Dr. Deena Kuempel answers questions about the process he followed in starting a periodontal practice from scratch in Iowa...

Bridging the Way: 2003 Student Event
STARTING YOUR OWN PRACTICE

Below is an interview with Dr. Deena Kuempel.

Deena Kuempel, D.D.S., is a private practitioner in Cedar Rapids, IA, and has been a member of the American Academy of Periodontology for 6 years.  Prior to returning to dental school and becoming a periodontist, she was a hygienist for 12 years.  She is a member of the Committee on the New Practitioner and consultant to the Committee on Public and Professional Communications.  She received her D.D.S. in 1995 and periodontal certificate from University of Iowa in 1998.  She became Board certified in 1999.  She's married and has a 16-year old son and a 14-year old daughter.

What was your plan after graduation?

My original plan was to associate with one of the two established practitioners in the area with whom I had decided I wanted to practice.

What made you consider starting your own practice?

When those people were contacted, in one case the interest level was not enthusiastic and in the other the physical plant would not accommodate two practitioners. Also, there was a long established staff that I was concerned may not be open to a new practitioner with new ideas. The fact that I was a woman also concerned me that their acceptance of that might be difficult. There was also a practice for sale in the area, but I felt the asking price for a 3-4 year old practice with minimal active patients was way too high. I offered a lower price but a practitioner came in and offered more and was awarded the practice.

What factors affected your plan and decisions about your career and future?

I knew where I wanted to locate and was fairly inflexible about that. Therefore, my choices about establishing a practice were fairly limited.

How did you begin the process of starting your own practice?

Talking with other dental professionals, mainly an orthodontist friend, who had gone through this process just a couple of years earlier. I had a realtor in the area that I had worked with before to help with finding the physical location. I chose a local bank with the idea that a smaller local bank might be more open to new business in the area.

What variables influenced your decision on location?

My family. Elderly parents and a husband with a good job that he enjoyed made me want to stay in the area that I had chosen.

Did you meet with an attorney, practice consultant or accountant before pursuing a loan? Why or why not? What did they do for you and why was it beneficial?

The University of Iowa had a Small Business Consultation office in the School of Business. They were helpful in assisting me with developing a business plan. They also gave me advice on what statistics I might take into the meeting that would drive home the point to the banker that I would be a good risk. My realtor was extremely helpful in choosing location, negotiating a lease contract and also in providing information for the bank.

How did you determine the financial requirements for starting a practice?

I mainly used information provided by the dental supply people. They ultimately were a little low but gave me a good starting point.

How did you obtain financing?

I met with the banker and presented my business plan along with several statistics that prove that dentists are good risks for investment.

What risks were involved in starting your practice?

There certainly is a risk of pride. What if you don't succeed? There is also a risk financially. You could lose a lot if it doesn't take off as you have planned. But who better to bet on than yourself. You will put in long hours, answer a lot of phone calls, do more cleaning than you thought you would ever do and you may not use your skills as a periodontist as much as you would like initially.

How did you assess and manage those risks?

I was fairly well educated on what would happen as I had been a hygienist before going back to dental school and my first job was with a periodontist who started a practice from the ground floor.

What is your situation now?

I am four years into my practice and have a small staff of 1 receptionist, 1 assistant and a part-time hygienist. I have been able to meet my expenses almost from day one. People say that is not usual. I do not take a big income however, and that is the benefit of having a spouse who can pay the house payment and provide for the family. It is sometimes frustrating though, as friends are accumulating spendable wealth and you are gaining assets that cannot be used for personal gratification directly. You definitely have to be able to look down the road a few years and realize that these assets are a good thing too and when you are done paying the bank that money will be yours.

How did you structure the practice's finances in the beginning to pay the bills, yourself, staff and to buy equipment, etc.?

As mentioned above, I have met my expenses from day one. My structure was to keep a small office. It was me and a receptionist/assistant for the first year and one half. I was very conservative on when I should hire another staff member. I was/am not afraid to answer the phone, type letters, pay the bills and do dentistry.

What financial issues or considerations came into play when planning for the future?

When to expand my office has been a big decision but in the end those decisions seem to make themselves.

Using real or fictitious numbers, how did the realities of your finances compare to the plan you originally outlined?

I originally thought it would take about $100,000 to set up my office with 2 operatories. I chose to do some things differently than initially intended and costs were also greater than I was initially informed. In the end I had borrowed almost $200,000. I did intend to be in this location long-term and do feel that you spend more time in your office than your home and therefore you have to be happy with your surroundings. My office is not flamboyant but clean in appearance, friendly looking and comfortable. I find patients appreciate these things too. I have since completed my remaining 3 operatories for approximately an additional $80,000.

What resources (i.e., people, publications, groups) did you find the most helpful?

People who have done this before you are great resources. Bankers, dental supply people, other dentists and realtors all are very helpful.

Given what you know now, what might you do differently?

I don't think I would change anything that I have done with my office design or equipment. I did go to fee for service this year. I have never been a participant in any insurance program, but did give some flexibility for patients to pay me after the insurance company paid them. I would start out as fee for service from the start if I were to do it again. The only bad accounts that I have at this time are people from my early practice.

What suggestions do you have for individuals considering starting their own practice?

Get information from those who have done this before you and don't be afraid to gamble on yourself. Realize it won't be an easy trip but it will be your own, your way.

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