OBSERVATIONS GORDON J. CHRISTENSEN, D.D.S., M.S.D., Ph.D.

The best way to initiate a dental practice

ost of us have had to start a dental practice at least once in our career. Some have moved from one location to another and had to initiate a second or third practice, often in their mature years. Because of my early involvement in fulltime dental education, and eventually in delivering private continuing education and conducting research, I have had to initiate four separate dental practices during my career. The title of this article appears to indicate that I have the answer to the formidable question of how best to initiate a dental practice; I admit I do not have the answer for all dentists, but I may have some help for those starting a practice. During my career, I have dpracticed in the office of another dentist without being a formal associate; dpurchased the practice of another dentist who had recently died; dstarted two new practices

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without any association with another dentist; dpracticed with peer dentists who were not associates, and who did not share in the profits; dhad several young dentists, one at a time, work as employees in my practice; dhad a profit-sharing associate dentist work in my practice; dsold a practice and remained in the practice as a subordinate to the purchaser; dwatched two sons and one son-in-law go through the painful initiation of a dental or dental specialty practice. This article expresses my opinions on starting a practice, including the advantages and disadvantages of the various ways from the vantage point of the person attempting to start the practice. Next months article will express my views from the standpoint of the dentist looking for an associate or planning to sell a practice.
STARTING A PRACTICE YOURSELF

Every dentist initiating a new

practice, whether neophyte or experienced, has visions of patients flocking to his or her new practice, just because the doors were opened and the newspaper had an announcement about the new practice. Such has not been the case in either of the practices I have started myself. Advantages of starting a new practice yourself: dThe geographic location of your practice is your decision. dYou may incorporate any ideas, concepts, philosophies of practice or techniques you prefer. dYou may have a new facility or old facility, and you may plan it, build it or remodel it to meet your needs. dYour employees are the people of your choice. dYou are the boss. Disadvantages of starting a new practice yourself: dYou need to obtain a major amount of money or a large loan. dYour trusting family may be your only initial patients. Build241

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ing a patient base requires several years and diligent effort on the part of everyone in the practice. dThere is no assurance that the initial practice income will keep up with the financial outgo need. In my personal experience, and after observing many new practices, a typical new practice requires about five years to mature financially. Your spouse and family should be made aware that the first few years might not meet their financial expectations.
BUYING THE PRACTICE OF AND TEMPORARILY WORKING WITH A RETIRING DENTIST

Purchasing a retiring dentists practice and working with him or her for a temporary transition period sounds like a real winner. However, be aware of both the advantages and the disadvantages. Among the advantages: dYou have immediate income. dThe facility and the equipment are functional. dYou do not have to plan an office or be creative at the beginning of the practice experience. dYou have patients to treat immediately. dThe change from your previous professional activities (school or another practice) is not a major shock. Among the disadvantages: dThe patients are devoted to the previous owner of the practice, and you must make a positive impression with them to gain their confidence and keep them in the practice. dThe previous owner may continue to treat the desirable patients while he or she is still in the practice, limiting your income and productivity.
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dThe employees are devoted to the previous owner. dThe equipment may be old and out of date, requiring an outlay of money as soon as the previous owner leaves. dThe building may be old and in need of repair, or in a geographic location that is not your choice. dThe previous dentists work may have been of a different level of quality than you want to have in the practice, and the staff will have to be re-educated. dThe previous dentist may want to fund a retirement program from your payments for the practice, and the cost may be high for you. dThe previous owner may want to stay longer than originally planned, and it may be difficult to take over the practice at the agreed time. I have seen this happen several times, and the buyer remains with all of the disadvantages of this type of practice and few of the advantages until the previous owner leaves.
BUYING THE PRACTICE OF A RETIRING DENTIST WHO LEAVES IMMEDIATELY

Buying a practice from a dentist who immediately vacates the practice may sound negative for a few reasons, but it has some distinct advantages. Among the advantages: dYou have immediate income. dYou have only minimal planning needs to start the practice. dThe facility and the equipment are functional. dYou do not have to be creative at the beginning of the practice experience. dYou have patients to treat immediately. dThe change from your pre-

vious professional activities (school or another practice) is not a major shock. dThe previous dentist is out of the office, eliminating many of the disadvantages listed for the above situation, in which the previous dentist stayed in the office for a time. Among the disadvantages: dThe patients are devoted to the previous owner of the practice, and you must make a positive impression with them to gain their confidence. A significant percentage of them will leave the practice and go to another practice. If the previous dentist remains in the practice for a while to introduce you, more of the patients probably will stay with you. dThe employees are devoted to the previous owner, and you must prove yourself to them or replace them. If there is any question about your compatibility with specific employees, they should be replaced on your entry into the practice. dThe equipment may be old and out of date, requiring an outlay of money as soon as you take over the practice. dThe building may be older and in need of repair, or in a geographic location that is not your choice. dThe work of the previous dentist may have been of a very different level of quality than you prefer to have in your practice, and your new staff will have to be re-educated. dThe previous dentist will want to fund a retirement program from your payments for the practice, and the monthly cost might be high.
DISCUSSION

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There is not a single way to start a dental practice that is the best

JADA, Vol. 134, February 2003 Copyright 2003 American Dental Association. All rights reserved.

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Dr. Christensen is cofounder and senior consultant of Clinical Research Associates, 3707 N. Canyon Road, Suite No. 3D, Provo, Utah 84604, and is a member of JADAs editorial board. He has a masters degree in restorative dentistry and a doctorate in education and psychology. He is board-certified in prosthodontics. Address reprint requests to Dr. Christensen.

for everyone. Each situation is different, and each practitioner has to make his or her own decision about the best way for him or her. In my opinion, if you have financial backing and do not mind working very hard for a while, my pref-

erence would be to start a new practice. However, this mode of starting a practice is not the one chosen by most dentists. If I were buying an ongoing practice, I would prefer to have the previous owner leave as soon as possible, preferably immediately on my entry into the practice. I would accept the loss of some patients to have the independence of administering the practice and putting my own ideas into it as soon as possible.
CONCLUSION

stance is different, and there are advantages and disadvantages for each mode for practice initiation. My experiences may assist those considering initiating or purchasing a dental practice. s
The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the American Dental Association.

Educational information on topics discussed by Dr. Christensen in this article is available through Practical Clinical Courses and can be obtained by calling 1-800-223-6569.

There is not a best way to initiate a practice. Each circum-

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