Startup or Acquisition? Decoding the Best Path to Dental Practice Success with Dr. Scott Leune

This discussion in this episode of Shared Practice Podcast provides valuable insights into the decision-making process for dentists considering whether to start a practice from scratch or acquire an existing one. Dr. Scott Leune and Richard Low explore the critical factors that differentiate these paths, emphasizing the need for a CEO mindset to ensure success in either scenario.

Key Highlights:

• Key Considerations for Startups: According to Dr. Leune, starting a practice offers complete control over location, branding, systems, and culture. However, it requires significant upfront planning, financial investment, and a longer timeline before profitability. Startups demand a strategic approach, including identifying the right market, building a patient base, and establishing effective operational systems from the outset.
• Advantages of Acquisitions: Scott explains that acquiring an existing practice can provide immediate patient flow, established systems, and a team already in place. However, it often involves challenges such as integrating into an existing culture, updating systems, or addressing legacy inefficiencies. Successful acquisitions require a thorough assessment of the practice’s metrics, patient demographics, and operational health.
• Adopting a CEO Mindset: Regardless of the chosen path, Scott stresses the importance of dentists stepping into the role of a CEO. This involves managing finances, operations, and people effectively rather than focusing solely on clinical work. Implementing daily, weekly, and monthly checklists helps streamline responsibilities and maintain accountability.
• Balancing Challenges and Opportunities: The discussion focuses of how startups offer freedom but come with higher risks and slower returns. Acquisitions provide immediate cash flow but may limit initial flexibility. Scott emphasizes that both paths require a disciplined approach to leadership and decision-making, supported by frameworks, coaching, and continuous improvement.
• The Right Fit: The discussion concludes that the best choice depends on individual goals, resources, and circumstances. Startups suit those who thrive on building something from the ground up, while acquisitions are ideal for those seeking faster entry into practice ownership with less initial risk. Both paths can lead to success if approached with clarity, structure, and a strong vision for the future.

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Here is the full transcript of the video:

Dr. Richard Low:
Welcome to the Shared Practices Podcast. This is very exciting for me today because going back to the origins of shared practices, we talked about this concept of ownership and we laid it out in a very season by season, topic by topic format and acquisitions and startups were such a core part of the depth that we provided in those early seasons. So I’m very excited to invite back my co-host today, Dr. Scott Leune, to discuss the potential of starting versus acquiring one or more dental practices, one or more locations. So Scott, welcome back to the show.

Dr. Scott Leune:
Yeah, thank you. And by the way, in this episode and talking about building financial success, building wealth through the ownership of one or more practices. In a way we’re speaking to the dentist that already has one or more, but my Lord, should the dental student be listening, oh my goodness. Should the associate dentist be listening Because it’s going to feel like, I think we’re talking right to you as well because we’re all in this kind of linear path that starts as a dental student to potentially could go as far as owning lots of locations. We’re somewhere in there and this conversation we’re now going to have is about that path and about the wealth that we build along that path.

Dr. Richard Low:
Yeah, and I will throw myself in there as a prime example of the relevance of this information no matter where you are in your career in that I’ve bought three practices with partners. I’ve walked away from those three practices because of differences of visions and long-term goals. I’ve bought two practices that were really one spread over two locations and then merge that and run a chain of offices. And now I’m interested in thinking about what it would mean to own one practice again, and I’m right back to square one of what would a startup look like? What would an acquisition look like? And so no matter where you are in your career, this is relevant. People move, there’s life changes where you have to sell a practice and you have to move on and start over or you want to because you’re tired of living in the same town. So I love how applicable this is to everyone bringing a fresh, fresh look.

We start with what you just mentioned, this concept of building wealth. And that is one of the principle things that seems to be available through ownership that might not be as easily accessible through practicing dentistry under someone else. You can still make good money, you can still build wealth via saving, and it’s dependent on your saving rate, depending on how much you spend and the difference and what you invest in. You can build wealth working for someone else, but this practice ownership gives a vehicle for building wealth not only in creating more income, but also the value of the practice and that trajectory over time. So how do you think about this concept of building wealth via practice ownership?

Dr. Scott Leune:
Well, let’s break it into some buckets already. That’s how I think. So we have the bucket that says we make money with our two hands and whether we own a practice or not, we’re making money with our two hands. So obviously everything that impacts our two hands is going to help us. We can see more patients, we could see bigger cases, we could have bigger fees, we could have more efficient schedule. All of those things impact the money we make with our two hands. But then there’s also the money we make from owning a location. And now we get suddenly of course the cashflow, the profitability from that business, that business that has more than our two hands in it. And that business provides us opportunities to make more, not just through growth but also through cost cutting. As an associate dentist, you want to make a hundred grand more get to work, roll up your sleeves and cut more teeth. But if you’re an owner and you want to make a hundred grand more so often you can find a hundred grand of expenses to cut that overnight. You’re making a hundred grand more without cutting more teeth. So you just have more opportunities to build income when you own the practice because you are now controlling so many more things that impact, of course the financial result of that company.

Dr. Richard Low:
And I’ll add in there too, not to mention things like tax savings or having people on payroll or running through things through the business that as the owner operator you are legally authorized and able to do that you can’t do when you don’t own and run the business. So the list goes on and on of those cost savings as well. But

Dr. Scott Leune:
Let’s just keep adding to the list. Being an associate to an owner, I get to choose the practice model. I’m not on a Medicaid model anymore. I’m on a fee for service model. I get to choose the team. I have the team that is going to represent my way, my vibe, my philosophy, and that results in me being happier, me being less stressed and patients saying yes more often. I get to pick the equipment, I get to pick the location, I get to pick how we market, how we answer the phone, what our payment options are. All of those things are moments of opportunity to do better financially or of course to do worse. As an associate, I’m a victim of someone else’s decisions with all those things, but as an owner, I have the opportunity to decide something better and that is giving me more cashflow, but that entity is also worth something someday that I sell.

And what if I have more than one of those entities? I suddenly become an investor in assets that we call dental practices. And yes, I might have to work in them as a dentist or yes, I might have to be the CEO or I could on an extreme just be an investor in these assets. But this is the game we’re playing and if we can, I hope it’s okay. I want to tell a quick story, and I’m not going to name any names because I haven’t asked this person if I can tell this story, but I recently had a coaching client join me. She’s got three locations and she does about 8 million a year combined across the locations. And she is a two time breast cancer survivor. She is not giving her family the time she wants to give them. She doesn’t have focus on health.

She’s actually talked to me about she feels a disconnect with her faith and she’s not making very much profit like 400 grand, something like that, not very much profit. And so here she is working hard. Her bills every single month are what a typical practice will collect in a whole year. So real risks and what’s the right thing to do in this situation? We don’t know how many years of health she has until the next fight. And she’s got a 7-year-old daughter, she’s got a husband, she wants to have time for her health time for her family. She wants to have time for her faith. She wants to use these days with more intent than other people who are kind of procrastinating living their days with intent. And I totally understand and in her situation when we look at it, we actually realize that if she were to sell everything, including the property she owns, the practices she owns, she’d walk away after tax with $10 million, $10 million in cash, plus she’d end up with about 800 grand of income every year off of the 10 million and what her husband makes.

And so she could live the rest of her life without picking up a handpiece the rest of her life without working at all. And if heaven forbid she were sick or she were no longer here, what would she be leaving to her husband and her child? $10 million and no liabilities. And how is she in this set for life position? Because she became an owner and because she decided to have multiple locations and while it was hard, she was able to get to a point where if she wanted or had to sell it would be a massive win. And she is in a way being forced to speed that up due to life challenges. What if she just lived a world of mediocrity that said, I’m just going to be an associate. I don’t know if I can be an owner. I don’t know how to do it.

I don’t know if I’m ready. And then she got breast cancer and then she had to figure out what to do with her family that relies on her income and what to do with her time she has left where she’s forced to work full time and be stressed. You see these things we’re talking about can have massive life implications. It’s not just about how do I make more money? It’s about what happens when we have more money, what the choices are in front of us and what life deals, what life throws at us. And so I am so happy for her that she became an owner and she went into multiple locations so that when life deals her a tough hand, she’s able to cash in her chips and spend the rest of her life focused on things that are way more important than teeth and money. Does that make sense?

Dr. Richard Low:
Yes. And like you said, in this situation, there wasn’t a ton of profit here. And so there might’ve been a lot of fear around what was built and all of these things. If someone has opportunities to build along the way and bake in more profit, more opportunity, that can be reached sooner. And whatever version of this journey we end up on, I think there is an element of purpose and options that is opened in a very significant way via practice ownership. So a beautiful example and very real and concrete showing this is what ownership can do for you even when it’s hard, messy, imperfect, and feels scary and risky and at the end of the day provides opportunities that just simply wouldn’t be available otherwise.

Dr. Scott Leune:
And if she wasn’t going to sell everything, what would we have in front of us? We would have a large organization where it doesn’t take very many decisions to free up one or one and a half million dollars in costs. We were able to cut and very quickly this becomes a very profitable organization. I always use analogies. I hope that doesn’t bother too many people, but it’s how I think and communicate. It’s messy and uncertain. Being a parent, it’s hard. Sometimes we break, but the beauty behind it outshines the messiness and we shouldn’t expect perfection. So we might never be ready to be a parent if we were waiting until we felt like we’d have certain perfection. So I think that sometimes we just have to have this uncomfortable confidence to move forward down a path that we know has a lot of opportunity for us.

And look, if the path of owning a practice doesn’t work out, sell it. If the path of owning practice number 10 doesn’t work out, sell it or fix it or fix the path, go around the obstacle and fix it or get help or there’s so many things we can do. This is not a permanent decision, but how is an associate dentist going to build $10 million of wealth early on in their career? I just don’t know how they do it being a dentist. No. And I’ll tell you, once you have 10 million of wealth, you quit making so many compromises about your dentistry, you quit making compromises about your day about how it feels to be a dentist where you practice. You quit compromising about your health, about your relationships. Of course, you could also screw it up. You could also start getting drunk and high on the choices in front of you. Now that you have 10 million, you could have your Ferrari and all kinds of lifestyle mistakes, mistakes

That could happen as well, but we could always do wrong or do right in almost any kind of situation. But when we play this game of ownership, whether it’s starting or buying, whether it’s having one or more locations, that game has an extra zero or two on it. And with those extra zeros, we get extra safety, we get extra choices, and we get an opportunity to control a lot more than we used to. Of course, a lot of people are stuck because they don’t know whether they should start or they should acquire practice. They feel just completely lost at that whole thing. Do you see that?

Dr. Richard Low:
Yes. And it brought to mind, just to overview real quick, what we’ve said already, there’s the income of producing dentistry. There’s the income of being an owner, the cashflow being an owner, the savings of being an owner that can be baked, the dials that can be turned there is the value of the organization that you build. And George calls this the practice oh one k. It’s rather than having a 401k, you’ve got your practice oh one k of the wealth that you are building in that practice. And then lastly, you mentioned even real estate, the vehicles of leveraging your business to own real estate. If that opportunity is appropriate and can be leveraged also can create a lot of wealth. So we’ve outlined some specific opportunities, but this starting point or restarting point, if we’re looking at number two or beyond or restarting in our ownership journey of starting versus acquiring has a lot of facets to it of the opportunities in front of us, our goals, what the intentionality, the picture that we’re building, and for some who are not experienced, even this decision is too much to even get started at all.

Dr. Scott Leune:
Yeah, I kind of sometimes think about the advice people give dental students and new grads and it makes me sick to my stomach, but the advice I hear all the time is go work for A DSO, get your speed up, pay down some debt, make some money. And I’m like, man, speed doesn’t matter yet. Working for a DO is definitely not the way that you are going to make a bunch of money to pay down your debt. That’s going to be maybe some of the smallest amount of money you’ll make under immense amount of compromises and things you don’t control. It’s all based out of a fearful way of thinking. When I think about George, let’s just use him as the example for a second. George is now of course one of y’all’s owners. He owns a piece of a massively successful company that will set him financially for life and probably his children for life.

And while that’s not everyone’s goal, how did he get there? He didn’t go work for A DSO and gets to speed up and pay down a little bit of debt and live in mediocrity for 10 years before he signed to do something. He actually showed up as a dental student, interned in my company and learned how to schedule and learn how to file claims, and went through my seminars and as a new grad, he went through the seminars. He learned first didn’t judge first, he learned first. And you see, if you learn the right information and you are inspired by someone doing what you want to do, that is maybe all you need to flush out the noise of mediocrity. And so he then went and started owning practices early on and then started following and mimicking people doing the things he wanted to do, which then led to shared practices group and now it’s a huge success story.

And had he waited 10 years, where would all of us be 10 years later? No, let’s get a headstart on this by getting fear out of the way. Let’s go learn information so that we’ve got facts and let’s go be inspired by people that are actually doing it. Not loud voices, but just people doing it. And the combination of that will lead a whole lot of people to this conversation, to this ownership conversation much earlier in their career. And what do you do you’re scared to own? Are you scared to start? You’re scared to buy, you go learn how to start practices and you go learn how to buy practices. Actually, if I were graduating today or if I already own a practice today, I bought it years ago and I’m thinking about owning another one, I probably would not own another practice until I was trained how to start them and trained how to buy them.

I would not judge one of the other without knowing how to do it. First I would go learn how to start and learn how to buy and then go to my area and run the analysis of both. I’d play out that whole analysis on analyzing demographics and locations that are available for potential home run startup while also analyzing the proforma financial analysis on all the acquisitions that are available in the area, reaching out to everyone I can. And I would gather all that information under these two skills I’ve earned by getting trained and I’d look at, okay, what does it mean to buy the next practice and what does it mean to start the next practice? And you see, when you have that information, you feel connected with facts, you feel in control of your destiny. You don’t feel swayed by the fear of the unknown of not knowing how to do it. Does that make sense?

Dr. Richard Low:
It does, and it also is creating more work for myself in this very statement because as we talked about briefly, I think at the end of the last episode we were mentioning the fact that I was inspired by our conversations and now am starting to leaf through acquisitions and look at listings. And there’s a part of me that because I have been in a world that has been more acquisition focused, that it is easier for me to start that process and I need to do what you just said, which is re-arm myself with the same information that I explored and that we’ve podcasted about and we’ve done, I mean to be honest, we’ve done a lot of startups for our denture implant group and you talked about George’s path and our path in this group. The funny thing with owning A DSO and podcasting about practice ownership is that we have an informed audience that knows what’s possible in ownership and therefore we’re having to provide a model and we are happy to provide a model of partnership and ownership and income in a group that is comparable and competitive with practice ownership because we have an informed audience and group of dentists.

But now for me, in my personal situation, I am looking at, okay, dang it, I got to start running demographics again. I got to start looking at this. And so this is, our audience might find themselves in a situation where one of these two is more appealing, whether it’s the Instagram appeal of doing a startup, it might not be the right reason that they lean towards doing a startup or just this idea of I want to do something that is my own and that I feel like I’ve built from scratch or there’s a fear of doing all of that. And so they lean to let’s buy a business that’s already profitable and then I have less risk going into this. So we’re challenging this idea that there is a right answer, and in fact, giving people the prescription to arm themselves with the tools and the knowledge to accurately assess both because they might be sitting on an amazing acquisition target that if they’re only looking at startups, they would completely miss. Maybe there’s a startup plus in their area where it’s a practice that’s done all the work of starting up and has the potential to grow, but just hasn’t had an owner operator that can grow it. Or they might only be looking at acquisitions and they might miss out on this growing side of town that has an ideal situation where they could start up and have immense success from the beginning. So I’m excited for us to challenge these potential owners of a first or second practice, myself included, to look at all the options.

Dr. Scott Leune:
Well, there’s the conversation around I’m going to get the next practice, should it be a startup or an acquisition? And then the conversation changes a little bit. If I’m saying I want to go get 10 practices

As soon as possible, will that be a startup or an acquisition? Those are two different conversations, both conversations. We have to understand how to do either one, so we can’t even join in the conversation without understanding the language of startup and the language of an acquisition, but we might look at those things a little bit differently depending on the scale we’re trying to accomplish. The vast majority of listeners are not trying to accomplish the 10 at one scale. The vast majority of listeners are looking for that next one, whether it’s their first one or their third one, it’s their next one. And unfortunately for the associate dentist I’m prescribing to you own a practice, but you don’t know how to do a startup, how to do an acquisition, and so you’re just stuck not making a step forward. It’s almost like I prescribed to you, Hey Richard, you need to do some sports.

You need to work out a little more and you know what would be really good for you? Something like tennis or pickleball, but you don’t how to play either one, and you don’t decide to go even learn or pick up a racket or understand it or see you’re just scared to do it. You don’t even know what you’re talking about and you end up not working out. You end up living this life of mediocrity. So go learn how to do a startup and you will see it’s quite predictable and it’s cheaper in the long run than buying a practice. Also, you build something ideal for the long haul, something you’re proud of, something that makes you excited to show up to work because you are surrounded by your vision having been made a reality and go learn how to do acquisitions. You’ll see that you can very quickly make money, even though you do pay twice, you pay to buy it and you pay to fix it.

You make money very quickly. You get rid of the whole ramp up and delay, and there’s something that feels more certain about that. You can also get it financed more easily. And while you have to have a stomach for change, it can be very fulfilling to watch something change from what it was to what you changed it to. And both of these are lucrative. Both of these are fulfilling. They both are different flavors once tennis and one’s pickleball, but they’re both working you out and I can’t imagine not having that kind of wealth building in my life as a dentist. I think that even if I have an associate mindset that says, I don’t know if I like owning a company, I don’t know if I want the risk or the worry or I want to manage people, I’d say those comments are coming from a lack of information.
I would find it way more stressful and way more risky to not own the practice and to be a victim of it than to own the practice and control it. If I don’t want to manage that many people, fine. I won’t have very many people. If I don’t want to do certain types of things, then I won’t do them. I’ll have someone else do ’em like I have control. I find it way more risky to be kind of at the receiving end of by chance whatever is handed to me from this practice I don’t control. I hope that makes sense.

Dr. Richard Low:
And this might even be its own episode. Maybe it’s a small conversation we can have right now. I do think it’s really worthwhile to explore the risk we’re suggesting arm yourself with the tools to do either of these extremely well, which eliminates or minimizes the potential risk and the alternative risk of not ever having owned and working for someone else because of fear we’re saying is actually higher than the minimized risk of owning via either of these routes. But I do think there is a part of people’s worry that relaxes when we can dissect the risk of these two options. So what is the risk of a startup and what is the risk of an acquisition And understanding how to do it poorly sometimes then illuminates, okay, I need to not do that now. I need the tools to do this well. So that’s a conversation I’d love to have of what is the risk of a startup done poorly and what is the risk of an acquisition done poorly? And then we can spend future episodes talking about doing these well and the implications of them.

Dr. Scott Leune:
Yeah, well, in a big picture sense, the risk of owning a startup or the risk of owning acquisition is that your business is eating away cash to the point you run out of cash. Okay? That’s the financial risk. So you are losing money to the point that you spend whatever you have in reserve. That’s the risk. There’s also this kind of emotional risk, this management risk that says that you allow yourself to become sucked into and burnt out by the day to day of running the practice. Then we’ve got a lot of other risks that I find insignificant, like the legal risk. I find things like that insignificant because legal costs of lost lawsuits are tiny. They’re covered by insurance so often they’re very small in occurrence. There’s a lot of these kind of serious sounding things that are very scary in their words, but they’re insignificant when you statistically look at what’s actually happening.

So I think the big two risks are the money and the management and how do we get rid of the financial side of this, the risk, well, one easy way to de-risk ourselves to be well-funded. So we get a big fat loan for a startup, we get a big fat loan for an acquisition. It’s not that we’re being irresponsible by taking on debt we don’t need, no, it’s getting the extra money in case we ever get in a situation where we do need it. If we take that money, we’re not going to use it unless we need it. That is being well capitalized. That is much lower risk than barely getting enough money to acquire this practice or barely getting enough money to open the doors of startup. We have to be very well capitalized. Then in addition to that, we have to understand, we have to get trained.

We have to understand how to run a company where it doesn’t lose money, and we have complete control over that. Just like we’re trained on how to do a filling and not pulp the freaking tooth. We’re trained on how to cut a crown prep and not get too close to the bone. We’re trained and sometimes bad things can happen, but in order for us to lose all of our money, we’d have to be pulping our business every month for an extended period of time until we’re out of money, we can get trained to not freaking pulp our business every month for a year. So we have to get trained to not lose the money in the operations while we are well capitalized from our loan from starting or buying this practice that gets completely rid of this fear that we have on the financial side if we’re thinking about it logically. Does that make sense?

Dr. Richard Low:
It does, and I’ve experienced this. I have in the denture implant model, I bought a practice about three years ago, maybe three and a half at this point, and within the first year because it is not a GP practice that has a recurring hygiene base, and I was not using the marketing that my now partners have used successfully in this model. It’s a high risk model. You have to spend a lot on marketing and if there’s no new patients coming in the door, I ran out of my reserves $200,000 in the back half of that year, I watched as money went down, I did not pay myself and the reserves ran out. So I have experienced what it feels like to have that risk as an owner, and that’s what we minimize and have figured out for our offices. But I think two other, I think both startups and acquisitions, I see very specific scenarios in a failure to execute, but they’re, they’re different.

So with a startup, I think if someone has the tools and the education, they then can be successful doing that on their own. They can also, because you’re building so much, there’s a lot of decisions, there’s a lot of systems, there’s a lot of momentum there. Marketing the growing of a dental practice, this failure to thrive when someone does the DIY version of it, there is an extended risk of pulping your business every month because you don’t know how to effectively market and you’re doing it on your own. You do not have the coaching, you do not have the support. So what you just said, being well capitalized in a startup allows you to have accountability, have coaching to afford marketing, to invest back into the business. And if someone is not well-informed, that is where I see the most risk is that someone does it and doesn’t execute well.

And there is this failure to launch, failure to thrive from both a lack of knowledge, but sometimes a lack of execution. On the acquisition front, I think that risk is concentrated in the acquisition target. So someone does the DIY version of an acquisition, they buy a three op $400,000 practice that just doesn’t have enough margin, but it’s the dentist that they grew up with and they feel comfortable with this practice down the road and that risk is its own version of this cap of what’s possible. Or they buy the 200,000 or the 2 million practice that is doing procedures that they can’t replicate, and as soon as they drive that off the lot, it instantly loses value because they can’t have case accept or they don’t yet have case acceptance, they don’t have diagnostics at that level. But my point is that the risk is concentrated in that upfront decision, and once again, if they get help in the execution of choosing a practice, that risk is minimized to the point where you proceed if it’s a green light and it’s a great opportunity, you don’t proceed if it’s not a great opportunity. So I think some of those specifics of failure to launch and failure to choose the right acquisition target are some of the biggest areas of risk that I’ve seen.

Dr. Scott Leune:
I would restate what you’ve said. If you DIY it, that’s actually the point of risk.
So if I take my cousin and I hand him some YouTube videos on how to prep a cavity and I hand him a high-speed handpiece and say, go, he’s going to DI WT and he’s going to pulp some teeth. There’s a big difference between that and actually going through dental school and learning the proper way of doing it. I think if we learn the proper way of doing the startup and follow that advice and we learn the proper way of acquiring a practice and follow what we learned, assuming we’re capitalized enough, the risks are tiny, but we like to think of them, we like to blow them up, those fears, those risks, and we hear stories all the time of people that have screwed it up, but those were the people that just watched the YouTube video and did it.

They weren’t following proper training. So like, okay, buying a practice for 400 grand that has no margin. Well, you wouldn’t be taught to do that unless there are these certain steps that you could take in that specific location to make it profitable or buying a 2 million practice that it relies heavily on the procedures you don’t know how to do. You would not be taught to buy that practice either unless you took some very specific steps to de-risk that moment. Those are extremes and those are the extremes that screw people up that haven’t understood how to do it. So a listener here, whether you’ve bought a practice or started one or not, if you’re thinking about the next practice, the very best thing you could do is learn the right way of doing it because it really does work that way. There really are right ways, and then there’s ways that have heavy risk.

There’s recipes you could follow or you can just kind of do a pinch of this and a pinch of that and hope it works, and sometimes that doesn’t work. So startups, yes, you could go do it yourself. You like the neighborhood you live in and you want your kids to go to school there and you find a spot that’s available for a practice that has windows and it gets you all excited because Starbucks is across the street. Sure, you could go build a really expensive equipment practice there in that location and fail because it didn’t need a dentist because you didn’t have the proper budget, you didn’t follow the right method, the right strategy. Of course that happens to people that just wing it. I’m not talking to the people that are just going to wing it. Good luck to you guys. Y’all are making it difficult for the rest of us freaking us out. You’re freaking us out with your failed winging, but those of you that don’t wing it, let this be the universe telling you right now, you need to go learn how to do it the right way. Just like you’d learn how to use the laser before you zap a patient with a laser, go learn how to do it the right way and then go through the process to go own this practice. For sure.

Dr. Richard Low:
This is great. I love that you just kind of minimized or made fun of the ways that you can fail here because that’s what people need to hear is that the ways that people screw it up are not because this is an inherently risky process. It’s because they’ve failed to arm themselves. Because if they knew anything of what they were doing, they would steer clear of these types of opportunities, of site selection, of cost, of doing the startup of acquisition target, too big, too small, inappropriate. If you have the knowledge, it is really easy to identify this is not a good opportunity. This is not a good startup site. This is not the way that I want to build a practice or acquire a practice,

Dr. Scott Leune:
And it’s kind of counterintuitive, but who needs the knowledge the most is the dentist that already owns practices kind of counterintuitive, but the dentist that already owns practices that adds more locations, has less of an ability to put their all in that next location and impact it or fix the problem or see the problems. They have to be at a higher level of maturity of not just knowing how to do the next one, but also managing their own and understanding how to stretch themselves across the organization. So that’s the dentist that maybe needs it the most, but we or I kind of label it as the associate that I’m talking to right now because they’re the ones scared. They’re the ones being influenced by misinformation. It is just like someone tries to put an implant on thin crest bone on a smoker and it doesn’t work out, and then they go tell the world don’t do implants.

No, that’s not how it works. There are startups being done every freaking day that are wildly successful. There’s acquisitions happening. Even when you don’t think anything good is available, you don’t know how to look at it because you haven’t been trained. What doesn’t look good to you might look amazing to me. So get trained and then look at the world and then decide here in my area that I’m considering living here is what’s available to me on both sides of this coin. Which side is prettier for what I want to do? Let’s look at both sides and let’s make sure we polish that coin first.

Dr. Richard Low:
So I don’t think you can overstate the point you just made, which is the person who should be the most careful about this is the successful practice owner of a single site who’s looking at adding more because what was successful in that first location with them as an owner operator that can be onsite and can manage and operate that business hands-on is not necessarily what is going to work or with the same margins or with the same degree of flexibility in the second or third location. And so I think that owner is the one who needs to be the most cautious and the most well-informed and arm themselves with the best tools. And that is also why we’ve biased towards growing a single site into a multi-doctor location when possible and applicable minimizes some of these risks of the potential for overconfidence and exposing yourself to multi-location risk because instead you’re the owner operator there, a lot of the overhead is covered by a larger hygiene base by associates, the profitability goes up. So I will continue to return to some of my biases of one large location versus multiple single site GP offices when a possible and when applicable and when advisable. But in general, I steer people in that direction and I’ll let you push back as you have on other episodes and say, no, it is possible to do multi-location well as well if you are appropriately informed and armed, and I’ll continue to raise the red flag for people.

Dr. Scott Leune:
Yeah, I think I keep harping on this and I apologize if it’s getting to be too much to some listeners, but I really feel like so much of our success, so much of the path we choose in our career is heavily impacted by what we’ve learned. And so many of us, we quit learning when we got out of school, maybe the occasional course here or there over something dental related, but what we never studied is our career. We never got a degree in the career of dentistry. We got a degree in the practice of dentistry. And so many of our complaints are about the career of dentistry. They’re not necessarily about the practice of it. So I’m hoping that I’m speaking to someone right now that maybe you’re ready to start getting a degree in the career of dentistry. And with that, you will learn there’s so many low risk ways to build freedom, and that’s financial freedom, that’s time freedom.

That’s the freedom to do the dentistry you want. And of course every way there is to build freedom. There are also examples of people doing it wrong and having a bad result, but that should not scare you away from at least learning how to do it right. So yes, we’re going to talk in, I’m assuming the next episode about buying or starting and having four or five or 10 locations, and where are those points of challenge and where are the points of benefit? Let’s talk about the granular moments in that whole story. But before we do that, I have to tell people, I have to tell listeners, maybe it’s time that you get a doctorate, maybe not even a doctorate, a bachelor’s degree, and the career of dentistry, it will completely change your thought process, your decision making, who you listen to, how you prioritize things. It will probably even change what you think you could accomplish in your life outside of dentistry is when you understand the business side of what you’re going to do for the rest of your career.

Dr. Richard Low:
This is great, and I, I’m going to continue to on air out my laziness around startups because there’s a real part of me that feels like, oh no, I am too much a perfectionist. I delay in decision making. I’m not as good of a project manager, therefore a startup is not a good fit for me. So I will continue on air to bring up these concerns that maybe I should probably shove down, but so that you can challenge me and we can arm me with more of the skills and tools and also realize I don’t have to do all of the stuff if I get the appropriate help and support. And I should absolutely be evaluating startups in my area. If I’m considering GP practice ownership. Again,

Dr. Scott Leune:
I’ll tell you, if you don’t feel like you’re a good manager, a good leader or a good operator, you don’t have a handle on all those kinds of business things. Yet, buying a practice is more difficult than starting. You buy a practice overnight, you got seven employees, you got 30 or 40 patients showing up a day. Your bills are double or triple of what a startup is. A startup is slow when you open and you got 18 months to prepare for it. It’s like you’re in labor giving. You’re pregnant with this startup practice. It takes 12 to 18 months to deliver it, and when you deliver it, it goes slow. It’s got three patients a day, it’s got two employees open three days a week. That’s the easier way to learn and perfect being a manager and a leader and an operator. So I think just a lot of us have painted startups with this color of risk that gets at some point, it gets irrational to me, but I get to say that because I’ve lived both sides of this equation, I’ve done both. So I’m coming from a different position than I think a lot of people are.

Dr. Richard Low:
Yeah, absolutely. And to throw the punch back, the acquisition, you just have to not screw it up. You buy it and you don’t break it. And if you can do that, then here we go. So this is good. We’re actually getting into the debate here that we’re going to have to continue on this next episode. But I will say I continue on air to air my flawed thinking and let you take the punches because I think our listeners might have some of the same flawed thinking that I do, or same laziness or proclivity towards one or the other. And we are going to continue to challenge your thinking to really lean into both become an expert in both arm yourself with the tools and know exactly who you would hire to get help on both. And just realize that is the best money you could possibly spend is hiring someone to help you do a startup extremely well, or hiring someone to help you select the right practice that is a green light that is ready to grow, that is ready to operate at a high level with you as the owner operator. So this is going to be a good series of episodes, and we’re going to have to talk about, like you said, multiple locations, the financial implications a little bit more in concrete detail. We’ve got a great series of episodes coming up here.

Dr. Scott Leune:
I’m excited. And by the way, this is the only way to get to the truth of the matter is to push back from both sides. That is the most valuable thing we can do here. So I appreciate the punches.

Dr. Richard Low:
I love it. Thank you, Scott. We’ll talk to you next time on the Shared Practices Podcast.