(Your Own) Practice, Made Perfect

From Scratch: A Guide on Starting a Practice

Chonway Tram, DDS
Townie name online: chon2617
Rancho Cucamonga, California

If you could go back and do something differently during the startup process, what would it be?
Not hiring a consultant right away. Most consultants deal with practices in transition, and with startups you’ll have a lot of time in the beginning to deal with aspects of marketing and system building.

What was biggest challenge you faced in starting up a practice?
The most daunting aspect is having a zero patient base and growing it. Other than that, hiring and training the staff who will see your vision and execute your plan for the office is the next-hardest thing.

What’s one piece of advice for a dentist about to start a new practice?
Don’t pay in advance for anything that relates to construction or interior design. Spread the payments throughout the buildout, until the work is done and you are happy with it. Also, know your demographic. If your demographic target is younger, advertising dentures doesn’t mean much.

What were the top products or services you used or discovered when starting up your practice?

• Patientpop.com. Website creation and SEO management.
• E4D/Planmeca. System for crowns in a day. Adds to the technology and cool factors.
• Six Month Smiles, Clear Correct or Invisalign. Broaden your scope of practice.
• Open Dental. Cheap, easy to use and customizable.
• Breakaway Seminars. Needs no introduction, but super helpful in systems building.

Scott Leune, DDS
Townie name online: Scott Leune, DDS
San Antonio, Texas

If you could go back and do something differently during the startup process, what would it be?
Be more disciplined in setting up the proper business systems and staff management and organization on Day 1. This requires deeper learning, more time spent initially and much more auditing at the start of the practice.

What challenges do you see as consulting clients start up their practices?
I see challenges on both extremes—of a slow opening or a fast opening. A slow opening has the big challenge of pumping up new patient flow, getting higher case acceptance and increasing patient retention...all while delicately balancing the need to spend with the need to save working capital. This is a very tough emotional game, and most dentists may not have all of the experience or information needed to navigate this properly.

On the flip side, a fast opening presents other harsh challenges in staff management and expansion, patient retention and, most importantly, profitability. Fast-growing startups typically have expenses rising very quickly. Unless they maintain their operations and capacity well enough to take advantage of this demand, some of these startups can end up in financial binds. It takes a disciplined approach to grow quickly while maintaining quality relations and profitability.

What’s one piece of advice for a dentist about to start a new practice?
Learn from those who’ve been part of a large volume of startups; track everything and actually act on the results; never stop auditing your team; and know what to expect financially. If the game is played properly, a startup practice can be a very lucrative and enjoyable long-term success, but at the price of short-term work and initial losses.

What were the top products or services you used or discovered when starting up your practice?

• Henry Schein. To help oversee the equipment setup and install.
• Tip-Out bins. Properly organize our inventory control system.
• Dental Vibe. Enhanced patient comfort.
• Lumadent headlights.
• Star NuTorque electric handpieces.

Puneet Aulakh, DDS
Townie name online: ppsaul
Bellevue, Washington

If you could go back and do something differently during the startup process, what would it be?
I spent too much on the buildout, equipment and supplies. As a new startup, you don’t need a lot of inventory and you shouldn’t buy in bulk, because you don’t know how much you will be using. As far as building out, you need a practical office. Don’t try to build a palace; save the palace for when your practice is more mature and you’re moving or buying a building.

What’s one piece of advice for a dentist about to start a new practice?
Don’t lose sight of the big picture—you’re building for the long term. Each day is an opportunity to learn. If the schedule has holes, practice your interpersonal skills. Experiment with dialogue, jokes and explanations on how you do things. Don’t be discouraged. Take every experience and setback and look at it as an opportunity on how to improve yourself. For example, if an extraction took two hours, ask yourself how you can improve next time, how you would approach it differently, and what you’d tell the patient to calm their nerves.

What were the top products or services you used or discovered when starting up your practice?

• Dentaltown. No explanation needed. You have questions, Dentaltown has answers.
• STA. Painless anesthesia. It has helped me so much with children and adults who are nervous and scared.
• DSLR camera. The hardest part when a new patient comes in the door is building trust. I take a complete set of intraoral pictures and go over those pictures with the patient. After you blow up the tooth 30 times bigger, there’s not much explaining to do. Using a camera makes you a better dentist, too: You’ll make sure you do the best work you can, because patients will request to see the before-and-after photos. You also compile a portfolio of before-and-afters (composites, RCT, crowns, veneers, ortho, etc.) that makes discussing treatment with patients easier.
• Tucker study club. Dr Richard Tucker Sr. was my mentor in Tucker Gold study club for four years. The professionalism and attention to detail he put in his work was inspiring. Because of him I strived to become a better dentist. When asked, given all his accomplishments, what he wanted to be remembered for, he said, “I want to be known as a good dentist.” He will be dearly missed.
• Triodent. The V3 rings and sectional matrix bands make our bread-and-butter dentistry, the Class II restorations, so much better.
• AGD. Continuing education, knowledge and mentorship. The most important thing I did was to join the Mastertrack group that the WAGD had setup. The continuing education I received allowed me to become a complete general dentist.
• Ebay.

Tuan Pham
Townie name online: fliegenfischen
Austin, Texas

If you could go back and do something differently during the startup process, what would it be?
I’d focus on both new patient rate and attrition rate. If you can grow fast (especially in an area where you’re the first) you can plant and establish roots. To do so requires growth and retention of patients. Too many docs, including myself, focus only on new patients early on, not retention. It is the net growth of patients that contributes to planting roots and long-term growth and dominance.

What was biggest challenge you faced in starting up a practice?
The fear of not knowing. When one has so much at stake and such large loans looming, it’s easy to question yourself and doubt if you can do it. Everyone has these moments where you want to give up. Fear will challenge your confidence and cause many docs to change their goals. The answer to this is research and learning as much as you can to be prepared. Success does not occur because of luck; it occurs because of planning and knowledge.

What’s one piece of advice for a dentist about to start a new practice?
Truly know and understand how you want to practice. You must know your ultimate practice philosophy. If you don’t know what your ultimate goal and vision are, every decision that you make in the interim—demographics, office layout, advertising, decision to be in or out of network, hiring, management, etc.—will be unfocused and hold you back from reaching your goals.

Know for yourself what you want in life, then make decisions that hone you toward that goal.

What were the top products or services you used or discovered when starting up your practice?

• Open Dental.
• Sirona CEREC.
• Design Ergonomics for office design/products.
• Isolite Systems.
• RGP chairs.

Trent McCord
Townie name online: hogtooth
Centerton, Arkansas

If you could go back and do something differently during the startup process, what would it be?
Being only a few weeks away from opening, I wish I had spent more time in the past year getting to know other businesses in my community and getting the word out about my office. Now that I’m about to open, my to-do list is a mile long and it will be hard to get to know my neighbors in my community. I should have made it a point months ago to get out and visit one new business each week.

What was biggest challenge you faced in starting up a practice?
The biggest challenge for me was making the decision. Starting up is a lot of work, a lot of money and a lot of risk. Initially I wrote off a startup as something I couldn’t do, something I wouldn’t be able to handle. I was pretty torn for a while about doing it and stressed out, but after making the decision I’ve been all-in. But making that decision was tough.

What’s one piece of advice for a dentist about to start a new practice?
Begin with the end in mind. Write out your goals, what you want out of this profession and your career. Take some time with this and put it on paper. Once you know what you want, then start planning and looking for a place that will help you get there. That may be a startup. That may be an acquisition, a partnership or a long-term associateship or corporate job. If you have a family, talk to them and make sure your vision lines up with theirs, and that they’re on board for such an adventure.

Gather as much information as possible to help you make your decision, then just dive in and spend some time daily thinking about your goals (so you don’t lose sight of the big picture and go crazy).

What were the top products or services you used or discovered when starting up your practice?

• Dentaltown. Check out all the startup threads. Read anything by Scott Leune or Graham Dersley. So many people giving great value on there for free. In addition, lots of people presenting arguments on why not to startup. It’s good to see it from all sides.
• Breakaway Practice Seminars. Without this course, I doubt I’d be doing a startup right now. Just do it.
• Practice on Fire Mastermind. Just a group of us docs going through startups and acquisitions. Been amazing to always be in contact with others going through the same thing. Unlock the PPO. I didn’t have to do much for insurance credentialing, and they made it easy and negotiated better rates for me. No-brainer.
• Craigslist. I’m not kidding. I’ve been able to acquire most of my equipment for pennies off Craigslist. It’s been awesome.

At Your Service(s)

A special thanks to Benco Dental for allowing Dentaltown to use a portion of its “Independence Guide: Setting Up Your Dental Practice.”

In addition to the guide, Benco offers several service resources to help dental practices run smoothly, including these four Practice GPS solutions.

• Communicator: Exclusive ReachAll Dental Recall can help increase patient loyalty and retention, and creates new appointments by making sure you reach 100 percent of your patients. Automated appointment reminders reduce no-shows.
• Marketer: Obtain new patients and increase website traffic. Develop your brand presence with a professional designed responsive website, and increase brand awareness with My Practice TV and treatment acceptance with patient education videos.
• Navigator: A real-time dashboard gives you access to your practice’s key performance indicators and reports. Actionable solutions can improve productivity and profitability in your office. Insurance reviews and fee analysis for your office are available at a click of a mouse.
• Recruiter: A web-based hiring system advertises your openings to Internet job boards and provides you with an applicant processing system that scores and filters all incoming applicants.

For more information about these services, visit practicegps.com or benco.com.