Life After Dental School: Preparing for and Ultimately Purchasing Your Own Practice
by Dr. Gino Pagano
As I sit down to write this article, I reflect on the past three years of my life. In the past three years, I tied the knot with my wife, took boards, graduated from dental school, adopted my first dog, completed a GPR, entered a dual degree oral surgery residency, left that residency, held three positions as an associate and finally purchased my own general dental practice. It has been a story for the ages with more ups and downs than the stock market. I would love to tell the whole story, but I am going to choose a topic that I feel is most relevant to new dentists: preparing for and ultimately purchasing your own practice.
The first issue to address is, "When are you ready to purchase your own practice?" The answer is, "NEVER." No matter how many degrees you have or how many courses you take, nothing can adequately prepare you for being solely responsible for the day-to-day operations of a business. However, you must feel clinically prepared to handle whatever walks through the door. This is a very personal decision. Some students feel ready upon graduation from dental school. For me personally, I realized I would have to see more than two patients per day to stay in business.
As a result, I applied to General Practice Residencies (GPRs). My personal opinion is that everyone would benefit from a GPR. It allows you to increase your speed and try more advanced treatments with the help of specialists, as well as learn a tremendous amount about medicine.
GPRs vary in their emphasis on medicine vs. clinical dentistry vs. oral surgery. I suggest researching several and find one that has the balance you are looking for. Once there, do as much as possible. Some GPRs require a lot of self-motivation. Do overdentures with attachments, do surgical extractions, and work with as many dentists and specialists as you can. Pick their brains for as many different techniques as possible. In addition, do as many physicals, intubations and medical rotations as you can fit in. Assist an open-heart surgery. You will never get opportunities like these again, and they will be invaluable when you leave the hospital and enter the real world.
Now it's time to find a job. At this point you may be ready clinically to run a practice, but you must go find your dream practice. Once found, you must secure financing, negotiate the details of the practice, meet the staff and possibly relocate. This is unlikely to happen while in your residency. As a result, I would suggest starting as an associate. Ideally, you would like to find an associatship that could lead to ownership or partnership in the future. A very good source for finding a job is area dentists. Almost every dentist knows two or three colleagues looking for an associate or ones who are getting ready to retire. Another good source is the Pennsylvania Dental Association; it has a wealth of resources to find a dentist who needs help. Also, dental supply sales representatives are a very good source of leads. They interact with nearly every dentist in the area and tend to have a good feel for who is coming and who is going. Do not be too picky about an associateship; just get into the work force and start racking up experience and put some money in your pocket. However, at some point you will come to the realization that you are a guest in someone else's practice. Now you are ready to find your own practice.
Finding a practice is not something that happens quickly. I suggest using the same resources as previously mentioned to find a job. If the practice you find yourself in currently suits you, you are ahead of the game. However, this time your decision cannot be a hasty one. Look at many different practices in many different areas. There are a lot of factors that enter into play. What type of dentistry do you want to do? Do you want a cosmetic practice, or a bread and butter practice? Do you want a fee-for-service practice or one that is driven by insurance? Do you want two chairs or seven? Is there room to expand?
Once you have found a few practices that fit your general type, it's time to intensify your efforts. Meet the staff. Spend a couple of days at the practice meeting patients. Get a feel for the type of dentistry patients are accepting as well as the chemistry of the office. Ask to see the last three years of production, and then get a good accountant to crunch some numbers. The biggest factor is going to be can you pay for the practice, pay your student loans, and have any thing left over to live on?
Once you have found "the one," you need a good attorney to iron out the details of the deal. Next, start shopping for financing. There are a number of companies out there that specialize in these types of transactions (Sky Financial, Matsco, HPSC). The rate will be slightly higher than a bank, but I found that they are much easier to work with because they are familiar with the procedure and the risks associated with it. A bank will see this as a high-risk investment for them because if you default on your loan, they are stuck with a dental practice. The specialized companies will do their own number crunching and be sure the numbers work for you. It actually acts as a second opinion for you.
Once approved you are ready to hold your nose and dive in headfirst.
Now the real challenge begins-payroll, staffing, ordering, marketing, finding a good lab, etc. But, those are all topics for another day.
Dr. Pagano practices in the east suburbs of Pittsburgh.