Podcasts

How Many Operatories Do You Actually Need? The Factory Math Of A Dental Office

You can’t gross $3 million in four operatories. Ask a dentist where they want production to be in five years and you’ll get a confident answer. “Three million, all in.”

Ask how many operatories are in the new office plan. “Four. Maybe five.”

Nobody in the room does the math. And the math is the whole story.

We spent an hour on the Dentelligentsia podcast with Chuck Cohen, Managing Director of Benco Dental — the third-generation family business he runs with his brother Rick, and one of the largest dental distributors in the country. Chuck has spent his career walking into dental offices, and the conversation kept returning to one theme: the building decisions dentists make once, under pressure, without the rules of thumb that would make those decisions obvious.

Here are the rules he shared. Write them down before your next lease or purchase, not after.

The factory math

Cohen’s mental model — offered with full respect for the level of care involved — is that a dental office is a factory. Patients and materials in one end, dentistry out the other. And nobody sizes a factory by feel.

“If I said your goal is to build a factory that makes a million pairs of shoes a week, and you want to build it in 2,000 square feet, you’d say some version of: are you out of your mind?” It’s why shoe manufacturers aren’t based in Midtown Manhattan. Yet dentists do the equivalent constantly.

The rule of thumb: a general practice grosses roughly $200,000 to $250,000 of production per operatory per year, per ADA data. The operatories are the machines. So a $3 million goal means thinking in terms of eight, ten, twelve operatories — not five. “The number of operatories you have dictates the revenue you can produce in the facility, almost without bound,” Cohen said. “Most dentists don’t realize that.”

There’s a second layer. The technology most dentists want — CBCT, a mill, a 3D printer — requires a certain revenue base to support it. Revenue requires operatories. Operatories require square footage. Skimp on the space and you’ve quietly capped everything downstream: the production, the technology, the associates you can bring on, the patient care you can offer.

Cohen calls this the most underutilized rule of thumb in dentistry. In our experience it’s also the conversation that changes the space program more than any other, which is why we have it with clients before we tour a single property.

Own your real estate

We asked Cohen for his single best piece of business advice for dentists. He didn’t hesitate, and we promise we didn’t pay him for it.

“Own your own real estate. You’re going to be paying rent to somebody — it may as well be to yourself. It’s the number one way independent practitioners can build wealth over the course of their career.”

He practices what he preaches: Benco owns its own main facility in northeastern Pennsylvania and rents it to itself. And he backed the advice with two facts most dentists have never heard.

First: “Paying 10 years’ rent is about what you’re going to pay to own the location.” If you plan to be somewhere longer than a decade, the arithmetic favors owning.

Second: dental offices very rarely move. Once the plumbing is in the slab and the equipment is in the walls, relocating is so painful that offices stay dental offices for generations, passing from owner to owner. That ten-year threshold isn’t a stretch for a dental practice. It’s the default.

You don’t need a trophy corner, either — Cohen’s view is that a solid B-plus location you can actually buy beats the A-plus location you can only rent. Where dentists go wrong is being too conservative to buy, or too impatient to wait for the right building to come available.

This is most of what we do all day, so we’ll just say: agreed, and in Southeast Michigan nearly every doctor we represent is trying to get there. The ones who succeed started looking early.

Match the office to the strategy

Cohen pushed back, politely, on one thing we said — the notion that dentists are weak business people. “Dentists have a very unfair reputation,” he said. “They’re excellent business people. Look at the P&L of most dental practices.” Where they stumble isn’t strategy — almost every dentist he meets has one — it’s articulating the strategy clearly enough to build around it.

That matters because in his experience any strategy can win. Medicaid-focused, family, implant-heavy, high-end cosmetic — he’s seen every one of them succeed. What fails is misalignment: the would-be premium practice operating out of a 20-year-old facility with sagging waiting-room chairs. The facility, the marketing, and the team all have to tell the same story the strategy tells.

So before the floor plan, write the strategy down. One page, not a hundred. Then let it pick the location, the size, the design, and the equipment — in that order. Cohen’s related warning: the design of the office matters more than the equipment in it. A well-designed small space outperforms a badly designed big one, which is why he tells doctors to sweat the design with people who do dental offices for a living, not a generalist architect.

The second-office trap

Here’s the one that will annoy the peanut gallery. Cohen — who makes real money selling equipment for second offices — thinks the second office is the biggest mistake dentists make.

“I’m a huge fan of a second office if you’re on your way to your fifth,” he said. Four, five, six locations create real efficiencies: shared back office, call center, systems. But a standalone second office adds expenses, splits the owner in half, and never reaches the scale that makes the model work. “If it’s just a second office — a guy retired eight miles away and you got a deal you couldn’t refuse — not smart.”

The test is simple: is office two a step in a written plan toward three, four, and five? Or is it an impulse purchase with operatories? A practice buyer’s version of the boat you use twice a year?

Invest in your 50s

You may notice a pattern forming on this podcast — our last guest told sellers to ramp marketing up five years before a sale. Cohen said the facility version of the same thing.

Your 50s feel expensive: college tuition, weddings, everything at once. They’re also your highest-earning years, and — this is the part nobody says out loud — your last realistic window to invest in the practice and get the money back out. “By your early 60s, you’re thinking about transitioning, and the equipment just gets more tired. It doesn’t show well when you sell. Your mid-50s is the perfect sweet spot to invest in your practice.”

We see the proof at sale time. The practice with T12 fluorescent tubes they don’t even manufacture anymore is worth less than the refresh would have cost. Buyers pay for a practice they don’t have to rescue.

And if a full renovation isn’t in the cards, Cohen’s cheapest fix: the reception area. Every patient experiences it, every visit. Walk in your own front door — most doctors haven’t in years — and ask whether the room clears the bar of a decent coffee shop. Redo it every five or six years; wallpaper, paint, chairs, carpet, ten or twenty grand and a weekend. “When you upgrade your reception area,” Cohen said, “everybody will think your crowns fit better.”

If you’re building: go learn first

One resource worth knowing about. Benco runs a program called Build Your Future — a free two-day course for dentists planning to buy or build, held three times a year at their showroom campuses in Dallas, Southern California, and Pennsylvania. The keynote is Tristan Hamilton, one of the only people in America who is both a practicing dentist and a registered architect. Attendees bring their actual site or preliminary plan and work it over with designers. Cohen’s measure of success is simple: doctors walk in scared and walk out confident. It’s oversubscribed nearly every session, so plan ahead.

That’s the theme of the whole hour, really. The building is the biggest decision of your career, you make it about once, and every rule above is learnable before you sign instead of after. Do the operatory math against your real production goal. Run the own-versus-rent numbers past the ten-year mark. Write the strategy down and make the space serve it.

The full conversation with Chuck Cohen is on the Dentelligentsia podcast. And when you’re ready to put the factory math against actual buildings — sizing, own-versus-lease, and what your market will actually allow — talk to us.