Make Your Money on the Buy, Not the Sell

Not long ago, I had a conversation with a young dentist preparing to purchase her first practice. She was sharp, motivated, and had clearly done her homework. But as we talked through her criteria for evaluating the opportunity, something became clear: she knew what she knew — and didn't yet know what she didn't know.

That gap is more common than most people realize. And it's not a reflection of intelligence. It's a reflection of training.

Dental school prepares you to be an exceptional caregiver. It does not prepare you to run a business. And yet, the moment you sign on the dotted line for a practice acquisition, you are no longer just a dentist. You are an entrepreneur — and that practice is your primary vehicle for building the life you want.

Many dentists I've worked with — five, ten, even twenty-five years into ownership — find themselves far from where they imagined they'd be. The reason is almost always the same: they mastered clinical dentistry and never fully developed the business and leadership skills that drive sustainable growth.

Without that foundation, it's easy to fall into familiar traps: chasing new patient volume through heavy marketing spend, signing up for more insurance plans to fill the schedule, or delegating business decisions entirely to an office manager without clear direction. When things slow down, the instinct is to look outward — blame the economy, the demographics, the competition — rather than inward at the systems and culture within the practice.

Here's what I know after more than three decades in this profession: there are practices thriving in every economy, in every market, in every demographic. The difference is almost never location. It's leadership.

The dentist I spoke with wanted to build a fee-for-service (FFS) practice and believed she needed to locate in an affluent, white-collar area to make it work. Her reasoning? The upscale practice where she worked as an associate had far fewer broken appointments than the other practice in a more modest neighborhood.

I smiled when she said that — because I was working at the time with a FFS practice in Greenwich, Connecticut, one of the wealthiest communities in the country. And one of the biggest challenges we faced there? Patients who regularly broke appointments because they considered themselves too busy and too important to prioritize dental care.

A broken appointment problem is rarely a demographics problem. It is almost always a communication and systems problem — and that is entirely within your control.

The same principle applies to the FFS model itself. I have worked with successful FFS practices in blue-collar communities, rural markets, and mid-sized cities. I have also worked with practices in affluent zip codes that struggled to hold onto patients. The determining factor, in every case, came down to the beliefs and communication skills of the team — not the income level of the surrounding neighborhood.

When I work with a dentist on a potential acquisition, I don't start with the financials. I start with them.

Before evaluating any opportunity, you need clarity on:

• Your life goals — career, family, lifestyle, financial — and the timeline you're working toward
• The kind of dentistry you want to practice — comprehensive care, esthetic, family, restorative, or a specific niche
• Your vision for your ideal day — your team, your patients, your pace

These aren't simple questions. They have layers, and they deserve real exploration with someone who can help you build what I call a life by design plan. Once that foundation is in place, the business questions follow naturally:

• What does your practice need to produce to support that life?
• What obstacles stand between where you are and where you want to be?
• Where are your entrepreneurial strengths — and where do you need support?

Only after those answers are clear does it make sense to evaluate specific opportunities.

Here's where the real leverage lives — and where most first-time buyers leave significant money on the table.

Consider two practices, both running at roughly 55% overhead:

• Practice A produces $700,000 annually and is listed at $500,000
• Practice B produces $450,000 annually and is listed at $275,000

On the surface, Practice A looks like the stronger investment. Higher revenue, higher income. But look closer.

If Practice B has untapped growth accelerators — underutilized hygiene, incomplete treatment plans, an underdeveloped recall system, or a team that hasn't been trained to present comprehensive care — it may be entirely realistic to bring that practice to $700,000 or more within the first year or two of ownership.

If that's the case, you've just acquired a $700,000 practice for the price of a $450,000 one. That $225,000 difference in purchase price represents nearly half the return on investment you'd be working to recover if you bought the more expensive practice — and it's money you never had to borrow in the first place.

There's an old saying in real estate: you make your money on the buy. The principle is identical here. The best investment isn't the one with the highest sticker price or the most impressive top-line revenue. It's the one with the strongest growth potential relative to what you pay for it.

When you buy well, you recover your initial investment faster and build wealth while you own the asset. When you buy poorly, profitability takes longer to reach — and some dentists never get there, spending their careers hoping to make it up when they eventually sell. That rarely works out the way they planned.

Practice acquisition is one of the most consequential decisions of a dentist's professional life. The financial stakes are high. The personal stakes are higher.

Working with an executive coach who understands both the business and the human side of that decision — someone whose job is to match the right practice to the right person, not just close a transaction — can mean the difference between a career that generates real wealth and one that generates real stress.

The goal isn't just a profitable practice. It's a practice that becomes the vehicle for the life you actually want to live: professionally fulfilling, financially rewarding, and meaningful to the patients and community you serve.

That starts with buying right.

Thinking about acquiring a practice or wondering whether your current practice is performing at its potential? Download the free Practice Profitability Audit Guide or book a strategy call with Liz to get a clear picture of where you stand.