Drs. Michael K. McGuire, Bobby L. Butler, Marc L. Nevins, and Denise Shapiro answer questions about their experiences starting a periodontal practice...

2006 Student Event: Ride the Wave to Success
Starting a Practice

Drs. Michael K. McGuire, Bobby L. Butler, Marc L. Nevins, and Denise Shapiro answer questions about their experiences starting a periodontal practice.
Photo Dr. McGuire is in practice in Houston, Texas. He completed his periodontal residency at Emory University in 1979.

What was your ideal plan after graduation?

My plan after finishing my residency in 1979 was to open my own practice limited to Periodontics in Houston, Texas.

What made you consider starting your own practice?

I wanted to be my own boss and the idea of my own practice was appealing.

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

My early mentors were young periodontists in private practice. How did you begin the process of starting your own practice? I visited a number of perio offices and collected as many ideas as possible.

What variables influenced your decision on location?

I considered three areas of town that were growing rapidly at that time, and found that two of the three had a new periodontist. I then focused my efforts on the third area and looked for office space in a professional building that was on the fringe of established Houston with high growth areas adjacent to it. In this general area, I found three suitable professional buildings. An endodontist beat me to the space in one of the buildings, and one of the other buildings was partly owned by a periodontist and he was not willing to rent space to a competitor. Based on that, I chose the third building and signed a lease for 1,200 square feet.

Did you meet with an attorney, practice consultant or accountant before pursuing a loa

n? Why or why not? What did they do for you and why was it beneficial? I did have an attorney that helped me negotiate my lease, but I did not use an accountant during the processes of setting up my practice. I was watching every penny and I did not feel the need for a practice consultant. In fact, I did not know what a practice consultant was.

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

The financial requirements for opening the practice were primarily determined by calculating the cost to build out the suite and buying equipment. I also had a small amount of money set aside for six months of operating expenses.

How did you obtain financing?

I visited two banks in Houston, and was able to take out a $70,000 unsecured loan payable over seven years.

What risks were involved in starting your practice?

It was a very scary thought to think about this note payment and rent due for the foreseeable future without one patient in sight.

How did you assess and manage those risks?

I tried to build my practice through visiting all of the dentists in my area.

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

The loan covered the build out of my suite, equipment for two operatories, and furniture for the reception room. I hired one employee who could assist chair side and answer the phone when it rang, which was rare. She had no periodontal experience, but then again neither did I, but she did know how to fill out an insurance form, which I had no idea how to do.

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

By 6 months, I was making enough money from the practice to pay the bills and by 7 years, my note was paid off.

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

The other residents in my class along with my periodontist mentors were the most helpful.

Looking back on the choices you made, is there anything that you would do differently?

No.

What is the most useful advice you can offer to someone who is considering starting a practice?

The best advice I could give someone in their residency who wishes to set up their own practice is not to spend lots of time as an associate in someone else’s office if your goal is to set up your own practice and be a solo practitioner. It just gets harder, and the quicker you get started the better off you will be.

What do you like most about being a periodontist?

There are many things I value about being a periodontist. From a business standpoint, one of the nicest things is that you are your own boss, and are in as much of control of your own future as you can be. We are not a part of any dental plan and, therefore, have complete control of our fees and how to run our office, and there is great potential to have significant financial rewards, while at the same time, be able to provide patients with procedures that greatly enhance their quality of life. Photo

Interview with Bobby L. Butler, D.D.S.

Dr. Butler is in practice in Seattle, Washington. He completed his periodontal residency at University of Florida in 1993.

What was your ideal plan after graduation?

To start my own practice. I chose an area where I wanted to live and started my own practice.

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

I did not have a lot of debt nor did I have a family that required significant income.

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

I researched the general dentists in my area and located where a new periodontist had not gone in many years.

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?

I only met with an accountant. They helped with my loan Performa.

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

I priced out all equipment, supplies, and staffing expenses as a part of a business plan and loan Performa.

How did you obtain financing?

I went to several banks until I found someone to give me a loan.

What risks were involved in starting your practice?

There were many Periodontists in my area and competition was extreme.

How did you assess and manage those risks?

I tried to set myself apart and offer different services. We had varied hours, and offered patients the option to get in without notice.

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

We worked off of a business plan and planned for the practice to run overhead from our loan for 6 months. We started to show some profits at month 4.

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

I did not collect a salary myself for 6 months.

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

We showed a profit 2 months before our plan.

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

Going office to office and handing out referral slips and making lunch appointments.

Looking back on the choices you made, is there anything that you would do differently?

No.

What is the most useful advice you can offer to someone who is considering starting a practice?

Be patient and be prepared to work hard. Always be available and extend your hours for people to see you late in the day or early evenings.

What do you like most about being a periodontist?

I like running my own practice and I like choosing the types of surgical care I focus on. Photo

Interview with Marc L. Nevins, D.M.D.

Dr. Nevins is in practice in Boston, Massachusetts. He completed his periodontal residency at Harvard School of Dental Medicine in 1997.

What was your ideal plan after graduation?

I wanted to start as an associate and work into a partnership.

What made you consider starting your own practice?

I had an opportunity to transition an existing practice into a partnership with a transition to solo practice.

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?

A practice consultant developed a win/win business transaction for the practice and I then utilized an attorney and accountant for the transaction.

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

It is important to make a realistic business plan accounting for conservatively estimated practice growth to budget the financial requirements for the practice. I used a dental financial specialist for advice on these matters (Cain Watters and Associates).

How did you obtain financing?

I used a commercial lender and obtained an SBA guaranteed loan.

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

It is important to have working capitol included in the business plan.

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

It is important to make sure a realistic budget is used to do the planning. You want to be able to pay the bills and draw some salary from day 1 to alleviate added stress. The working capitol helps with this.

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

The plan was very accurate.

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

Dental financial specialists Cain Watters and Associates specializes in practice transitions and dental practice finances. My partner Dr. Marilyn Canis was a key resource from her experience in running the practice.

Looking back on the choices you made, is there anything that you would do differently?

No.

What do you like most about being a periodontist?

The excitement of new challenges. Every day the practice changes a little with new advances. Photo

Interview with Denise Shapiro, D.D.S.

Dr. Shapiro is in practice in Providence, Rhode Island. She completed her periodontal residency at Boston University in 1987 .

What was your ideal plan after graduation?

After graduation I was thinking of either an associateship with or without a partnership ultimately. School does so little to prepare you for the real world.

What made you consider starting your own practice?

I worked for 4 years in a variety of practices including a clinic, general dentist offices and periodontal offices. I realized that I could run a better practice on my own. I had fine tuned my clinical skills, was highly organized, and felt I had an excellent business sense.

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

I began the process of starting my own practice by determining how much it would cost to rent space, pay for equipment, supplies, and a staff of three. I gave up various jobs so that I was available three days a week yet kept my favorite job in a general dental office two days a week so that I had a guaranteed income still coming in.

What variables influenced your decision on location?

I started in a location in which I had already gotten to know some of the general dentists. If I had it to do all over again, I would have started "cold" in another area with fewer periodontists. There are only 20 periodontists in the whole little state of RI and about 10 of us are in a 5 square block radius.

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?

I met with an attorney and accountant I had already been using so I really trusted them and could have open honest discussions with them. We discussed the pros and cons of my plan and I got the go ahead. My accountant is also very conservative and I knew if he thought it would work that it would.

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

I met with several dentists who had started their own practices, primarily not periodontists, to look at office lay out and equipment and supplies needed, as well as wages of an office manager, dental hygienist and assistant. I studied the numbers carefully until I felt confident in what I needed to make to keep the office running. I initially was accepting of breaking even, which was not the case, but was willing to accept that as a possibility.

How did you obtain financing?

I saved money to finance much of what I needed for equipment and supplies and obtained a loan from my father, with interest (unfortunately for me). I did the same thing when I moved my office to a new building and had to gut the space and build/purchase additional equipment.

What risks were involved in starting your practice?

The risks are obviously having no patients coming through the door. I felt confident in my ability to run the practice if I had patients.

How did you assess and manage those risks?

I had a marketing strategy to meet with general dentists that was quite extensive and I kept track of who I met and results of various marketing techniques. I ultimately met with a marketing person who streamlined the process. That for me has been the most difficult piece of what I do. I still find that a lot of dentists do not want to try me out partly because Rhode Island is fairly provincial and not necessarily that friendly to female specialists.

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

I knew what I had to make each week to pay staff, rent and the loan from dad. I am still a solo practitioner and so did not have to pay myself at all. As I noted earlier, I kept another job so there was some income coming in.

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

I had financial goals that have been exceeded every year. I have been fortunate to work so efficiently that in 3 days/week I produce what a periodontist typically produces in 4 days/week. I have grown such that my staff and wages have grown as well. I think that one has to weigh the pros and cons of a smaller vs. larger practice. Larger offices have larger overhead and more waste.

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

My numbers exceeded my original outline.

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

The most helpful resources were other dentists. I was not shy about meeting other dentists and asking several questions.

Looking back on the choices you made, is there anything that you would do differently?

I would have moved to another state and/or started in another location in Rhode Island.

What is the most useful advice you can offer to someone who is considering starting a practice?

Running a practice successfully takes dedication, a lot of hard work and a good business sense.

What do you like most about being a periodontist?

I LOVE being a periodontist! Saving teeth and meeting patients for what might become a lifelong relationship is rewarding.

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