A Simple Dental Practice Appraisal Formula

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Whether you are buying or selling a dental practice, the method used to appraise the practice can make an enormous difference in the success of the transaction. An accurate appraisal is vital for many reasons, including but not limited to:

Decreasing selling time

Boosting both buyer and seller confidence

Reducing the risks of practice failure during the transition

Better financing options

Simple Dental Practice Appraisal Formulas

There is no single best way to appraise a dental practice. It is both an art and a science, and is best performed by an expert. Still, it is important to understand the common appraisal formulas that are used.

Income-Based Valuation

Income-based valuation is the best way to appraise most dental practices. It is simple and easy to follow, and works particularly well for practices that have strong, growing patient bases and a history of revenue growth. There are two income-based valuation methods.

Capitalized earnings: This valuation looks at the practice’s net income for the prior year or the average of the past few years. The net income is divided by a cap rate of 25 to 31 percent to determine the fair market value.

Discounted cash flows: For this method, the next 10 years of net income are projected, and then converted to a net present value. The projections are based on a reasonable growth in costs, and then discounted by the assumed cost of capital plus a premium of 23 to 31 percent.

Market-Based Valuation

This valuation method assesses the market data of similar dental practice sales in your region. It is based on historical collections data multiplied by 60 to 80 percent. Although market-based valuation is appropriate in some scenarios, it is often considered less reliable than income-based valuation.

Net Asset Valuation

Net asset valuation considers both tangible and intangible assets. Tangible assets are physical property such as real estate and equipment, while intangible assets include practice goodwill. Since an estimated 80 to 85 percent of the value of a dental practice is intangible, it can be difficult to accurately appraise practices in this way. However, this method is useful for practices with either significant tangible assets or financial difficulties.

Appraising a dental practice is not easy. You can use a simple appraisal formula to get a rough idea of what your practice is worth, but only a professional can fully determine the best valuation method and take into account all the little details that can dramatically affect the final appraisal.

Ascent Dental Solutions is a full-service agency dedicated to helping dentists build their practices and map out their careers. It is the brainchild of Dr. Kevin Coughlin, who earned his doctorate at Tufts University School of Dental Medicine and currently serves as a faculty member there. While Dr. Coughlin continues to practice dentistry as the principal owner of the 14-location Baystate Dental PC, he has a strong passion for helping fellow dentists maximize their success. If you are interested in learning how to take your dental practice to the next level, please contact Ascent Dental Solutions today at 413-224-2659 to learn how Dr. Coughlin can help.

Estimating the Cost of Buying a Dental Practice

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Whether you are fresh out of dental school or have been working as an associate for several years, the time may come when you want to buy your own practice. More and more dentists are choosing not to go this route, opting instead for corporate dentistry, but there is an undeniable appeal to owning your own practice. Yet it can be tough to figure out exactly how much it will cost to buy a practice. Here are some considerations.

Valuation

The valuation is simply how much the dental practice is worth. This is determined by formulas that range from simple to highly complex, and is always an approximation. Still, the valuation is the jumping off point for negotiating a purchase price, so it is important to have a professional appraisal. Common valuation methods include:

Income-Based Valuation

Based on either capitalized earnings or discounted cash flows, income-based valuation works well for dental practices that have a strong history of growth. This type of valuation can be more challenging for newer practices and those that have gone through financial issues.

Market-Based Valuation

Market-based valuation can be a desirable choice for a newer practice without much history, as it is based on the market data of similar practices in the area. However, it is not generally considered as reliable as income-based valuation.

Net Asset Valuation

Net asset valuation attempts to put a dollar figure on not only tangible assets like chairs and real estate, but also such intangibles as the goodwill the practice has developed. It is tricky, since as much as 85 percent of the value may be intangible, but can be the right choice for practices that have had financial problems or have major tangible assets.

Other Considerations

At best, valuation is an educated guess. There is simply no way to take into account all of the factors that are part of buying a dental practice. Here are a few more things to consider:

Unexpected Overhead

Equipment breaks. Staff members must be paid. Operational budgets may not be streamlined. Although a careful look at recent budgets can help you plan, always build in a cushion for unexpected expenses.

Inherited Staff

Until you actually purchase the practice, you have no real way to know how the staff operates day to day. From family troubles to workplace feuds, staff members are human beings with lives that are often messy. Be aware that workplace productivity will never be as high as it seems on paper, and try not to schedule more than 80 percent of any individual’s day. Over time, you may need to weed out bad apples to boost staff morale.

Patient Transitioning

Accepting change is hard for most people, especially when it comes to their healthcare. Some may leave the practice altogether. Prepare your budget for a dip in patient numbers, and make a plan for actively recruiting new patients.

Referrals

If you are a specialist, tapping into an existing referral network is vital. If you don’t have a local network, and one didn’t come with the purchase, you will need to invest some money and time into building those relationships.

It is nearly impossible to predict all of the costs associated with buying a dental practice. However, if you start with a professional valuation and then set aside cash to meet unexpected expenses, you will go a long way toward quickly achieving profitability.

Ascent Dental Solutions is a full-service agency dedicated to helping dentists build their practices and map out their careers. It is the brainchild of Dr. Kevin Coughlin, who earned his doctorate at Tufts University School of Dental Medicine and currently serves as a faculty member there. While Dr. Coughlin continues to practice dentistry as the principal owner of the 14-location Baystate Dental PC, he has a strong passion for helping fellow dentists maximize their success. If you are interested in learning how to take your dental practice to the next level, please contact Ascent Dental Solutions today at 413-224-2659 to learn how Dr. Coughlin can help.

Corporate Dentistry vs. Private Practice: Pros and Cons

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Whether to pursue corporate dentistry or a private practice is one of the great dental debates of our age. Corporate dentistry has long been demonized for turning something highly personal (dental care) into a franchise model governed by the bottom line. Increasingly, though, some dentists have begun to realize that corporate dentistry has its own unique set of advantages. Ultimately, which route to choose will depend on how you see your career progressing.

Private Practice

If you are looking for full autonomy in the theories, practices, and techniques you choose, private practice is the best choice for you. As long as you follow the best practices outlined by your governing bodies, you are free to craft your practice however you see fit, from opening an in-house dental lab to offering cutting-edge techniques. You can focus your practice on a particular patient group, such as children or those with special needs. You can offer sedation dentistry or not, dental implants or not, all at your discretion.

Likewise, in a private practice, your time and earning potential are your own. If you want to golf on Tuesdays or offer late night hours on Friday, you are free to do so. With the right leadership skills, a deep understanding of your clients’ needs and desires, and a bit of luck, you can even earn a higher income in private practice.

However, the freedoms of a private practice come with a price. You are a small business owner, with all of the responsibilities that the title entails. You alone are in charge of hiring, scheduling, insurance filing, accounts receivable, vacations, workers comp issues, and all the rest. If you don’t have a solid, experienced team that you can trust, you may find yourself spending more time handling the business side of your practice than you do practicing dentistry—yet you only make money for the time you spend actually treating patients.

Another consideration is how established corporate dentistry already is, or is likely to become, in your town. With a huge marketing machine and the ability to offer targeted incentives based on market research, corporate dentists are very difficult to compete with. Once your practice is up and running with a loyal client base, you may be able to withstand the onslaught. However, it is incredibly tough for new dentists to gain traction when competing against the big corporations.

Corporate Dentistry

If you want to focus solely on dentistry, corporate dentistry may be a better choice. In many cases, you can negotiate a schedule and salary that are guaranteed regardless of the ups and downs of the market. You may even be able to negotiate a part-time schedule, such as four days a week at your preferred hours, that pays the salary you would like. In nationwide groups, you may even have the freedom to simply transfer to a new location if you decide to move.

In addition, you will most likely not be assigned duties outside of the typical scope of dentistry. Hiring and firing, accounts receivable collection efforts, patient and staff scheduling, training, and all the rest are typically handled by the corporation’s team rather than the dentists.

However, corporate dentistry also has its own drawbacks. You will be a cog in the corporate machine, expected to maximize the practice’s income. You may be constrained to a specific theory of dentistry and limited only to the techniques and materials that the practice selects. Your treatment plans may be scrutinized by corporate management, and you may be asked to attend meetings where specific ideas are strongly pushed. You will likely be unable to try out new, cutting-edge techniques or strategies.

Ultimately, there is no right answer to the question of corporate dentistry vs private practice. Your personal and career goals, your approach to dentistry, and even your location should all factor into your decision. If you do decide to practice corporate dentistry, make the effort to find the right fit. Just like any other service industry, there are excellent, good, marginal, and poor dental organizations. Of those that are good to excellent, some will be a better fit for you than others.

Ascent Dental Solutions is dedicated to helping dentists build their practices. If you are interested in learning how to take your dental practice to the next level, please contact us today at 413-224-2659.

Checklist for Buying a Dental Practice

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Whether you are newly out of dental school or have been running your own practice for years, buying a dental practice is a huge commitment. It is absolutely essential to do your homework, ensuring that the practice you select will truly serve your needs. In addition, the paperwork requirements are significant, requiring a great deal of time and effort. With so much going on, it is easy to overlook some very important steps. Here is a checklist to keep you on track when buying a dental practice.

Research Phase

The first step is to research available practices in the area you would like to serve. Make appointments to go see each practice and speak with those in charge. Examine the existing equipment and make note of anything you would like to upgrade or change. Talk to the staff. Find out how many regular patients are currently on the books. Learn as much as you can about the practice’s current financials.

Build a Team

Once you have narrowed down your list to the ideal practice for you, it is time to build your team. At a minimum, you will need to retain a CPA and an attorney. You might also choose to add a business coach, a partner, and other professionals who can help make your transition as smooth as possible.

Apply for Financing

Although some dentists wait until their offer is accepted to find financing, it is far better to obtain pre-approval for a loan. Presenting a letter of pre-approval reassures the seller that you are serious and minimizes the risk of the deal falling through, which can help move yours ahead of offers from other dentists without pre-approval.

Make an Offer

Remember that you are not buying an inanimate object. You are purchasing another dentist’s life’s work. He or she has worked very hard to build the practice and form relationships with both the staff and the patients. Therefore, a lowball offer, like you might make for real estate, is inappropriate. While you certainly want to leave room to negotiate, and to get the best deal, consider the full package when preparing your offer. A fair offer shows respect and will be seriously considered, while a lowball offer may cause the dentist to move on to the next offer without negotiating.

Also include your letter of pre-approval, as well as your resume or CV and letters of reference. These documents show the dentist that if he or she accepts your offer, the practice will be in good hands.

Review the Sales Contract

With your lawyer, go through the sales contract with a fine-tooth comb. Ask for clarification on any clauses that you don’t understand. Make sure all blanks are filled in, and that all terms are as expected.

Manage All Other Documents

If you are assuming equipment leases, contact the lease companies for the proper assumption documents. Review the accounts receivable if they are part of the purchase. Assess the practice’s regulatory compliance status. Also speak with the property owner to set up either a lease assignment or a new lease on the physical location.

File Business Documentation

The exact documents that you need to file vary widely by location. Your attorney can help you determine what documentation you need. In general, expect to file paperwork with the state board, the IRS and state tax commission, any dental societies to which you belong or plan to join, and the unemployment office. You will also need the appropriate licenses and permits to operate a dental practice in your state and city. In addition, you will need to set up a business bank account if you do not already have one.

Get Insurance

Depending on your state and local laws, as well as the requirements of your bank, you may need several different types of insurance. Speak with an insurance agent in your area who is familiar with dental practices to ensure that you get everything you need.

Set Up Your Practice

Although you are buying an existing practice, it is important to adjust it to your needs and goals. Set your fee schedule. Decide which dental insurance carriers you will accept, and file the appropriate forms. Choose an employee benefits package. Set up your accounting system. Decide how payroll will be handled. Organize your billing and insurance filing systems either internally or through an outside company. Order business cards, prescription pads, stationery, and other branded products. Select a dental lab. Order new equipment if needed.

Smooth the Transition

Immediately after signing the sales contract, determine how long you will need to get the office reopened. Review the appointment book and contact any patients whose appointments need to be changed. Send out a letter of introduction to all existing patients, and plan an open house. Meet with the employees to explain how the transfer will affect them. If desired, present a letter from the seller to the patients, employees, or both, to help them understand why the previous dentist left. Send a letter to your own existing patient list, if applicable, to let them know of your new location.

Buying a dental practice is complicated, but the rewards can be significant. Do your homework, assemble an experienced team, and take the time to help smooth the transition for both patients and staff. This will minimize disruptions and help your new practice start off on the right foot.

Ascent Dental Solutions is dedicated to helping dentists build their practices. If you are interested in learning how to take your dental practice to the next level, please contact us today at 413-224-2659.

Should You Hire a Dental Practice Consultant?

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Most dentists enter the practice because they have a passion for the work, not out of a burning desire to be a CEO. Yet building and growing your dental practice requires you to be a top-notch business owner, capable of running everything from marketing to human resources, and from bookkeeping to daily operations. You certainly do not need to perform all of these tasks yourself, but you do need enough understanding of each process to tell whether it is working well or needs adjustment. As insurance reimbursements go down and expenses rise, it is more important than ever before to run a streamlined practice that drives profits without compromising the quality of care.

A dental practice consultant can be the solution. While you are understandably attached to certain ways of thinking and managing your practice, a consultant provides an outside perspective.  He or she can take an objective look at the business side of your practice and help you see things in a new way. With a consultant by your side, you are truly poised to take your practice to the next level.

However, hiring a consultant is not for everyone. If you are considering taking this step, it is important to understand some basic truths about what to expect.

Consultants Are Not Miracle Workers

A good consultant will challenge your assumptions and help you see your practice in a new way. However, the hard work of implementing changes will fall on you. In the short run, while you are developing new systems and processes, your workload may skyrocket. Your consultant will likely give you lots of homework to complete between meetings, and you may wonder why you brought this person in at all. Remember that it is the consultant’s job to assess your practice and make suggestions, but your job to bring those ideas to life. In the long run, though, your practice will thrive. Just keep your long-term goals in mind.

Change Begins with You

If your dental practice is struggling, it is easy to blame external factors. Your location is terrible, your staff is lazy, you can’t afford a fancy new machine, or a myriad of other excuses. While some of these may be objectively true, they are symptoms of the problem, not the root cause. As the business owner, you and you alone are ultimately responsible for the practice’s success. Bringing in a consultant is a sign of strength and good decision-making—you are admitting where you need help, and hiring someone with the specific skills and knowledge to fix those areas. Take a deep breath and trust the process, remaining open-minded to ideas that might at first strike you as strange.

Clinical Skill Is Important, But Not Sufficient

Many dentists with struggling practices try to educate themselves into success. Post-doctoral training, clinical workshops in cutting-edge techniques, adding in-house dental labs…all of these things help you to become an objectively better dentist, but have little to no effect on growing your practice. Remember, your patients are not trained in dentistry. Although the digital generation has more general knowledge about various treatment options than its predecessors, few patients are really able to judge whether one dentist’s clinical skills are better than another’s.

Continuing education is always an excellent idea, but to truly take your practice to the next level, you need to switch gears to focus on the business management side. Sometimes it’s as simple as going back to basics: Do you accept the insurances that are most common in your area? Are your wait times reasonable? Do you offer online appointment scheduling? Do you have extended or Saturday hours? Your consultant will analyze all of the little details that could be hurting your business.

Avoid One Size Fits All Solutions

Be wary of dental consultants who want to sell you their practice management “system.” Implementing systematic processes is an excellent thing, but they must be tailored to your practice. Every dental practice has a different patient base and different staff members, all with their own unique needs and desires. Local norms and conventions vary widely, as do individual offices. Look for a consultant that will make the effort to analyze your practice and make recommendations that are tailored to your needs, rather than plugging you into an existing system.

In today’s economy, dentists must run smooth, streamlined practices that provide top-quality care at minimal cost. To achieve this, it is vital to ensure that the business side of the practice is fully optimized. As most dentists are not business experts, bringing in outside help can be the solution. However, a dental consultant is not right for every practice. The points above can help you decide whether it is the right choice for you.

Ascent Dental Solutions is dedicated to helping dentists build their practices. If you are interested in learning how to take your dental practice to the next level, please contact us today at 413-224-2659.

New Dentists: independent or corporate practice a personal choice

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Congrats. You’ve finished school and graduation was a blast. However after you’ve taken off the cap and gown, you have dentistry degree certificate and a lot of decisions to make. Life happens fast and you don’t have a lot of time before you have to begin your career.

You’re at the proverbial fork in the road. And you really have two options: corporate dentistry (Managed Service Organizations or Dental Support Organizations) or starting your own practice.

Corporate dentistry is definitely an easier road and a lot of grads are tempted by the allure of a steady, predictable income. I come from a different world. I know how great it is to have your own practice, set your own rules, define your own standards for performance, and even set your own hours of operation.

I’m not here to judge. What works for one dentist won’t work for another. Corporate dentistry isn’t going anywhere and both private practice and corporate work each have pros and cons to consider.

One of the objections I’ve heard when speaking to new dentists who are considering opening their own practice is, what they see, as a lack of experience in clinical skills and complete absence of any practical business knowledge.

To these dentist corporate dentistry looks pretty good: more skill experiences, a built-in primer on running a business and the piece of mind that comes with knowing everything else is the corporation’s problem.

But here’s the thing. I’ve talked to many practicing dentists who have taken this path only to find out that the above scenario isn’t necessarily true.

Experienced dentists today say 50 or 60 percent of the stress in their practice, is not related to their clinical focus but rather, caused by staff and patients.

These are stresses that will happen whether you’re the captain of your boat or a hired hand on someone else’s.

For me, being independent and in control of both the clinical and business aspects is very important. Not only do you control every factor in your professional life, it also pushes you to get the training on the clinical skills you need and upgrade your management skills.

It really comes down to the kind of person you are. Do you just want to do A, B and C? Then explore a corporate dentistry opportunity.

Just don’t do it because you’re lacking clinical skills and business savvy. You can learn those while developing your own practice. And this is something I help new dentists do through my private coaching programs.

So ask yourself: what kind of a person am I? Are you happy being the employee, or would you rather develop the skills to create something special? The answer to that will ensure you make the right decision: your right decision.