Is private practice ownership still possible for young dentists? The 5 Ps of a profitable dental practice

It was supposed to be an ordinary night at Chicago’s United Center. Scott Foster was a regular attendee of Blackhawks’ professional hockey games and volunteered regularly to be an emergency goalie. Should the Blackhawks or the visiting team have their first- and second-string goaltenders suffer injury, he would be ready. On March 29, 2018, Scott went in a fan and emerged a hero.

Before the start of the game against Winnipeg, Chicago Blackhawks’ coaches requested that Scott “dress out” just in case. First, team member Anton Forsberg was hurt. Within a few minutes, the second netkeeper, Delia, would be sidelined with an injury. That left only one option: put Foster in. Scott played the final 14 minutes and one second of the game and stopped all seven shots fired in his direction. Accountant by day, superstar emergency goalie by night!

The Blackhawks defeated the Jets that night 6 goals to 2. Heroes are made for moments like this. A fan being called out from the stands? That’s straight out of a movie script. When asked in a postgame interview about the idea of ever being called up, Foster downplayed the moment, saying “I figured there’s always a chance!”

In the movie Dumb and Dumber, the main character, Lloyd Christmas (played by Jim Carrey), is interested in a relationship with Mary Swanson (played by Lauren Holly). He asks, “What do you think the chances are [that we get together]? … Like one out of a hundred?” She responds, “I’d say more like one in a million.” Optimistically, he replies, “So you’re telling me there’s a chance …”

Where there’s a chance, there’s hope.

Dental private practice ownership is in decline. According to the Health Policy Institute, overall practice ownership dropped from 84.7% to 73% from 2005 to 2021.¹

A recent paper by Vujicic, Flynn and Munson states “Younger dentists are far less likely to own their own practice than younger dentists 20 years ago.” Many are opting for group or corporate models that appear to shy away from the uncertainties of practice ownership.²

For the young dental practitioner, what are the chances that they can achieve the dream of private practice ownership? Will this model still be a viable option in the future?

This past year, LSU School of Dentistry offered a senior-level predoctoral course to a limited group of students who one day desire to own a private practice. The instruction was designed to familiarize the prospective future dental practice owners with the broad requirements associated with ownership.

From personal finance to searching for appropriate practice possibilities, the course culminated in a capstone project entitled “Shark Tank.” Each student posed to a panel of four “sharks” a purely fictitious practice that they wished to purchase.

All panel members had investment banking and/or financial planning in their background, and some even had experience in dentistry. The students’ goal was to convince the panel that their dream practice and their ability to assume the helm was worthy of the $1–1.5-million loan package. Even though it was imaginary, the students soon realized that a hierarchy of practice features exists. Shiny objects may dazzle the prospective buyer, but not the banker.

The students were generally surprised by what did and did not motivate the sharks. Consistent revenue stream; controlled reasonable overhead; a practice mix that the younger dentist could adapt quickly without serious disruption; strong new patient attraction—these were things that ranked near the top.

The sharks dismissed the students’ description of attractive furnishings. The latest equipment plus a full array of digital offerings did not impress the investment bankers in the least. Regarding curb appeal, one shark commented, “You might be surprised by what $50,000 and a tube of lipstick can accomplish.”

What should future practice owners look for in a prospective practice? What should they ignore? What are the chances that a current healthy revenue stream will continue after the transition? Beyond pure numbers, what features of an attractive practice should be present?

Following the exercise, the students found it helpful to consider the five P’s of a desirable dental practice; a practice that would garner investor attention and be attractive to purchase.

1. Patient-centered

A desirable practice should be relationship based, as opposed to stranger oriented. The latter says it does not matter that the clinician and the patient have a relationship prior to treatment. The former says it is imperative that the dentist is in pursuit of a friendship that promotes a high degree of trust. The patient’s needs are placed ahead of the practice’s projections. Client-centered practices favor a comprehensive approach to care. Flavored throughout is the mantra “their needs before ours” from introduction to post-treatment follow-up. Dr. L.D. Pankey saw patients as people and potential friends, rather than problems to be solved.³

2. Personnel appreciated

Valued staff members more closely resemble family than employees. In extremely well-organized practices, each team member is personally invested in the success of the practice. They take ownership and consequently monetarily share in the overflow of the practice.

Practice consultant Mary Osborne reports that, “Progressive practices today are organized more around talent than tasks. They hire people for intelligence as well as skills, creativity as well as experience, and passion as well as knowledge. Those practices have an ongoing commitment to finding, attracting and maintaining people who are capable of that kind of commitment.”⁴

Some practice owners are familiar with how to best motivate their team; others have to work hard to develop this skill. Money motivates, as does agency. Well-compensated staff who know that their opinions are treasured are not liabilities. A practice that views team members as valuable assets is worth a second look.

3. Perennially profitable

Revenue margins are steady, and overhead is monitored. While it is often said that there is a pulsating rhythm to the revenue stream in a practice, it can be noted that expenses are often seasonal, too. For example, Federal quarterly tax estimates and tax payments are front-loaded to the first six months of the year. The last half of the year only sees one quarterly estimate, while the first half gets three. The practice that pays attention and takes advantage of the ebb and flow of patient interaction is better positioned to compensate during times of slower cashflow.

A healthy service mix that can adjust to economic downturns allows a smoother ride. In addition to variety, superior skillset in a particular discipline will also offset dental “bear markets.” Desirable practices possess attractive service mixes.

Moreover, practices that pay attention to overhead by regularly monitoring costs typically fair better than practices that track these areas less. Roger Levin, founder of the Levin Group, has advocated for attention paid to expenses for years: “Most had a monthly overhead review by the office manager or doctor, and categories that weren’t within a reasonable range as defined by the practice were addressed … These practices weren’t perfect, but they did have a strong focus on maintaining overhead control, which is a crucial part of the discipline of running an excellent practice.”⁵

4. Process predictable

Operations and systems are carefully monitored and altered as needed. As little as possible is left up to chance. Before systems are implemented, they are reverse-engineered and reassembled to ensure, with a degree of certainty, the best desirable outcomes. When these systems are monitored, they are often found needing additional attention.

Practices that elevate efficiency find a productivity increase consistently. Dr. James DiMarino explains, “Improving your efficiency by upgrading your workflow system will provide more time to perform more treatments. Workflow improvements can include reducing room setup time, modernizing the sterilization process, or decreasing chair time of dental procedures through training, newer materials, and technology.”⁶ Practices that value efficient systems run like well-oiled machines and are not difficult to identify.

5. Personally rewarding

Private practice ownership at its core is about one word: freedom. The owner/clinician is at liberty to design policy, engineer their schedule, select or deselect procedures performed, donate dentistry to the needy, and build relationships that are meaningful, lifelong treasures.

Often is takes decades to see fruit from the seeds sown from this approach. Spiritual return on investment is rarely measured by the clock—a calendar is preferred.

Littered across the landscape of a couple of decades will often be notes sent and received, plates of cookies brought, and stories circulated expressing heartfelt gratitude for all the tangible and intangible extras that were levied. Patients often responded in gratitude for the extra mile walked by the staff and doctor. Patients at this type of office rarely feel like a number; they are treated with dignity and respect. Many times, this is born out of recognition that they are fellow image-bearers made in the image of the Creator.

For the recent graduate who wonders if there is hope for private practice ownership, please hear the timeless words of Dr. L.D. Pankey, “whatever you desire, oh discontented [one], step up and pay the price and take it.” For the one who takes Dr. Pankey’s advice and anticipates potential ownership, chances are the right practice is out there waiting for you!

Editor's note: This article appeared in the November/December 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Health Policy Institute. Practice Ownership Trends Among Dentists: 2005–2021. Webinar presented by the American Dental Association, March 2022.
2. Vujicic, Marko, Jordan Flynn, and Bethany Munson. “Younger Dentists Are Far Less Likely to Own Their Own Practice than Younger Dentists 20 Years Ago.” Journal of the American Dental Association (JADA), January 2025, 85–92. doi:10.1016/j.adaj.2024.10.011
3. “Dr. L.D. Pankey Saw Patients as People and Potential Friends, Rather than Problems to Be Solved.” Texas Dental Association Journal 119, no. 2 (February 2002) Practice Renewal, a Leadership Guide for Dentists p3.
4. Mary H. Osborne, Practice Renewal: A Leadership Guide for Dentists (Seattle, WA: Mary H. Osborne Resources, 2003), p3.
5. Levin RP. Takeaways from top dental practices: strong hires, low patient attrition, controlled overhead. Dental Economics. January 1, 2021. https://www.dentaleconomics.com/14195591
6. DiMarino J. Can your current dental practice systems be the key to efficiency and profitability? Dental Economics. December 13, 2023. https://www.dentaleconomics.com/14299896