Expanding Your Dental Business from One Location to Two or Three is Easy, Until it Isn’t.

Young, energetic, and ambitious dentists can often easily buy their first practice. There are plenty for sale, financing is relatively straight forward, and one doctor can usually be productive enough to thrive in their first location. At the very least, a solo dentist can still do reasonably well in life, even if they make questionable business decisions.

With this newly found success, some of us who are gluttons for punishment start to think that if they can do it once, they can repeat their success and scale it up. The good news is you can. The realistic news is it gets harder with each location you add until you have built the appropriate infrastructure to accommodate for growth. If this is the path you choose and have expectations that align with the reality of this journey, it may not be bad. If this is your passion, like it is mine, then you will be fine, but you will have to work harder than ever.

In a business of any kind, at any scale, systems and teams are important. My business partner and I very quickly found out just how necessary they are as we acquired our second office less than a year after buying our first. Not only had we not yet refined our systems and assembled the right team in our first office, but now we had two. Just as many young owners of emerging groups have experienced before us, and will continue to after us, the amount of work involved and stress accumulated is exponential, not linear.

So, we got to work – creating marketing systems, buying equipment, hiring the right people, providing new SOPs and training for everyone, finding the right vendors for purchasing, outsourcing things which we could not internalize, and so on. You know, the typical things every office or group goes through. The work we put in was starting to pay off. Profits stabilized, cashflow improved, and predictability increased.

The daily challenges of dentistry and running a business would always be there, but perhaps our systems and teams were stable enough where we didn’t feel the stress as much, or we developed a thicker skin and were learning how to manage situations better. Perhaps a bit of both. Therefore, we thought, why not expand to a third? Surely we had enough knowledge and resources now. It can’t be that hard, can it?

The thing is, our third location was going to be mostly associate driven. For that to work, you need associates. We very quickly incorporated our systems and our SOPs into this new acquisition. We even brought in our existing staff to train the new hires and to build the scaffolding for success. What we learned from our first two helped us bring the third location up to speed very quickly. Yet, the whole thing seemed to bring on new stress, new challenges. Maybe it wasn’t as easy as some may believe.

This brings me to the most important of this all – systems and auxiliary teams are important, yet your biggest pain point when scaling up will be finding, training, and retaining dentists. Just like we created a marketing engine, a billing system, an human resources platform, and a lot more, having a dentist recruitment and retention system will be paramount if you want to scale up. Your way of practicing dentistry must line up with who you recruit – they need to be productive, ethical, engaging with patients and staff, and a reasonable human being.

In order to recruit the best, you have to be the best. Before you expand into associate-driven offices, ask yourself some questions:

What differentiates you from the competition?
Do you use the latest technology?
Do you compensate well?
Can you be a mentor?
Can you ask someone to perform a molar endo procedure when you yourself tremble at the thought? If you aren’t a top level clinician, perhaps that’s okay, but can you support the associate in learning?
Can you pay for their CE courses and reasonable new supplies and equipment they may need?
Can you create a pathway to success for them?

If you cannot provide these things, another dental group or DSO will. How you treat an associate will likely become the blueprint for the success or failure of your initial expansion. My humble opinion is to treat them like clinical partners. Support them the right way, and your dentist recruitment and retention engine will start to build itself. Don’t treat them like employees, or worse, a commodity.

We all start somewhere, and the first few steps of any journey set up the stage for the remaining. Here are some key takeaways from my journey:

Decide and stick to your core values, your list of the non-negotiables in your business and build on that.
This journey is full of lessons, so start learning as much as you can even before you think of expansion.
Maximize each location before bringing on further debts, challenges, and personnel.

After thinking hard about this, and answering a lot of internal and external questions, if you still want to expand, then get help from those who have done it before. Talk to people in the industry – there are plenty of resources, plenty of groups to be part of, and plenty of people who have been on this journey and have likely made the mistakes and faced challenges similar to yours. Yes, you can do this, but not with hubris; with humility, respect for the process, and with help from others.

I am aware that this short article is merely skimming the surface; expansion of your business can be a grueling yet rewarding process. There are many details and talking points; numerous opinions, viewpoints, and ways of accomplishing your goals. In the future I will delve into this topic more deeply.

Dr. Kartik Antani is a practicing dentist and CEO of Bergen Street Dental Management, an emerging group in New Mexico. Here to start and continue a dialogue of small practice to small group growth is his goal, from both a clinical and administrative standpoint. He can be further reached at kantani@gmail.com or 848.565. 5070.

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