personally, if I were to open my own practice, it would only be after I have worked as an associate in one or multiple dental offices. This way, I would allow myself time to develop practice management skills (and skills stated above in this post) while working. Also, I would take note of what I find to be positive and negative about the offices to use as part of my vision of what my practice should be like.

I really like this post, and appreciate everything that you want in a practice. It is definitely fulfilling and rewarding to open a practice, build and design it exactly to the way that you envision it. Although, a concern when comparing opening a practice from scratch vs. taking over a practice for me would be the time that it would take to develop a patient pool. When, if you take over a practice, you already have those patients "handed over" to you. Personally, if I were to open my own practice, it would only be after I have worked as an associate in one or multiple dental offices. This way, I would allow myself time to develop practice management skills (and skills stated above in this post) while working. Also, I would take note of what I find to be positive and negative about the offices to use as part of my vision of what my practice should be like.

This is a topic I have been thinking about recently. My uncle does a fair amount of consulting for dentists trying to decide. I spoke with him recently and he brought up a few good points I hadn't thought of before. If you are looking to buy a practice, it is likely that the dentist is in the end-stage of his career. Because of this, my uncle has seen often that the practice is essentially being "run into the ground." A major part of that is the equipment. The dentist has likely just been trying to get by with his old stuff. So that definitely needs to be considered in the terms of the buy-out. Also, it is possible that other issues may be going on because of the practice being "run into the ground." For instance, how are the patients being cared for, how the employees are being treated, how the records are being managed, so on and so forth. Beware of buying a run-down practice for top $$.

I appreciate the excitement that you have exemplified with regard to becoming a business owner. I too share the same motivation to one day own a practice, especially to establish a state of the art practice in an area of need. The one thing that I have heard mentioned time and time again is to learn as much as you can before committing to such a grand project. If you do the research, educate yourself about the market that you are entering, seek professional help to advise you, then hopefully things will work out well. Also, we can't forget about the clinical side of dentistry. The charge for a DDS or DMD is to provide pristine dental care for the community that we serve so we can't negate that. Sometimes the best thing that you can do for yourself and your patients is to gain more clinical experience so that your dental strengths will be solidified.

I cant imagine starting from scratch right out of school! I would imagine the experience and skills you learn from working an established office could prove to be extremely helpful when creating you own standards for your private practice. I hope it works out for you and am interested to see how an experience like this worked out for others in the past.

Where do you begin when starting up a practice from scratch? Where's the best place to look for equipment and supplies, and how much should I plan on taking out a loan for? Thanks for any advice!!

I think our ASDA chapter is planning on a lunch and learn on this topic soon. Should be great for all here interested in this subject!

im joining a group upon compltion of my fellowship any advice/

Finding the existing practice is sometimes the tough spot. What experience or recos do you have?

One of the primary advantages of starting and building your own practice is related to the freedom to practice wherever you wish to live.  Every geographic area has its more desirable and less desirable states.  Within these desirable states, there are, of course, desirable and less desirable communities.  Even within the communities there are desirable and less than desirable areas.  Providing that the area demographics will support a new dentist, the primary advantage of a scratch start is being able to select where you wish to practice.   

The most noticeable disadvantage of starting a practice from scratch is the lack of patients.  It takes time to build a patient base, which translates into the opportunity to produce and collect for dentistry performed, i.e., generation of cash flow.  Implementation of a good marketing program is imperative to overcome this disadvantage.  Even at an ideal start of 25 new patients per month, and assuming normal attrition, it will take five years to develop a thousand patients in your base.  While this is occurring, it may be necessary for you to supplement your income through employment and other means to make the required principal and interest payments on your start-up loan plus meet living expenses.  

It is fairly easy to summarize the advantages of purchasing an existing practice if we look at the previous discussion relative to the disadvantages of starting a practice from scratch.  The primary asset acquired when one purchases an existing practice, typically representing 70% to 80% of the purchase price, is the “goodwill” associated with the existing patient base.  As noted in the following example, the sample practice used will have an existing patient base of 1,333 patients.  As noted from the above example, it took five years to develop 1,150 patients.  Most importantly, this existing patient base immediately translates into income for the practice. 

The primary cited disadvantage of acquiring an existing practice is the price.  Many new dentists are frightened by the so-called “sticker shock.”  At first, by sheer size, the price of acquiring an existing business can seem to be formidable.  However, a careful review of the cash flows and projected future cash flows will quickly point out that the purchase price can be readily supported.