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How the AACD got me off the ground

Jan. 1, 2009
Should you build a dental practice from scratch or buy an existing one?
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Should you build a dental practice from scratch or buy an existing one?

by Darce Slate, DDS

For more on this topic, go to and search using the following key words: AACD, starting a practice, buying an existing practice, Kois Center, Dr. Darce Slate.

To build a practice from scratch or buy an existing practice. This is probably the most difficult decision any dentist will make. Certainly, it was the most challenging one I had ever faced when I was called upon to make it. No one can determine what is best for you, but looking at the experiences of others can help you choose with your eyes open.

I chose not to open a practice just out of dental school. For me, this was the right decision. During this process, there were several factors that helped as I weighed the options. For sure, starting a practice is more than just deciding on equipment and location. It requires defining yourself, your brand, and business model. The focus of this article is to show why defining your core philosophy and practice beliefs can dramatically improve the success of a new practice.

I haven't met many dentists who built a start-up dental practice immediately out of dental school. Often this is for good reason. In addition to the enormous debt incurred after four or more years of school, the costs of a new life and a new practice can be daunting. Finances aren't the only reason for a dentist to delay ownership in favor of working for a more established dentist.

Spending some time in a fully operational dental practice — whether it's a good or not-so-good experience — will help you understand the business and clinical aspects of dentistry. This helps in honing a vision for your office. Being an associate allows for the time to build your core beliefs. Associate relationships range from dreadful to excellent.

Those who traveled that route almost always agree that it helped them define who they are, what they wanted, and where they were going. When it came time for them to build a practice, much of the journey of self-discovery had begun.

So how can you make the most of an associate position? I recommend you take advantage of every opportunity to learn what you do not yet know and experience what you have not yet experienced. Show up early. Leave late. Participate fully. Ask yourself what you would do in situations if you were the owner. What standards would you establish and how would you function as a leader and manager?

Definitely take this time as an associate to develop strong and effective communication skills with patients. Undertaking these simple actions will help you understand the myriad of obligations and choices you will encounter when you do choose to move to your practice.

While you are working for others, you can simultaneously ask yourself the “normal” questions about establishing a practice. Do you want an all-digital office, and how much will it cost? Where should you build and what type of facility will you need? Will you want to establish a fee-for-service practice or one that relies on HMOs and PPOs and manages patients' insurance? What type of patient flow do you want? What staffing configuration will you need to begin, and how will you expand as you grow? How much money will you need and how much working capital is sufficient? How far ahead of the grand opening should you market the practice?

Without a doubt, the time leading to your start up is valuable, and should be used to gain experience that will help you avoid mistakes and make the best choices. Don't overlook the advantage of learning from your employer. Ask many questions. Observe everything and learn from what you see.

Ask why he or she made one choice over another, and what this person might have done if given another chance. Does this person own or wish he or she owned a building? How does he or she figure monthly overhead expenses and keep them under control? How long did it take to become profitable? Is this person actively marketing the practice? If he or she could practice differently, what choices would be made?

The best use of my time while an associate was pursuing a path of continuing education. The best place for virtually unlimited resources and educational opportunities was the American Academy of Cosmetic Dentistry.

One's core philosophy begins with education and is brought to fruition through experience and a continuation of these educational events. Dental school education is only the foundation for dentists. The choices we make in continuing education will continue to shape and mold us.

Education was, and will continue to be, a key component that helps define who I am as a dentist. For me, continuing my education was a given. I have an ongoing passion and desire for learning.

Early on, I searched for the best places for advanced learning. I sought out the best educators and clinicians, the right curriculum, and right clinical philosophy. The same names kept coming up. People like John Kois, Peter Dawson, Frank Spear, Corky Wilhite, Betsy Bakeman, Brian LeSage, Lee Culp, and others. A friend suggested I join the AACD. Then I could hear these people's lectures at AACD annual sessions.

My first AACD annual session in 2003 in Vancouver, British Columbia, was memorable. I remember looking around in amazement at the dentists, laboratory technicians, and staff, as well as at the level of excitement and enthusiasm on their faces. The people at that scientific session were as energized and passionate about dentistry as I was. I remember feeling humbled by the caliber of dentistry being presented during the meeting.

The effect of being surrounded by excellence, beauty, and dentists excited about dentistry helped change the way I thought about dentistry. I asked myself some fundamental questions, such as the kind of dentist I wanted to be and how my practice could support that vision. These were difficult questions.

But via contacts and the support I gained through the annual sessions, courses at the Kois Center in Seattle, and several tremendous mentors, I was able to strengthen my vision for a practice.

Kois Center training gives a dentist far more than just clinical training. In my opinion, no one connects with dentists' hearts and passions better than Dr. John Kois. He and the Kois Center had an enormous impact on my core philosophical beliefs as a dentist.

I went to the Kois Center to learn about interdisciplinary treatment planning and occlusion, but I left there with much more. Dr. Kois gave me what I wanted to hear — the facts. He supported his training with factual data and practical ways to implement solutions. What is difficult to put in writing is that he spoke to the part of me that always wants to do what is right for patients — without compromise.

I left each course understanding that it is possible to build a practice based on strong, ethical core philosophical beliefs. I knew then that I could build a practice from scratch and that I would succeed. I still had questions, but I give credit to a handful of fantastic mentors who aided me in the process.

Having a mentor throughout your dental career is quite an advantage. I think having a mentor at the beginning of one's career is even more valuable. It would be regrettable to build a dental practice without one. We know that not every vendor, dental supply company, or office contractor has a dentist's best interests in mind.

Usually mentors just want to help you out of trouble and prevent you from making the same mistakes they made. The AACD is a wonderful place to meet dentists who have done what you are getting ready to undertake.

Moreover, mentors were at AACD annual sessions so I could bounce ideas off them and have them guide me through the process. Simple questions such as whether I should purchase an item now or later, what practice management software is best, and other questions never went unanswered. A mentor can help you decipher the large and small decisions, and can be a great resource as you build a practice.

Are you ready for a start up? Have you discovered your core beliefs and defined them through experiences, educational opportunities, and with the help of your mentors? It is essential that you understand that you are embarking on a professional journey and, with the help of others, your trajectory and landing can be more predictable.

Most dentists will build only one office in a lifetime. You can make quick, snappy decisions and have to live with your mistakes for a long time, or you can take some time to develop a practice philosophy and build your practice into a benchmark dental practice of which you can be proud.

In my case, I followed the latter approach and am grateful that I took the time to cultivate and invest in myself. My core beliefs were the building blocks of my practice and are evident in all that my practice does. I constantly gain from new experiences while staying up to date with dental education, and I continuously thank my mentors for sharing their experiences with me.

Dr. Darce Slate practices in Rocklin, Calif., at his practice, Pure Dentistry. He is active in many local and national dental organizations, including the American Academy of Cosmetic Dentistry. A Bay area native, he received his degree from the University of California, San Francisco School of Dentistry. Reach Dr. Slate via e-mail at [email protected].

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