Thinking back to dental school graduation, I’m sure I was pretty naïve as I planned my future. I was going to work as an associate, and within a year or two open my own practice or end up partnering with my first jobs owner. I was going back to my hometown and already had that job with my childhood dentist. The weekend following my graduation I was getting married and already had an apartment not far from the practice I would soon be working in. Everything was proceeding pretty much as planned.
It only took a few months before my first employer fired me because he didn’t have enough patients and the ones he had were moving over to my schedule because I was working Fridays and Saturdays. A few years later, I was going through a divorce. Two years following that I was addicted to cocaine, depressed, and leaving my second job.
Like most things, life happens. We react, adapt, correct, and move on, or so I thought. Almost fifty years later, I find my hindsight far better than my original naïve vision of the future. As it happens, things worked out, and today I am writing you this note.
I think most graduates see their future with a couple of associate jobs and then ownership of a “great” practice. Sadly, this rarely happens. In fact, over 50% of the graduates from the last 15 years do not, and I suspect will never, own their own practice. It might be the crushing debt, stiff competition, cushy jobs as an employee, or even generational proclivities to avoid ownership. It’s almost endemic when I look at all the doctors I speak to on a daily basis. Many did finally open their own practice, that same large group ended up in a solo practice that is average in every way: $650,000 to $720,000 in collection a year, 67% to 75% overhead, 20 to 30 new patients a month, about four staff members, and finding themselves not quite as engaged in their businesses as they could be. That’s the trouble with “average”. It’s the sweet spot and, for some, the final destination for a practice that is pretty easy to obtain. Too often it is the default setting for those who fail to actively strive to test themselves, and consistently move towards resetting the bar for their practice. I am sure many of the average or even below average practices might tend to think that dentistry just isn’t what they thought it would be, but. The “but” is a long list of obstacles that make it hard to get out, encompassing everything from debt to the seemingly wasted years of study. They likely keep telling themselves “surely I can make this work”. If you consider that average practices don’t take a lot of commitment, basically show up and trade time for dollars, it’s not a bad spot to be. But probably far short of the practice you always thought you would have.
What happened? You were one of the smartest in college just to get accepted into dental school. You graduated with great expectations. Once again, life happens. We started with the vision of a “great” practice, and many have settled for something less. Now before you get your panties in a wad, I never said average was bad. I am merely saying it was short of your initial goals. Or maybe it wasn’t. It certainly doesn’t fit the description that most of us had for what we thought a “great” practice looked like at the time. I think most us were thinking something North of “average”. No settlers and no plateaus for us: Onward and upward. The exception would be an average practice where you save at least 20% of your take home and successfully invest it. You have controlled your burn rate of spending and have little or no debt. You live below your means and are happy and fulfilled with life, family, and practice. This too, can be a super general dental practice.
For the rest of us, I want to pose a challenge and ask you to question your commitment, actions, and goals. I certainly can admit that I never thought of an average practice as a destination. I assumed that I would persist to something more. But I also am sure that at that time I never really knew what average was, let alone what great looked like. I, for one, struggled through years of my practice before actually seeing it take off.
Take a moment and quickly jot down what a great solo practice would look like to you: Fee for service? 40 to 50 new patients a month? Long-term staff that are talented, motivated, and loyal? No debt, lots of money in the bank and in investments? You only work a few days a week, you have thousands of 5-star reviews, do mostly full mouth reconstructions because people are beating a path to your door, etc. You get the idea. Wave a magic wand and list the characteristics of what most doctors would consider when thinking of a “great” solo dental practice. Now, look back up at the first of the article and compare that to what the ADA says an average dental office looks like. I’ll bet dollars to pennies that the great practice is light years ahead of that average one.
One more step and also a question. Review your “great” list, revise if you want or just add something you forgot. Now remember this is a great solo practice. The question is: Do you have a great solo dental practice? If you answered yes, consider this bit of logical deduction and then think again, or as the Riddler would say, “riddle me this Batman”.
This was a trick question, because if you had most of the list that you wrote, there would be no way for this practice to survive as a solo practice. Everything you wrote would have been created by inspiring your patients, delivering on your service and clinical excellence, and maintaining a business structure that embraced change while you constantly adapted to this new dental economy. In an era of dentistry where we have increased dental graduates every year, existing dentists have postponed retirement into their seventies and still will not have enough. Insurance has become an increasingly strong factor in where our patients decide to buy services and products. We see the solo practice decreasing 7% a year and multiple doctor practices increasing 20% a year. Forget about DSOs or large multi-office corporate dental groups. Successful practices (consistent growth every year, higher than average production and profitability) seem to be changing the face of what most graduates will need to define as great. “Consumerism”, giving patients what they want, when they want it, at a price they can afford, has increasingly forced many to adapt to this and many other circumstances that never existed 15 years ago. With fewer that 50% of graduates moving into ownership, corporate practices have an unlimited number of doctors to staff their offices with. The independent practice of dentistry is in jeopardy. If we do not wake up and stop believing in the myth of the “great” solo practice, many of us will find ourselves out of a job or in a job that might not pay the bills.
I assume the winner in the long run will be a Super General Dental Practice, but I am not naïve enough to believe that I have a crystal ball. I do know that we as a group need to challenge the bureaucracy of thought that has gotten us to where we find ourselves. We must stop “thinking like a dentist” because many of those views were forced on us by an archaic system of learning from those that cannot compete in the trenches of the independent dental practice, lack of challenging the norm, and failing to have situational awareness. The time is short and the future of dentistry can still be great, but currently that success is going to the dentists that have distanced themselves from the outmoded traditional dental practice model. Those that cling to the past will be the last to adapt and the first to fall. It is happening daily. Stop “thinking like a dentist” and begin to look through the eyes of the consumer. This is how you Summit.
Michael Abernathy, DDS