There are quite a few orthodontists who wisely sold their practices to DSOs while the prices were higher than ever before. In selling they also divested themselves of accumulated debt, leases, baggage, problems, risk and/or mistakes. Plus the time to sell is when the prices are high! Many of these once and future practice owners are now approaching the end of their post-sale commitments and deciding what to do can be daunting. I’ve had several friends, acquaintances and even total strangers reach out and ask for advice on how best to go about firing up the owner/operator engines again. Many of these inquiries included an admission that starting over is a bit intimidating so rest easy and know that you’re not the only one. In the recent past I’ve avoided these asks for many reasons but I was being selfish and will admit to being afraid to engage folks or dispense advice and start over myself. However, the bravery of those who were intimidated but overcame it to ask for help has inspired/shamed me to quit being a wimp so for those who are interested, I have a few thoughts and ideas to share…

First let me reassure those of you who have run practice in the past well enough to get paid big bucks by a buyer of practices that you got this! If you decide to open/buy/run an ortho/dental/OS/pedo/etc. practice again know that you are better prepared, smarter, more experienced, wiser than ever before to do so and the odds that you will do a better job this time around are extremely high. You now take so many things for granted that you didn’t know the first time around and the mistakes/missteps of the past will only serve to help you avoid pitfalls in the future. Of course this doesn’t mean that the second iteration of Dr. GoItAlone will be error free but it will certainly be better! What you did last round was obviously fantastic given how much you were paid and how much the new practice owners want you to stay. Don’t let anyone tell you any differently. Don’t let the fact that others grew bigger or got paid more dampen your enthusiasm about your awesomeness. You don’t need to compete with anyone! Just be the best version of you you can be by getting a little better at what you do every day. There will always be some one richer, smarter, faster, better and that is great because you and I can find those people and ask them nicely if they mind us visiting their office and learning from them! I love being the dumbest, poorest person in the room and where we live that happens daily which is fabulous.

I know, I know you want examples of this wondrous knowledge you’ve accumulated so here you go:

  • Demographics – you know who you want to serve and how. More importantly you know who you don’t want to serve and why!
  • Office location details – you are better at picking a great state, county, city, corner, space to locate your office… you are better at figuring out how many people are in an area, do they work there, live there, commute through, the schools, the other businesses etc… you know what kind of location you need, how much space you need, now it needs to be laid out, and how much you want to pay, you know how much parking you need, the value of visibility, the kind of signage you need, you know how to design an office, how to buy and arrange equipment and how to make it flow.
  • You know how much money it takes to start a practice and hopefully you still have some of that money you were given for your old practice to start a new one!
  • You know how to hire and train staff.
  • You know customer service. 
  • You know how to deliver quality care in a great environment. 
  • You know how to run on time.
  • You know how to keep the business in check and not let it run your life.
  • You know all about insurance, what plans you want to be on and how to negotiate with them.
  • You know how taxes work and how to incorporate, buy, build, operate to maximize your tax efficiency. 
  • The list goes on and on and on but this should get you started thinking about all you know this time around that you had no idea of before. Also if you’re thinking about starting another practice it’s a great time to start visiting offices and talking to people about what they know and can share with you!

Of course the big question is… WHAT DO YOU WANT?

What I mean is that it is of the utmost importance for you to sit down with those important to you and DECIDE what you want and why. You know all of these things and you can start a practice tomorrow without a care or a thought and do very, very well but why not make a proper go of it and maximize every aspect with some planning? For example:

  • Do you want to practice where you are now or do you want to move somewhere else to maximize your practice potential? Can you practice where you are or are there restrictions on you like size of the population, non-competes, etc.?
  • Do you want to move to a new location to maximize your personal life in terms of lifestyle, climate, people, taxes etc.? What would that new place look like?
  • What did you love about practicing before? What did you not like so much?
  • How many days a year do you want to practice? How many hours a day?
  • What kinds of cases do you want to treat? What kind of cases would you avoid?
  • What kind of referral sources do you want? What kind do you not want?
  • What kind of people do you want to serve and who would you rather stay out of your office?
  • How busy do you want to be? How many chairs? How many staff?
  • And on and on…

For Bridget and I the vision for our second time around was something like this:

We wanted to move to a warm place with a great airport, lots of stuff to do, a high percentage of business owners that was also a state with no state income tax. That left us Texas, Arizona and Florida. We picked Florida and then we picked Orlando because we didn’t want to live on the coast because we don’t like hurricanes. Within the Orlando area we picked our home based on the chain of lakes it is on, the proximity to school and the proximity to the club we belong to. We didn’t have any intention of opening a practice when we moved so that played no part at the time. When we decided to open a practice we knew we wanted a fun place that offered affordable treatment and we wanted to continue to serve traditionally underserved populations. We wanted control over our own new patient supply. We looked all over Orange and the surrounding counties and ended up at our location because of the demographic and psychographic surveys we did. We knew didn’t want to deal with referring dentists, we wanted to work less than 140 days a year, we wanted reasonable hours, we didn’t want to do the after school appointment dance and we like to be BUSY when we are at work. We thought we wanted to offer short term aligners but that was a mistake. We had to add some chairs and struggled with the associate game at first but other than that Smiley Face has gone very much to plan and much, much better than the first time around! If we can do it, you can too! 

Everyone will have a different vision and different “right answers”.

The point is to learn from your past wins/losses and make a conscious effort to do better this time. People often say “do the right thing” but it’s tough to know what that is and even tougher to do given all the variables in life and the fact that no one can see the future. A better plan in our minds is to set your priorities correctly and strictly adhere to the hierarchy you choose. By doing so you make it much more likely that you’ll do what is best for you and yours now and in the future. What is most important to you can only be determined by you. Here’s our chosen set of priorities in order just for an example:

  1. Family
  2. Friends 
  3. Free time/fitness
  4. Finances

Plan you ideal existence and make the practice fit into that instead of allowing work to engulf everything and rob you. The goal is to have a lifestyle practice not a practice lifestyle after all!