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In today’s economic climate, young doctors are becoming increasingly discouraged with the shortage of available practices for sale and are considering du novo or scratch start practices.
A typical general dental practice start-up consists of four to five treatment rooms plumbed, two rooms equipped with a moderate level of technology and cabinetry at a cost of $350,000-$500,000. In order to pay for the start-up, financing is obtained for the office furniture, fixtures, equipment, build-out and working capital. Working capital enables the dentist to pay the bills while the patient base builds. In addition to the practice loans, young dentists are typically already saddled with $200,000+ in student loan obligations. With all this debt, you can see how important it is that the practice grows quickly.
Once the build-out has begun, the practice owner’s attention turns to assembling a staff. Obviously the practice cannot support a hygienist. Dentists will often concentrate on trying to find an experienced receptionist to run the front desk, including making appointments, managing collections and filing insurance forms. Some start-ups will include a chairside assistant from the beginning and others will not. The new practice owner must weigh the additional service the practice wishes to provide to patients and the image he or she wishes to project against the extra cost of hiring an assistant. As you might imagine, this can be a difficult choice.
The day the practice opens, the dentist will have few patients beyond family and friends. In order to attract patients, external marketing is needed — and it is expensive. Sometimes it works and sometimes it doesn’t. Slowly over time, the practice will begin grow.
Starting a practice from scratch today carries a host of unknowns, risks, and uncertainties. The pertinent questions are:
On the other hand, when a dentist purchases an existing patient base, there is immediate cash flow from day one. It has been said that by purchasing a practice, the bottom line is $400,000-$600,000 greater cash flow during the first five years of practice, compared to a start-up practice.
When purchasing an existing practice, a dentist acquires the following assets:
I would encourage any young dentist to consider purchasing an existing practice first. If you can’t find a practice or if the practices you see are not satisfactory, only then should you consider starting a practice from scratch. Why struggle when you don’t have too?
Peter J. Ackerman, CPA, is a certified public accountant, licensed real estate and business broker and national speaker on business issues affecting dentists. For more information, email Mr. Ackerman or visit www.adsmidwest.com.
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