Buyer Articles

By Megan Urban

Who can help me? 
This is a very important decision and time for you and your family, so it’s critical to build your team of trusted advisors, such as dental specific broker (with a real estate license), lender, CPA, attorney. These professionals have done many unique transitions, and often with each other, so they work well together and know how to provide you with a successful transition. You can use your relative or friend in these professions, but they can’t know the things dental specific advisors know. It’s the same as when you refer out complete bony extractions or dentures, etc. Experience and knowledge in a select niche are worth its weight in gold.

Can I afford a practice and associated real estate?
Dental-specific lenders understand dentistry and understand that you may have student loan debt, potentially as high as $500,000. If the practice cash flows and provides you with the money to pay your practice and student debt, plus living expenses, you may be good to go. If you are thinking about a start-up, you will most likely need to work part-time somewhere else as you grow your new practice. Your trusted advisors can provide you with ideas to assist with your startup as well as potentially referring to a dental specific marketing company. So, the answer is, typically, yes, you can afford a practice and associated real estate.
Sometimes, depending on the seller and your finances, you may rent a few years. The things to consider here are that if you rent, you may still have the seller “visiting” when they want and still act as though it’s their building and try to deter you from making your own decisions. It’s hard to make changes and you will someday understand this! If you rent, you will want your attorney to ensure there are solid details surrounding future purchase.
Some dentists prefer to own their own real estate and that can be beneficial for those with property ownership goals. Leasing in a commercial space or strip mall can be worth the potentially high rent if you have the opportunity to gain increased collections.

What do I need to know when looking at potential practices?
Where do you want to live and work? Once you determine the general location, look for a practice with a good and visible location and parking.
Work with your broker or buyer-representative to assist you to review the formal valuation or the following statistics.
Last 3 years financials to see collections and expenses. Some expenses may be backed out that would not pertain to the new dentist, such as “large” continuing education, cars, 401K, and family members on the payroll that may not have an active/necessary function in the practice.

• Accounts receivable. You will want to know the total and how much is over 90 days old that may not be collectible unless the practice accepts 3-4 months of in-house payment. Even if you don’t purchase the AR, you will want to know if patients are accustomed to paying at the time of service so you can slowly make changes as necessary. Any credit balances can be determined and addressed before closing.
• Procedure frequency. Confirm the services currently being done and if you are comfortable performing and what procedures you can potentially add. Check periodontal treatments and number of recare compared to active patient count.
• Patient demographics. This report will show patient age, zip code, and insurance participation. If the patient age isn’t what you enjoy, determine how you might acquire those patients. If many of the patients come from a zip code far from the office, be aware you may lose some of those patients. You may want to add or reduce insurance participation, but make sure you have a solid plan for this.

I want multiple offices.
Having multiple offices can be profitable if done correctly. Ensure you have solid processes in place that can be replicated. Consider doing a demographic study to determine where you want your locations. If patients may be going to more than 1 location, ensure your dental software is capable of being accessed by all locations.

What do I need to know/do before starting my first day in my new practice?
Work with your CPA to set up your entity, accounting system, payroll, and tax payments. Plan to have a confident first conversation with your new team. They will be anxious about the transition so you will want to put your arms around them and help them understand you want to continue the quality care and any small changes will only be for the better for patients and team. Be prepared for difficult questions such as asking for a wage increase, change in schedule, or complaints about other team members. Guide the team on how you want them to discuss you to the patients and how your goal is to retain patients.
Become familiar with your dental software. Most dentists and teams do not maximize the reports and statistics available to you. Remember, your dental software and accounting system are the 2 biggest tools you have to run your practice.

PURCHASING A PRACTICE, with your team of trusted advisors, should be a pleasant process that leads to a profitable and enjoyable career! For more information on our buyer’s program or for a free consultation, please contact megan@omni-pg.com.

With so few practices on the market, I often get the question “Should I just start a new veterinary practice?”  Since I am a commercial real estate broker specializing in helping veterinarians find new locations, as well as being a Veterinary practice broker, I can give you an educated answer.  That answer is “it depends”.

Here are 10 questions to ask yourself to see if you are a candidate to do a scratch start practice:

1. Do the demographics support another veterinarian in the area?  (1,500 people per 1 veterinarian)
2. Do you have the patience to do a startup?  (It may take up to 24 to 36 months to break even.)
3. Do you have another income, or 12 months cash reserves, to support yourself while you get your new practice going?
4. Are you good at project management – managing contractors, designers, vendors, etc. – to get things going?
5. Have you hired staff before?
6. Are you good at self-promoting and marketing? You may need to go door-to-door to get recognition and to get patients coming in.
7. Have you set up insurances, bank accounts, patient financing, etc., before?
8. Do you have good credit and some cash reserves in the bank to obtain a loan?
9. Do you have enough experience (minimum of 2 years) to jump in and get things going?
10. Do you have the fortitude to succeed? There will be down times when you want to throw in the towel. You need to fight through those down times to achieve success.

I have helped many Veterinary practices get started in their new practices, from finding locations to consulting on the entire set up. Each practice has achieved break-even in less than 18 months.  If you are on the fence on whether to do a startup, give me a call and I can help with analyzing your situation.

Whether your practice is collecting $100,000 per year or $10 million per year, you can always use a little more money.  Whether putting it away for your retirement or paying for your kids’ college education, some extra dough always comes in handy.  The best way to get more money in your practice is to grow your practice.  But how do you do that?  Here are a few suggestions:

1. PPOs – Unless you’re a fee-for-service practice collecting $5 million per year without any PPOs, or you’re the only dentist within 30 miles of your office, you should consider taking PPOs.  I know everyone wants to be a fee-for-service practice, but in this day in age, it’s quite difficult.  Many large employers provide some form of dental insurance.  Being a Preferred Provider for those insurance companies whom the employers subscribe to will give you another source of new patients.
2. Additional Services – Do you refer out endo, ortho or oral surgery? If you add those services, you can get approximately a 5% increase in practice production.  There are many courses available where you can learn and hone those skills.  There have also been advances in endo equipment which makes it much easier to perform endo procedures.  Placing implants is another procedure you can add to your repertoire.  Go back and look at how many endo, ortho, oral surgery, and implant cases you referred out.  Those procedures and the corresponding money from those procedures can be yours.
3. Marketing – Having more new patients coming to your practice is a great way to increase your production.  If you’re doing very little marketing, or not doing any, you should consider getting in the game.  The type of marketing depends on the type of practice you have, where you’re located and what kind of patients you want in your practice.  You can consult with a dental marketing expert to get a good idea on which type of marketing is best for you.
4. Where’s the Hygiene? Your hygiene production as a percentage of overall production should be approximately 30%.  That can vary by the type of practice. Emergency clinics or cosmetic practices, for example, will not have much hygiene.  Most general practices should target 30% of total production as hygiene.  You can increase your number by making appointments chairside, incenting your staff to fill the hygiene column and educating yourself with all the information on the internet on how to improve your hygiene numbers.
5. Turn “No” to “Yes” – We’re talking case acceptance.  Your case acceptance should be a fairly high number – 70% to 100% is a good range.  If you’re below that, your treatment diagnosed is walking out the door.  Build rapport with your patients so they trust you.  Work with your team, assistants, hygienists and front desk, to improve case acceptance.  Use the common phrase, “If you were one of my family members, I would suggest you get this procedure done.”  There are several good sources out there on improving case acceptance – books, YouTube videos, consultants, etc.

There are even more ways to improve your bottom line to make your practice more profitable, but if you implement just one of the above 5 items, you can increase your production by 10% or more within a month.  Best of luck in your practice.  As always, we are here to provide free advice or consultation.  Call us anytime – 877-866-6053.

Some dental practice owners own the building where their practice is located.  The longer the doctor has owned the practice, the more equity they may have in the building.  They also are paying themselves a high rent for tax planning purposes.  One of the questions we get asked when a dentist is considering selling their practice is, “Should I also sell my building?” 

One thing to consider when selling your practice regarding the real estate is do you want to be a landlord?  We have years of experience being a landlord and there are pros and cons.   The pros are that you retain the building and get a monthly rental payment.  Hopefully, that rental payment covers the mortgage, taxes, maintenance, insurance, and any replacement of major capital items.  That includes when the HVAC system or roof fail and they need replacing.  The other pro may be an appreciation of the real estate.  Currently, we are in a high real estate market.  Real estate markets are cyclical.  They go up and they go down.  There is timing involved in a sale.   You time it right and you can reap your rewards of all the years you have owned the building.  Time it wrong, and you feel a little pain from not selling at the height of the market.

The cons are like the pros.  Being a landlord requires you to be on call 24 hours per day and 7 days per week.  If a heavy storm occurs and the snow collapses the roof, the wind blows a tree onto the building, or the parking lot floods into the building, guess who gets the phone call?  That’s correct, you!  We have been on the receiving end on calls that happen at 2:00 in the morning when the building started to flood. 

Another con is when the lease is up and the tenant decides they want to own their own building.  They didn’t tell you that they purchased the building next door and you now no longer have a tenant!  The odds of getting another dentist to start up a practice in your building is very low.  It will also be difficult to get another tenant quickly.  There are three dental buildings within five miles of our office that have been vacant for several years due to this exact thing happening.

The third con is timing the market.   We’re currently in an up-cycle market.  With interest rates and building inventory low and demand high, building values and prices are on the high end.  Holding onto the building so you can get some cash flow and then sell the building later could cause you to lose hundreds of thousands of dollars.  Also, a building has more value to an owner/user than it does to an investor.  That means when you sell your practice, a buyer may be willing to pay 100% of market value, or slightly higher than market value, in order to acquire the building.  Whereas, an investor will try to negotiate and get the best possible price they can get.

In summary, owning your own building while you are in practice is the smart thing to do.  You build equity, pay yourself rent and can do anything you want to the building.  But after you sell your practice, it may be a different story.  Consult with your transition broker, who should also have commercial real estate experience, and get sound advice to help you make the right decision. ​