Office Visit: Dr. Rami Salha by Sam Mittelsteadt, editor & creative director

Office Visit: Dr. Rami Salha 
by Sam Mittelsteadt, editor and creative director
photography by John Vicory

Dentists spend most of their working hours inside their own practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of how they practice.

After a few years of working in public health and as an associate in a private practice, this young Townie purchased his own dental practice in Seattle’s funky uptown Capitol Hill neighborhood in August 2020. “I’d walked by [the practice] a million times and thought, ‘I would love to own this someday,’ ” Dr. Rami Salha recalls, and he placed his offer the same weekend he toured the facility.

There was a steep learning curve involved before Salha could actually take ownership of the practice, however: The next few weeks became a virtual crash course in business plans, balance sheets and bank rejections. Luckily, the sixth bank he approached agreed to finance the purchase, which let him focus next on transforming the practice aesthetic into something that blended with Capitol Hill’s neighboring cafes and shops. Paintings by local artists hang on the operatory walls and are available for sale gallery-style, while Salha stocked the entry with vintage furniture, plenty of live plants and personal collections to make it feel more like a living room than a waiting room.

In our exclusive Q&A, he discusses what younger dentists can do to be taken more seriously by peers and patients, the expanding role of Botox and fillers in a dental practice, and the biggest rewards and challenges of striking out on your own.

Office Highlights

Dr. Rami Salha

Graduated from:
University of Washington: Bachelor’s degree in biochemistry, 2013

University of Washington School of Dentistry: Doctor of Dental Surgery, 2017

NYU Langone Hospitals: Advanced education in general dentistry, 2018

Capitol Hill-Montlake Dentistry,

Practice size:
1,800 square feet
5 treatment chairs
Averaging 40 new patients a month

Team size:
1 doctor
1 office manager
1 scheduling coordinator
1–2 hygienists
2 assistants

How did you first decide to pursue a career in dentistry? What drew you to the field?

I shadowed my uncle, who’s a dentist in Washington, D.C., right after I graduated from high school. After that, I knew I wanted to be a dentist no matter what it took to get there. After choosing dentistry, I spent hundreds of hours shadowing in dental offices of different specialties and volunteering at community service organizations. The combination of serving others, working with my hands and the prospect of owning my own business drew me to the field. I never wanted a traditional desk job and feel lucky because I am genuinely passionate about the work I do. One of the most rewarding and surprising aspects of my practice is that I get to utilize all of my skills and interests on a daily basis. Dentistry has allowed me to explore my creative side, whether through taking before-and-after pictures or counseling a patient through a procedure.

What was your first job after graduating from dental school?

I became a dentist! I got my advanced education in general dentistry (AEGD) through NYU Langone hospitals. I worked at a public health clinic in South Seattle Monday through Thursday and moonlighted at a private practice Fridays and Saturdays. During this time, I had the best of both worlds—mentorship in a safe learning environment, coupled with real-world, multidoctor, private practice experience. At the public health clinic, I performed hundreds of extractions, which made me extremely comfortable with exodontia and surgery in general. I also completed hundreds of restorations and was forced to get my speed up. I was lucky to work with dentists who truly supported my development and gave me the opportunity to hone my skills.

At your next job, as an associate in private practice, you were the only doctor in the building. Is it hard for younger dentists to be taken seriously?

This job was extremely influential to me because I had a strong group around me who had been in the field much longer than I had. Being surrounded by such an experienced team provided me with exceptional support and helped mold me into the dentist that I am today. However, my experience with the group taught me more than just the skills I needed to have to be a good dentist; I also learned how to provide confident and compassionate care to all patients, and also give patients confidence in our office and in me. Without the support and mentorship of that team, I don’t think I would have had the confidence to make the leap into practice ownership—at least not this early.

Another major key in gaining patients’ trust is communication: When you’re able to tell people what you’re doing and why, it gives patients much more trust in you as a provider. I would rather overexplain than underexplain. Obviously you don’t want to bog the patient down with too much dental lingo, but you gain a patient’s trust by helping them understand what you’re doing. Lastly, if you are sincerely considerate for the health, well-being and appearance of your patients, they recognize that.

When you’re not working alongside a doctor with more experience, how do you improve your skills and seek out mentorship?

I think it’s important to utilize all avenues to continue advancing your skills, both in person and online. I am a member of two different study clubs with dentists who collectively have hundreds of years of experience. The meetings are always informative and truly interesting. At home I spend time on Dentaltown, Dental XP and YouTube (not to learn procedures but to learn different techniques) and listen to dental and business podcasts.

I’ve also surprisingly learned a lot from Instagram. Never underestimate the power of social media! There are such diverse groups of providers online who share their knowledge every day. It has been great to follow and connect with dentists who I respect around the world. In particular, I’ve been enjoying following @dr_bedrossian, @dr_miguel_ortiz and @rizalrizkyakbar, to name a few.

How did you decide it was time to venture out on your own?

It had always been a dream of mine to own a practice in the city, but I never thought it would be an option at such a young age. While working as an associate, I was consistently monitoring the local practice broker website to gain an understanding of practice valuations. Then the pandemic hit.

I stopped my search for about six months until I randomly decided to check the broker website. I found an office only four minutes from my house—a practice I’d walked by a million times and thought, “I would love to own this someday.” I saw the ad on a Friday, toured the office on a Sunday and made my offer on Sunday night. It all happened so fast; it was hard to overanalyze things. So, I purchased an office in the middle of a pandemic and haven’t looked back since.

Were banks eager to finance the venture of a young dentist in the middle of a pandemic?

Risk-averse banks eager to finance the venture of a young dentist in the middle of a global pandemic? Not a chance.

I was denied by five banks and realized I would have to get creative to receive financing. Banks had asked for a business plan, but I’d never taken a business class in my life. What is this mythical business plan they were speaking of? So I had to do some research on what a business plan looked like, the terminology, what a profit-and-loss statement and balance sheet were, etc. I put together a business plan outlining my production potential and compared that to the current production at the office I was trying to buy. After revisiting the problem from a different perspective, the sixth bank I spoke to finally agreed to finance the sale—but only at 80%; the seller had to carry 20%. In hindsight, I might have asked the seller to think about carrying earlier on.

One of the first things you worked on was renovating the waiting room—and the “vibe” of the entire office, to make it fit in with the Capitol Hill neighborhood. Tell us more about that.

The idea going in was to break the mold of what people think a dental office looks and feels like. A dental office is a scary place for many people. The high-pitched sounds and the sterile smells can evoke a visceral feeling of anxiety for many patients, whether they realize it or not. My goal was to transform the office, especially the waiting room, into more of a living room space as compared to a dental office. I wanted patients to feel calm and comfortable from the moment they walked through the door.

I took inspiration from our neighborhood. Capitol Hill, especially 19th Avenue, is a community-focused urban neighborhood. I’ve always loved the design and feel of the local shops and cafes and wanted the dental office to feel like an extension of the neighborhood, instead of a sore-thumb health care facility. Plants are just about as calming and soothing as it gets, and I genuinely enjoy caring for plants, so I started there and used plants as a template for the interior design. Then I brightened up the walls to provide a more inviting atmosphere. I am lucky enough to have an amazing group of friends who spent a few days at the office painting and helping with the remodel.

For the furniture and decor, I spent a lot of time on Craigslist, OfferUp, thrift shops and consignment stores. The right furniture and decor is essential in achieving the desired aesthetic, and I learned it takes time to find the right pieces. The benefit of going to thrift stores or using OfferUp was that I didn’t break the bank during the transformation. It took a little extra time but was very worth it in the end, both from a financial perspective and a visual one.

I also wanted to incorporate some of myself in the design and office vibe. I really like photography, art and music. I’ve started to collect vintage cameras and have displayed my collection in the waiting room. This has become a fun conversation starter with patients and some have even donated their early 20th-century cameras to the collection. Music is another passion of mine. We keep it fun with the music we play at the office and don’t just play the same old radio Top 40 hits. We even play disco music on Thursdays to celebrate the end of the week!

Those first months must have been exciting— but also exhausting.

To be honest, they were some of the hardest few months of my life. Practice transitions are tough, let alone in the middle of a pandemic. There was so much I didn’t think about when I was about to purchase the practice. Not only do you have to manage a new group of employees—again, with no prior business or management experience—meet 15 to 20 new people a day and still practice dentistry, but there also are so many other little things you don’t think about. Contacting insurance companies, changing software licenses, phone, internet, learning bookkeeping, running payroll, etc., all take time out of the day that you don’t have. I spent many 14-plus-hour days at the office during the first few months.

That being said, they really were some of the most exciting months of my life. I finally had my own business and was going to do whatever it took to make it a success. Failing was never an option and that lit a fire inside me I hadn’t felt before. I also had a strong support system around me to help me through those times. I had a knowledgeable practice consultant and we clicked perfectly; she was such an amazing resource during that time. Interestingly enough, she is now my office manager and has taken our office to a new level!

What was the patient response after you took over as the sole dentist?

The office didn’t have a large enough patient base to handle a transition period where both of us could practice, so one day I just picked up where the previous doctor left off.

But overall, I’d say the patients were very accepting of a new face. From a patient’s perspective, when your dentist hits his 60s, you assume he’ll be retiring at some point in the future—you just don’t know when. I understood it would take time for patients to accept a new provider and I tried to be conscious of the relationships he had built over his 30-plus years in practice.

There are always a few patients who are skeptical. One patient even told me, “I was told to watch out for young dentists because they have so much student debt and pay it off by finding problems in your mouth.” Instead of just telling her that wasn’t how I practiced dentistry, I showed her: I gained her trust over the course of the next few months and now she is one of my favorite patients. Dentistry is special like that. It isn’t just working on someone’s mouth, it’s a unique blend of health care and relationship-building.

What do you credit for your practice’s growth?

Communication, honesty and genuine care for others have been integral in growing my office. I really take the time to explain things to patients and don’t rush them in and out the door. I want everyone to leave the office feeling like they understand what’s going on with their health, have all their questions answered and are on board with a treatment plan they understand.

On top of that, I genuinely care for my patients and get excited to see them. I try to go the extra mile by giving every patient access to my personal cellphone; I call patients after hours to make sure they’re doing OK after a tough procedure or surgery and leave myself available day and night for questions or support. Also, I try to keep things light. Never underestimate the power of a good “dad joke”! A laugh can go a long way in reducing anxiety and can make the experience more manageable.

On top of all the social considerations, it’s still important to be a competent provider. Know what you’re good at and know when to refer. I have no problem telling a patient they’d be better suited getting treatment from a specialist. At the end of the day, I want my patients to receive the best care, whether that’s from me or one of my amazing colleagues.

I do my best to treat patients as if they are my family. Because of this, I haven’t spent a dollar on advertising and have almost doubled our patient base, with approximately 650 new patients since I bought the office in August 2020.

Top Products

iTero digital scanner. Not only has this set us apart as a technologically advanced office but it also has given me an irreplaceable visual aid for patient education. Every new patient gets a “wellness scan” that creates a study model of their mouth so they can see exactly what I’m seeing, in real time. We seldom take traditional impressions anymore and use the scanner for all our crowns, Invisalign cases, etc.

MouthWatch intraoral camera. Along with the digital scanner, intraoral photos are an integral part of patient education. As dentists, I think we often get too technical in our explanations. A photo is a great way to quickly show a patient what you are seeing, and acts as a visual aid to help them understand what’s going on in their mouth and what needs to be done to remedy a given situation.

Botox and dermal fillers. Injectables have helped us stay competitive in the cosmetic realm and provide treatment options for patients who need pain relief and those looking for aesthetic enhancements. My patients with TMJD have especially been thankful for the relief from Botox treatment.

Canon EOS 5D Mark III camera with Canon RF 100mm f/2.8L macro IS USM lens. This is a dream setup that has been worth its weight in gold. High-quality dental photography sets us apart and allows us to showcase our beautiful before-and-after cases. Being able to share our successes helps us communicate treatment expectations and cosmetic possibilities with patients.

Diode laser. As I continue to practice, I find myself using the laser more and more. Deep margins on crown preps tend to be the kryptonite of any digital scanner. The laser helps you visualize the margin without heme or saliva getting in the way. If you don’t have one, get one.

“Photo booth” with Neewer 400W photo studio strobe flash. Creating a photo booth in the office has allowed us to reach the full potential of dental photography. My office has limited space, so we repurposed an 8-by-6-foot pano room and turned it into a mini photo booth. This is where I take both my intraoral and portrait shots for before/afters. The quality of the images is unparalleled, and the best part is, it was only a few hundred dollars for the setup. I’ve learned you don’t have to break the bank to obtain studio-quality photos.

Do you have a favorite case story?
Office Visit: Dr. Rami Salha

I’ve got two! The first (Fig. 1) is a close friend of mine who’s getting married in October and wanted to enhance the appearance of his teeth before the wedding. His chief concern was the shade and height of his teeth, and his health/dental history was unremarkable. I opened his vertical dimension of occlusion and treated him with 12 lithium disilicate veneers on the maxilla and a mixture of six veneers and eight lithium disilicate crowns on the mandible to improve the proportions and dimensions of his teeth. He couldn’t be happier with the smile transformation and is very much looking forward to his wedding photos.

Office Visit: Dr. Rami Salha The patient in the second case (Fig. 2) didn’t have access to dental care earlier in his life and a previous provider had placed silver diamine fluoride (SDF) on his teeth to arrest the cervical decay. The patient was very self-conscious of the dark staining left from the SDF, but really wanted to feel comfortable smiling again. After stabilizing his periodontal health, we treated him with eight full-coverage crowns on the maxilla. Luckily for us, the SDF had done its job and while the build-ups were extensive, none of his teeth required endodontic therapy. I used a diode laser on #7 and #10 to apically position the gingival zenith and give him a fuller smile. He was speechless when he saw the results and was very thankful for what dentistry was able to provide him.

What has been the biggest reward of owning your own practice?

The biggest reward is the sense of community I feel here and the connections I’ve made with my patients. One of my favorite aspects of being a dentist is the relationships you develop with different individuals from different walks of life. I truly love my patients and the time I’ve spent with them over the past two years.

Another exciting reward is how quickly our office flourished. To go from banks not being willing to finance the loan to a thriving office in a short period of time feels really great. It makes all the hard work worthwhile.

And the biggest challenge?

Like so many other businesses, staffing has been a huge challenge. We are at a point where we need more employees to sustain our growth, but are having a difficult time finding folks. We are fortunate in that we’ve been getting a high quantity of new patients and even though that is any business owner’s dream, finding enough staff to serve a larger patient base has been a real challenge.

That being said, I feel fortunate to have the team I do! They’ve been a solid backbone during this journey and though it took a few iterations, I am so proud of our team.

What are you looking forward to in practice in the next year or so?

I’m most looking forward to expanding the aesthetic side of my practice. I’ve been taking a lot of continuing education courses for aesthetic dentistry and injectables, and I’ve been able to learn cosmetics from top doctors in the country. The cases that I’ve done so far have truly changed people’s lives. They speak more confidently, smile more often and just seem to have a better outlook on life. I’m very much looking forward to more education and honing my skills.

We are also in the process of looking for an associate dentist, which I’m really excited about. I love the idea of working side by side with another dentist. There is so much to learn in dentistry; what better way to do that than from a colleague working with you?

Outside of the office, what are you up to?

I am lucky to be surrounded by an amazing group of friends and loved ones. There’s always something going on in our friend group, whether it’s social gatherings, dinners, boating, etc., so I’m always tied up with one thing or another. I try to live an active lifestyle and go to the gym regularly. When I’m not doing those things, I travel quite a bit. So far this year, I’ve taken trips to Portland, Chicago, Charleston, S.C., and bounced around Europe.

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