Women in Dentistry: (Private) Practice Makes Perfect by Dr. Alexandra George

Editor's note:
For the second installment of our 2017 series about women in dentistry, Dentaltown magazine and Benco Dental's The Lucy Hobbs Project found an author who's been in practice for nearly 30 years: Dr. Alexandra S. George, who specializes in high-end cosmetic dentistry, implants and TMJ issues at her comprehensive dental practice in Pittsburgh.

A member of several dental associations, George often hosts seminars to inform dentists about TMJ common signs and symptoms, and for the past six years has been involved with Amachi as a mentor for children who have a parent who is incarcerated. George credits her success to the support of her husband, John, and daughters, Melina and Amalea, as well as her hard-working and dedicated dental team of hygienists.

To discover more about The Lucy Hobbs Project, which was created to help empower women in dentistry, visit thelucyhobbsproject.com.

We all have defining moments in our lives, and here's one I remember vividly: While I was in high school, my family was going through financial hardship, and my parents drilled into my head that I needed to get the type of education that would let me support my own family one day, if need be. I eventually decided to become a dentist because the career would let me help people, be my own boss, and still be a wife and a mother.

When I graduated from dental school in 1990, I was green and didn't know what was in store for my professional future. Fast-forward 27 years and my career has taken me though different stages. I bought a startup practice, built an office building to move that practice into and then built another office. I've learned five things along the way that are needed to operate a solo practice. Three of these are personal qualities: guts, a great work ethic, and the ability to grow and change. The other two are more business-specific—location and marketing.

Grit and determination
If I had gone by the proverbial book when it came to opening a practice, I should've gone in with a business plan, a consultant and some type of strategy. Consultants can be very knowledgeable, but my problem was the price tag. They came at a point when my pockets were empty—and in fact even had metaphorical holes in them, thanks to student loan debt. I had no choice but to identify and buy a practice myself, and that's just what I did. There wasn't any business strategy education in dental school, but my parents had taught me to listen to my gut.

I bought my first practice just eight months after I'd completed a general practice residency program, and I knew nothing about what would be necessary to run a business or which hurdles I'd have to overcome. I did know that I wanted to look for a practice that had been owned by a woman, because I believed it would be easier for me to fill her shoes than a man's. During an eight-month stint as an associate for an older, male dentist, I'd come up against too many patients who wouldn't believe me or my recommendations. If I suggested a crown for a tooth that had been patched 10 times already, I'd always have to ask the male doctor to back me up.

The practice that I bought had indeed been a woman's practice, but it was a satellite office with a measly 80 patients (and because the retention rate of existing patients was about 70 percent then, I ended up with closer to 50–55). I didn't have any money when I bought it and wasn't sure how I was going to manage this feat; all I had was a deep-down feeling that I could do it.

When the owner told me what she had valued the practice at, I asked if we could discuss how she came up with that price. (I thought she was off her rocker, but then again maybe it was me who was totally clueless!) I ended up buying the practice for one-third of her original asking price, and I asked her to be the bank for a year. I thought, "Why not? The worst thing she can say is no." She agreed.

I took one more leap of faith and requested that the money I paid to her in the first year be applied to the purchase of the property and the office building, which was a small old house. Again, she agreed. This may not have been the smartest way to approach a purchase of an office, but it made sense to me. I didn't even pay for an attorney—she paid her attorney and I signed the papers.

Sacrifices and sweat equity
I've had a job since I was 13. My grandparents were immigrants from Greece—my grandfather always used to say, "I work, I pay for," and that's the work ethic that I was raised understanding and emulating. Once the purchase of the practice was complete, we built out the basement to become an 800-square-foot apartment. My husband and I moved in, and four days later our first daughter was born. 

We needed to save as much money as possible to pay for our purchase. I knew I had to be available for patients to build my practice. I needed to be close to the office because I was everything in the office—the receptionist, the hygienist, the office manager, the assistant and even the cleaning lady! My family lived in the practice for three years, and in that time we saved enough money to buy property where we could eventually build our dream house.

When you purchase a practice, hard work and long hours should be expected. This is where a "balance," as many call it, comes into to play, but I looked at that balance as choices:

• I could choose to go home and get dinner, then go back and see more patients.
• I could choose not to schedule patients at certain times, so I could run and be the school lunch lady.
• I could choose to see patients at 6 a.m. on a Saturday, while the rest of my family was sleeping.

You must live with the choices you make. In my opinion, the simple equation "input equals output" holds true, and no career is worth losing time with your family. Other women at different stages of life might have completely opposite priorities, so they should make choices that help them live in a way that brings satisfaction and happiness, however it's defined.

Location, location, location
We've all heard the saying "location, location, location." Everything is about location—your house or apartment, your school, your shopping areas. How do you find the right one?

First, define what's important to you. That may sound elementary but it's a crucial task: Make a list of attributes to the area where you're considering opening a practice. Can you see yourself as part of the community—raising kids in the school district, etc.? For example, whenever I travel to a big city, it's difficult for me to visualize where the dentists' practices are actually sited, and the amount of competition is very strong.

• Would you prefer to set up practice in a large downtown office building, knowing that 100 other dentists may already be practicing nearby?
• Would you want to stay around your dental school and set up shop in an area where you like the comfortable surroundings? How many other dentists have had the same idea?
• How would you feel about venturing out to a part of the exurbs or the countryside, in an area where few other dentists have invaded?

I went to an area that I didn't know much about, other than that the school district was great and the potential growth was strong. I sat on the porch of my first practice and literally counted the cars and wondered where they were going. Lots of cars and not a lot of competing-dentist signs—that was the location for me. Most townships, cities or boroughs have traffic studies available. They know which roads are highly traveled, and which development sites are in the planning stages and could be destinations that families could drive by every day.

Marketing values
With the average school loan debt being $200,000 or more, you might have little or no budget available for marketing, but it's essential to market your business if nobody knows you even exist. Your signage may take up your entire marketing budget at first, so make sure your logo is simple and eye-catching, so people can catch a glimpse of it from the street. You'll also need a website and a Facebook Business page to help potential patients find you online; Twitter and Instagram feeds are additional marketing avenues to explore. In less-populated areas, radio or TV may be a financial possibility because advertising rates drop according to the number of viewers in the market.

The laws of evolution
As the years have passed, my practice has grown and changed as some of my clinical philosophies have evolved from what I was taught back in dental school.

• For the past seven years, I've been a fee-for-service office.
• I employ only hygienists who are cross-trained and can rotate positions.
• The ability to attend continuing education and implement changes in thoughts or procedures is crucial. Always be a student!

Stepping out of your comfort zone is the only way to keep growing! Technologies need to be embraced, updates need to be made and new concepts should be entertained.

A few final thoughts

• When you're ready to start your own practice, don't be afraid or intimidated about starting conversations with prospective sellers. Ideas need to be cultivated, and no matter how silly you think a question might be, it still needs to be asked.
• Realistic expectations and goals should be monitored—and adjusted, when appropriate. The reality is, you can't jump into the same income bracket and have the same level of knowledge that someone who's been practicing for 27 years has. You'll have to pay your dues, and there will be struggles, challenges and mistakes along the way. But if you don't reach for your dream, you'll never be able to touch it!

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