An Ownership New Year’s Resolution
By Michael Dinsio, Next Level Consultants
As a buyers’ representative and business coach, I talk to hundreds of doctors a year. Many themes emerge from these conversations, but the one that pains me the most is hearing how dentists delay considering practice ownership early in their career. Many desire ownership and watch as friends become owners with a thought of maybe someday. But, for themselves, they hope and wait till the “perfect” situation presents itself, if it ever does. As we roll into the new year, my hope is that more doctors get off the bench and into the game. The time for ownership is right now. Here is why.
#1 MONEY is Cheap
As once a dental specific banker, I can tell you interest rates have never been lower. With rates as low as sub 4% on 15 year practice loans, the cost of money is cheap for buyers. What does this mean? Lower payments equal more cash flow. Even with practices being priced higher than historical averages, lower payments offset the cost to make the purchase affordable. The lower payments also allow buyers to invest in new equipment, stronger marketing, and consulting services to set them up for success. These types of investments help buyers confidently take the leap into ownership!
#2 The Market is Primed
For over a decade, industry experts have predicted a slowdown of practice sales. Fortunately for the 25,000+ graduating dentists every year, this has not been the case. I predict that in 2020 more dentists will put their practices up for sale than ever before. Here’s why.
First, in 2020 the average age of the baby boomer generation will hit 65 and they become eligible for Normal Retirement Age (NRA) benefits. As their retirement benefits start to roll in, many will consider selling their successful practices.
Secondly, the stock market is at an all-time high. Last month the market hit another peak, as investors focus on the progress of the U.S.-China trade talks. Overall the Federal Reserve is upbeat and continues to keep interest rates low. For those retiring baby boomers, this means they can comfortably retire with the nest egg they have, not feel pressured to keep working.
Lastly, Washington State continues to increase taxes. Although a capital gains tax has been voted down, it continues to be an annual discussion in Olympia. New and expanding taxes are always a threat. Kitsap Daily News reported that, “Washington is one of seven states with no state income tax, and one of nine without a capital gains tax, making it an outlier among West Coast states.” Governor Jay Inslee released a three-year plan that contained a proposed 9 percent tax on certain capital gains over $25,000. Sellers may have dodged a bullet this time, but many owners will consider selling sooner to avoid the looming threat of higher taxes.
#3 TIME is valuable
It’s not a secret that small investments over the long term will yield more than large investments over the short term. In short, time is on your side. Working as an associate definitely has some benefits. The corporates make sure of that. With that said, the ownership opportunity dentists have in front of them is difficult to quantify. Just like a mutual fund or a piece of property, dental offices have real value. When my clients choose ownership, they are not only benefiting paycheck to paycheck, but they are also building real value in an asset to sell in the future.
I recently had coffee with a dentist and an old friend. In 2012, when I first met her, she was considering buying an office. I remember the first practice she looked at: it was in a desirable location, the equipment was in good shape and the financials were average. Despite my recommendation to buy, she ultimately passed on the opportunity.
When we sat down, she was so excited to tell me that she just received news of an accepted letter of intent to purchase her first practice. While I’m excited for her, the delay of 8 years got me thinking. If she had purchased in 2012, by now her initial loan would have likely been paid off and her business would most likely have surpassed a million in revenue. Eight years of lost income and equity over trying to find “the perfect practice.”
As a New Year’s Resolution, resolve to take your career into your own hands. The average associate struggles to make ends meet juggling two to three associate positions. For all that hard work, their income ranges anywhere from $120,000 to $150,000 per year and they have less than $25,000 dollars in savings. Yes, becoming an owner is daunting, but the statistics speak for themselves. Default rates remain lower than ever in this industry. The money is right, the market is primed, and time is ticking.
Make the decision in 2020 and invest in yourself!
Considering a Veterinary Practice Loan? Know What Lenders Look For – Before You Apply
Applying for a loan is probably not at the top of anyone’s list of favorite things to do. Sometimes applying for a loan can feel like a very opaque process, and often times it may seem endless. When you consider a Veterinary practice loan, you may wonder how to make the process easier, and what you can do to best position yourself for approval.
Different lenders have different parameters for approval. Some lenders place more importance on some factors and less on others. While not all lenders are alike, there are certain common factors most banks consider. Understanding these factors can help you position yourself in the best way possible to multiple lenders.
Increase cash flow, eliminate credit card debt
Cash flow is one of the most important things a lender considers. The monthly expenditures reflected on your credit report – such as personal mortgages, car loans, credit card bills, and others – affect your cash flow. High monthly bills can negatively affect your cash flow, while lower monthly bills can positively affect your cash flow. Consider how much credit card debt you carry from month to month. If you pay your credit card balances down to zero every month, this does not negatively affect you; however, if you do carry a balance, this can negatively impact your cash flow. To best position yourself to be approved for a Veterinary loan, you’ll want to carry less than $25,000 in credit card balances from month to month.
Student and existing business loans come into play
Student loans may also affect your ability to obtain a Veterinary business loan. Many Veterinary lenders don’t consider the total amount of student loan debt outstanding as the deciding factor but will look at your total monthly payment. This is where you may consider Income-Based Repayment as an option to lower your monthly payments and improve your cash flow. Be sure to ask your lender about whether this may be necessary.
If you already own a Veterinary practice, lenders will consider the monthly payments on any business loans you have. Most Veterinary lenders will look for a global debt service coverage of at least 1.20x. This means that for every $1.00 of debt you owe – both business and personal monthly bills annualized – you have at least $1.20 to pay it with, from all your annualized income (income from either your salary, practice profit, distributions, guarantor, etc.) A great exercise before applying for a loan would be to calculate your current ratio beforehand so you can either pat yourself on the back, or make changes to increase your chances for an approval.
Liquidity is key
Another thing to consider is your current liquidity – the amount of cash reserves you have, outside of retirement savings. Conventional veterinary lenders typically like to see at least six to 12 months of reserves when they consider your loan request. This means you have enough cash set aside to cover your monthly bills for six months to a year. If you are a current practice owner considering a loan, a good rule of thumb is to have between 5% and 10% of the total loan amount in cash reserves. Again, every lender’s requirements are different, but having adequate cash reserves in place will put you in the best possible position with multiple lenders.
Consider collateral
Conventional Veterinary specialty financing looks at collateral a little differently than SBA lending or non-specialty financing. Goodwill in an existing practice should suffice as collateral for Veterinary-specific lenders. Typically, they can lend up to 80-90% of total collections on a Veterinary practice without the need for additional collateral or a seller carry-back note. This amount will vary depending on the lender and the situation; keep this in mind if you have an existing practice and are planning to apply for a loan. When you’re considering a startup loan, you do not need to put your house, your spouse, or first-born child as collateral. Specialty Veterinary lenders will allow you to use the future potential of goodwill, as well as the equipment you purchase, as collateral for your startup loan.
Know before you borrow
As mentioned before, criteria for approving a loan may differ from bank to bank. This process may be arduous for the borrower, but know the criteria beforehand and you can best position yourself for practice financing. You can potentially alleviate the frustration of a loan decline before it happens. The good news is that rates are still at historic lows, and access to Veterinary-specific financing has never been easier. With this knowledge, you can prepare yourself for future success, for both the loan process and Veterinary practice ownership.
Be an Educated Dental Practice Buyer
I meet over 150 dentists each year who are looking to buy an existing dental practice. Of those, I would estimate that 30% haven’t done any research on what is involved in buying a practice. Of that 30 %, none of them know the beginning-to-end process of buying a dental practice. While I can’t cover all the steps in this article, I can give you some guidance on where to start and what steps to take before buying a practice.
The very first recommendation I have is that you should be at least 2 years out of school. I have seen dentists buy a practice right out of school, but I’ve seen the majority of them struggle for two years until they finally figured things out.
Now that I’ve got that out of the way, here are your steps:
- Contact a bank that finances dental practice acquisitions and make sure you can qualify for a good loan. The days of just having a D.D.S., or D.M.D. and being qualified are gone. Banks now require decent credit scores, cash in the bank, and in some cases, a current associateship. Try to avoid SBA loans if you can as they can be expensive with early payment penalties.
- The next step is to understand a little bit about dental practice valuations. You don’t want to go into a sale not knowing if the practice is worth the price listed or not. A “rule of thumb” is that a practice is typically worth between 65% and 75% of its’ last 12 months production. Remember – that’s a rule of thumb. I’ve seen practices go for as high as 110% of production and as low as 50% of production. For a book on Dental Practice Valuations, contact me and I’ll send it to you.
- Think about where you want to practice. You’re probably going to be there a while, so you might as well like the area. Also, research demographics. There are excellent demographic sites that sell great dental demographic information for about $500. This will tell you where the best locations are to practice.
- Put together a good team. Get referrals for a good dental attorney, a good broker, and a good accountant. They’ll help you analyze the dental practice, do the legal work, and help you find a practice.
- Study up on practice management and dental financial ratios. You should know that lab fees should not be any higher than 10% of the practice production, or that staff expense should be 20% to 25% of production. Be an informed buyer.
- Be prepared for your due diligence. You need to know what to look for when you do get to the point of buying a dental practice. Is it an older dentist selling that hasn’t done much treatment in the last 5 years (buyer beware)? Or, is it a conveyor belt dentist that has done every speck of dentistry, and then some, on all the patients, so there’s none left for you? Know how to spot these things.
- Finally, spend some time with a dental broker before you go look at the practice. Understand what the practice you are looking at is all about. Does the broker honestly think it’s a good practice? Why? Once you’re comfortable with the numbers, then go look at the practice.
By being an informed buyer, you will avoid a lot of headaches and potential problems down the road. There are practices that are gold mines and practices that you should not touch. Being educated and knowing the difference is critical in your dental practice acquisition success.
Read MoreTop 5 Fears Veterinarians Have About Practice Ownership (And How To Overcome Them)
There are many advantages to owning a veterinary practice over being an associate veterinarian and not owning a practice. For one, the average veterinary practice owner makes approximately 20% more in income than an associate veterinarian working for someone else. A veterinary practice owner also gets to choose what procedures he wants to perform and what type of animals he or she wants to work on. Heck, they even get to choose which animals they want to work on. They can also choose their own hours, pick the days they want to work and how much vacation they want to take. So, why aren’t veterinary associates owning practices? What are they afraid of? Here are a few fears we have encountered and how to overcome those fears:- Fear of the unknown – Associates feel they don’t have the experience in owning a practice. They haven’t managed staff. They haven’t kept financial records. They don’t know what marketing to put in place. They don’t know what benefits to give employees, how to hire or fire employees, or even how to balance a checkbook.
Fear not, you don’t have to know everything at once. You know how to do veterinary medicine. That’s the first step in owning a practice. You have a few years of experience working as an associate in a veterinary practice. You’ve observed the owner working with and managing staff. You may have experience leading a team in school, playing sports, etc. These are all examples of good experience in handling staff. You don’t have to know how to keep books right away. We suggest getting a veterinary bookkeeper and then getting educated on reading financial statements. This can happen over time. Bottom line is if you are good at what you do and willing to learn the other parts of practice ownership, you’ll be just fine.
- Fear of taking on more Debt – Read Robert Kiyosaki’s book, “Rich Dad, Poor Dad”. Not all debt is created equal. There is good debt such as student loans and practice debt that helps generate an income and there is bad debt such as credit card debt where you just borrowed money because you wanted something. Practice debt used to buy a practice that will help you make more money and build equity in an asset (the practice) is a positive thing. As long as it’s a good practice with good cash flow, you’ll be money ahead in the long run.
- Fear of the Corporate Giants – Don’t fear the corporate giants. They have their own niche targeting the bargain shoppers and lemmings who follow the crowd. They also have a high turnover in their staff and doctors. You will provide excellent service with the same staff and veterinarian that the clients will see every time they come to your office. In a corporate environment, they’re not sure who they’re going to get.
- Fear of not knowing what to look for – This is a valid concern. You can educate yourself in a number of ways. There are great resources via podcasts, YouTube, etc., that can help you know what to look for. Quite simply, you start by looking at your desired location, then look at the cash flow of the practice and after that, you can get into the details. There are consultants and brokers who can also help you with reviewing practices. Identify your team that will help you overcome this fear.
- Fear of a recession – Recessions happen, typically every 8 to 10 years and last 10 to 12 months. You cannot avoid recessions or downturns in the economy, it’s part of life. But, during recessions, employees typically get laid off of work. If you own your own practice, you’re probably not going to fire yourself. You’ll probably keep yourself employed and busy. Owning a practice is a deterrent from getting laid off during a recession.
These are a few of the fears that we’ve seen over the years, and there are others as well. But, the best thing you can do is educate yourself and talk to practice owners, brokers and bankers. Seek advice and counsel from everyone you can. This will help you make a wise decision in moving forward with practice ownership.
For a chance to get advice from a team of experts all in one place – broker, banker, attorney, etc., we have 4 Practice Ownership seminars coming up this fall, all are free! Click the link below for more information.
They’re Heeeere…
These DSOs are groups who are looking to consolidate the dental industry similar to what has been going on with pharmacies, surgery centers, and hospital systems for many years. In fact, as a side note, two-thirds of pharmacy revenues come from corporate-owned pharmacies. The DSOs, especially the large ones, are backed by private equity money looking for good returns on their money. Smaller group practices are typically backed by local or national banks. The private equity groups like the dental market as there are good margins in owning a dental practice. I’ve heard they can typically get a return of 15% to 20% after paying an associate salary and all other overhead. They don’t require financing, so they don’t have the debt service payments that individuals may have. They often consolidate the “back-office” functions – Human Resources, accounting, and billing to save money. They also can negotiate better insurance reimbursements and dental supply prices than the solo practitioner. For staff, they can offer decent benefits packages as a result of economies of scale. However, they may not pay staff wages as well as solo offices. The larger groups range from 30 practices under ownership up to several hundred locations with groups like Heartland Dental.
What are they looking for when they acquire a dental practice? Many of them claim they will pay a premium for a practice. I’ve been working as a practice broker for almost 15 years, and I’ve never seen a group, DSO, or Private Equity investor purchase a practice for an above market price. Most have purchased practices at market, or even slightly below. They like larger practices doing at least $800,000 and up. That doesn’t mean they won’t buy smaller practices, but the larger ones are more appealing. They like to acquire smaller practices in the area where they already have a larger practice so they can consolidate the smaller practice into the larger practice. Most of them want the selling doctor to stay on and work in the practice. Many of them want the seller to stay for up to 3 years. Most will negotiate down to 2 years. They usually do not give you your entire purchase price upfront. They’ll give you 80% of the purchase price at closing, you will have to wait for the other 20% to be paid out upon certain conditions being met. Those conditions include serving your agreed-upon employment term, the practice production staying at where it was before or even growing, and other conditions may be possible such as hiring an associate, managing the practice, etc. If you don’t meet your conditions, the DSO may pay none or only a part of the last 20% of the purchase price. And, if after a few months you decide that working as an employee for the group isn’t what you thought it would be, or you decide to move out of the area for health reasons, or for some other reason you decide to leave the practice and not meet your term, then too bad for you. You forfeit the 20% that the DSO owes you.
The small groups, DSOs, etc., will also tell you that they prefer you not get someone to represent you. That includes an attorney, a consultant or a practice broker. They want to use their experience, their sales tactics and their gaggle of attorneys to negotiate a great deal, FOR THEM! Yes, they’re not looking out for your best interest. They could care less if most of your retirement nest egg is in your practice. They care about building their market share so that they can make as much money for their investors as possible.
My advice if you have received a letter in the mail from a DSO or small group is to don’t go it alone! You’ve been a dentist for quite a few years for crying out loud and haven’t negotiated a multi-million-dollar deal, dealt with aggressive attorneys or a large corporation. Whether you use a broker, attorney or consultant, get someone on your team to represent you. Our group at Omni has negotiated many deals ranging from $500,000 to $7 million and up. This is what we do and have expertise. Feel free to call us anytime to discuss your transition, an offer you received, or anything else where we can provide knowledge. We’re always glad to help.
*Footnote: “Dental Service Organizations – The What and Why of DSOs – Part 1 of 6” Posted on May 13, 2019 by Sara K. Stock. www.stocklegal.com/blog/dental-service-organizations-the-what-and-why-of-dsos