Solo, Group or Managed Dental Practice?



By Deborah E. Bush, Partner & Managing Editor of Dentist Profit Systems LLC



“Deciding on a solo, group or managed dental practice is a personal preference based on a dentist’s individual desires and goals.  Each has advantages and disadvantages,” says Susan Kulakowski, Director of Practice Enhancement at Dentist Profit Systems.


Are you starting your career or leaving an existing practice?  Are you hoping to switch gears in order to create a less stressful life or better business environment? No doubt, you have been wondering if you will do better establishing a fresh practice, associating with an existing practice, or searching for a job in a managed group environment.


Deciding on a solo, group or managed dental practice is a process of weighing pros and cons.  Numerous priorities that drive success and happiness should be considered.


On Learning, Mentorship, and Coaching…


No matter which way you go, there is a learning curve.  Evaluate the opportunities before you with an eye on best learning opportunities.  Ideally you will find a practice in which you have the opportunity to work with a mentor you admire – or you will begin a fresh practice with the help of a practice coach with experience in starting a dental practice.  In any professional practice today and especially in the dental market of 2014, continuing education should be a priority.


In order to stand out and brand your excellence, you need to develop your behavioral, technical and clinical skills; sharpen your vision of how you want to practice; and distinguish your services.  Whether you do this through excellence in limited procedures, all procedures, or focus on a therapeutic niche such as sleep apnea, you are still pursuing artisan dentistry.


I know this sounds obvious but it’s only a percentage who passionately follow through and do this.  The costs concern them.  The true ROI escapes them.  No matter which style of practice you join or build, surrounding yourself with encouragement and other expert learners can make all the difference between happiness and disappointment.


Because there are so many aspects of dental practice (behavioral, clinical, technical, and financial), take time to study what others have done and learn from their insights.  An integrated system of continuing education courses (mastership, fellowship, internship, residency, mini-residency, or continuum program) in a supportive environment, as well as an active relationship with a committed mentor (employer, partner, senior associate, dental coach, study club leader…) will help you enjoy your career, give your patients best care, and stabilize you financially in anywhere from one-third to one-half the time of a new practitioner struggling to put all the pieces together on her or his own.


Mentorship Considerations


When responding to opportunities to associate with an established dentist, you’ll need to determine if you like the way the principal dentist does things and whether this dentist will be a committed mentor to help you learn the business of dentistry.  Working with such a mentor, you can gain important experience at a faster rate.


Many new dentists prefer to find a fine dentist or group of dentists in their community of choice who will offer them two years of mentorship and be open to partnering with them going forward and eventually purchasing the practice.  At the start, these new dentists may not make much money, but the experience gained is priceless.  The mentoring dentist will have an eager associate to carry part of the load at a time when the more mature dentist wants to spend fewer hours in the practice.


“Without expert guidance, starting out (or starting over) in a new practice, may not give you a financial advantage and peace of mind,” says Kulakowski.  “If you create a new practice with the hope of greater income, in addition to the great financial commitment you will be making, you will be concerned about attracting enough patients and being productive enough to successfully generate adequate income.  Because it is difficult for a dentist to provide excellent patient care, manage the patients and staff, and still run the practice as a healthy business, a management coach can be extremely beneficial.  With this mentor in place, the practice will realize a greater level of productivity while management systems, good communication, and excellent service are ramped up much more quickly.”


Today, there are opportunities to be hired by a practice management company that will free you to do the dentistry while it does the accounting, marketing, software solutions management, and human resources management.  If you are considering these opportunities, keep in mind that you will want to have a dentist-mentor or dental coach while you learn the business of dentistry — and, you will still need to build a reputation for excellence and expertise.  You will want to join a company that allows you to serve patients in the way you aspire to serve “your” patients.


Group Practice Considerations


A group practice can provide the opportunity to mentor and be mentored both in a clinical and business sense, along with the opportunity to share the joys and challenges of dentistry.  Many group practitioners appreciate having colleagues within the practice to consult with, find solutions, and receive encouragement.


According to Kulakowski, “A group practice shares the management responsibilities required to run a successful practice through effective systems management, personnel management, budgeting, marketing, facility improvement, technology, and continuing education.  The distribution of management responsibilities can make it less stressful, provided they are shared equally.  An unequal distribution of duties and responsibilities can create major problems.


“In a group practice, the doctor communication must be high.  Ineffective doctor-to-doctor communication contributes to leadership issues.  There must be strong, positive, and united leadership and a high level of teamwork.  In addition to effective communication and equally shared duties and responsibilities, the philosophy and goals of the new associate must be congruent with the group’s philosophy and goals.  If they don’t match, the new associate and practice are setting themselves up for probable failure.


“Also, bigger is not always better, and can actually contribute to greater management headaches.  The more doctors and team members in a practice, the more the challenges there can be.  There is greater potential for communication and system breakdowns, which results in diminished practice efficiency, increased conflict, and greater staff management issues.  So, even though there is potential to share in responsibilities and mentor each other, oftentimes practice coaches need to be called in to help the doctors define their roles, establish better systems, and create a group vision that all doctors own.”


Solo Practice Considerations


“In contrast,” says Kulakowski, “a solo practitioner determines his or her practice vision and goals and makes revisions as desired.  All clinical and management decisions are compromise-free.  Personnel selection and staffing, patient and practice policies and protocol, procedures and materials, equipment, budgeting, internal and external marketing projects, facility and technology improvements, and continuing education are all at the doctor’s sole discretion.  The dentist maintains full control of his or her own practice.”


Is this the best way for you to start your career? It well could be — if you can get the financing and practice coaching needed to be successful.


But, What About the Managed Practice Opportunity?


It comes down to knowing yourself and if this is the safest and happiest way for you to start practice (or start over again).


Assuming a well-managed and supportive company, you can grow as a doctor and enjoy your patients—even develop long-term relationships with them.  Examine these opportunities with an eye on the track record and philosophy of the company, the experiences of dentists who have worked for them, and your opportunity to develop expertise and self-autonomy that will satisfy you personally.


Consider the lifestyle you will live, community you will serve, pressures that will be on you, freedom to serve patients to the highest level you desire, marketing and operational systems in place, income opportunity, length of contract and non-compete agreement, and supportive services offered.  Think about the many things that will make you happiest.


*   Will you be able to arrange days off for the continuing education you want to pursue? 


*   Will you be serving the demographic you want to serve?  


*   Will you be able to spend the time you want to spend with your individual patients? 


*   Are there quotas for services or other expectations that will bias your treatment planning? 


*   Will you have opportunities to practice the higher value services in which you want to gain experience? 


A list of pros and cons should be developed before you make a decision and choose from among the choices available.


Dentist Profit Systems is Uniquely Positioned to Help Dentists Choose 


Because we are a dentist marketing company run by a CPA, CGMA, who advises hundreds of physicians and dentists on financial and business management, and have one of the nation’s most noted dental practice consultants on our team, we are ready to help you make the best decision based on your goals and the potential for success and happiness.  Whether a practice owner is hiring you or whether you are evaluating a solo or group practice environment, we are here to help you:


*   Assess your temperament for risk,

*   Ask the right questions,

*   Define your long-term goals,

*   Define you near-term objectives,

*   Find and understand your options,

*   Run the financial numbers,

*   Develop your decision tree, and

*   Review contracts and agreements.


Reach out to if you are facing a new practice decision and would like help.