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JADA, Vol. 134, February 2003 241

Most of us have hadto start a dental

practice at leastonce in our

career. Some havemoved from one location to

another and had to initiate asecond or third practice, often in

their mature years. Because of my early involvement in full-

time dental education, and even-tually in delivering private con-

tinuing education andconducting research, I have had

to initiate four separate dentalpractices during my career. The

title of this article appears toindicate that I have the answer

to the formidable question of how best to initiate a dental

practice; I admit I do not havethe answer for all dentists, but Imay have some help for those

starting a practice.During my career, I havedpracticed in the office of another dentist without being a

formal associate;dpurchased the practice of

another dentist who hadrecently died;dstarted two new practices

without any association withanother dentist;

dpracticed with peer dentistswho were not associates, and

who did not share in the profits;dhad several young dentists,

one at a time, work asemployees in my practice;

dhad a profit-sharing associate

dentist work in my practice;

dsold a practice and remainedin the practice as a subordinate

to the purchaser;dwatched two sons and one

son-in-law go through thepainful initiation of a dental or

dental specialty practice.This article expresses my

opinions on starting a practice,including the advantages and

disadvantages of the variousways from the vantage point of the person attempting to start

the practice. Next month’sarticle will express my views

from the standpoint of the den-tist looking for an associate or

planning to sell a practice.

STARTING A PRACTICE

YOURSELF

Every dentist initiating a new

practice, whether neophyte orexperienced, has visions of

patients flocking to his or hernew practice, just because the

doors were opened and thenewspaper had an announce-

ment about the new practice.Such has not been the case in

either of the practices I havestarted myself.

Advantages of starting a newpractice yourself:

dThe geographic location of your practice is your decision.

d You may incorporate anyideas, concepts, philosophies of

practice or techniques youprefer.

d You may have a new facilityor old facility, and you may plan

it, build it or remodel it to meetyour needs.d Your employees are the

people of your choice.d You are the boss.

Disadvantages of starting anew practice yourself:d You need to obtain a majoramount of money or a large

loan.d Your trusting family may be

your only initial patients. Build-

The best way to initiate a dental practice

OBSERVATIONS GORDON J. CHRISTENSEN, D.D.S., M.S.D., Ph.D.

Copyright ©2003 American Dental Association. All rights reserved.

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242 JADA, Vol. 134, February 2003

ing a patient base requires sev-

eral years and diligent effort on

the part of everyone in the

practice.

dThere is no assurance that the

initial practice income will keepup with the financial outgo need.

In my personal experience,

and after observing many new

practices, a typical new practice

requires about five years to

mature financially. Your spouse

and family should be made

aware that the first few years

might not meet their financial

expectations.

BUYING THE PRACTICEOF AND TEMPORARILY

WORKING WITH A RETIRING

DENTIST

Purchasing a retiring dentist’s

practice and working with him

or her for a temporary transition

period sounds like a real

winner. However, be aware of

both the advantages and the

disadvantages.

Among the advantages:

d You have immediate income.dThe facility and the equip-

ment are functional.

d You do not have to plan an

office or be creative at the begin-

ning of the practice experience.

d You have patients to treat

immediately.

dThe change from your pre-

vious professional activities

(school or another practice) is

not a major shock.

Among the disadvantages:dThe patients are devoted to

the previous owner of the prac-

tice, and you must make a posi-

tive impression with them to

gain their confidence and keep

them in the practice.

dThe previous owner may con-

tinue to treat the desirable

patients while he or she is still

in the practice, limiting your

income and productivity.

dThe employees are devoted to

the previous owner.

dThe equipment may be old

and out of date, requiring an

outlay of money as soon as the

previous owner leaves.dThe building may be old and

in need of repair, or in a geo-

graphic location that is not your

choice.

dThe previous dentist’s work

may have been of a different

level of quality than you want

to have in the practice,

and the staff will have to be

re-educated.

dThe previous dentist may

want to fund a retirement pro-gram from your payments for the

practice, and the cost may be

high for you.

dThe previous owner may want

to stay longer than originally

planned, and it may be difficult

to take over the practice at the

agreed time. I have seen this

happen several times, and the

buyer remains with all of the

disadvantages of this type of

practice and few of the advan-tages until the previous owner

leaves.

BUYING THE PRACTICE OF

A RETIRING DENTIST WHO

LEAVES IMMEDIATELY

Buying a practice from a dentist

who immediately vacates the

practice may sound negative for

a few reasons, but it has some

distinct advantages.

Among the advantages:d You have immediate income.

d You have only minimal plan-

ning needs to start the practice.

dThe facility and the equip-

ment are functional.

d You do not have to be creative

at the beginning of the practice

experience.

d You have patients to treat

immediately.

dThe change from your pre-

vious professional activities

(school or another practice) is not

a major shock.

dThe previous dentist is out of

the office, eliminating many of

the disadvantages listed for theabove situation, in which the

previous dentist stayed in the

office for a time.

Among the disadvantages:

dThe patients are devoted to

the previous owner of the prac-

tice, and you must make a posi-

tive impression with them to

gain their confidence. A signifi-

cant percentage of them will

leave the practice and go to

another practice. If the previousdentist remains in the practice

for a while to introduce you,

more of the patients probably

will stay with you.

dThe employees are devoted to

the previous owner, and you

must prove yourself to them or

replace them. If there is any

question about your compati-

bility with specific employees,

they should be replaced on your

entry into the practice.dThe equipment may be old

and out of date, requiring an

outlay of money as soon as you

take over the practice.

dThe building may be older and

in need of repair, or in a geo-

graphic location that is not your

choice.

dThe work of the previous den-

tist may have been of a very dif-

ferent level of quality than you

prefer to have in your practice,and your new staff will have to

be re-educated.

dThe previous dentist will want

to fund a retirement program

from your payments for the prac-

tice, and the monthly cost might

be high.

DISCUSSION

There is not a single way to start

a dental practice that is the best

C H R I S T E N S E N


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for everyone.

Each situation

is different, and

each practi-

tioner has to

make his or herown decision

about the best

way for him or

her.

In my

opinion, if you

have financial

backing and do

not mind

working very

hard for a

while, my pref-

erence would be to start a new

practice. However, this mode of

starting a practice is not the one

chosen by most dentists.

If I were buying an ongoing

practice, I would prefer to havethe previous owner leave as soon

as possible, preferably immedi-

ately on my entry into the prac-

tice. I would accept the loss of

some patients to have the inde-

pendence of administering the

practice and putting my own

ideas into it as soon as possible.

CONCLUSION

There is not a “best” way to ini-

tiate a practice. Each circum-

stance is different, and there are

advantages and disadvantages

for each mode for practice initia-

tion. My experiences may assist

those considering initiating or

purchasing a dental practice. s

The views expressed are those of the authorand do not necessarily reflect the opinions orofficial policies of the American Dental Association.

Educational information on topics discussedby Dr. Christensen in this article is availablethrough Practical Clinical Courses and can beobtained by calling 1-800-223-6569.

JADA, Vol. 134, February 2003 243

C H R I S T E N S E N

Dr. Christensen is co-

founder and senior

consultant of Clinical

Research Associates,

3707 N. Canyon Road,

Suite No. 3D, Provo,

Utah 84604, and is a

member of JADA’s edi-

torial board. He has a

master’s degree in

restorative dentistry

and a doctorate in edu-

cation and psychology.

He is board-certified in

prosthodontics. Ad-

dress reprint requests

to Dr. Christensen.


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