Podcasts

Should You Start A Practice Or Buy One? Put A Date On The Calendar And Work Backward

Here’s a conversation we have more often than any other. An associate dentist has been looking for a practice to buy for a year. Sometimes two. Sometimes three. Nothing fits — wrong town, wrong size, wrong seller. And every month the search drags on, they keep collecting a paycheck from a job they already decided to leave.

They don’t have a practice problem. They have a calendar problem.

We put that to Stephen Trutter, CEO of Ideal Practices, on the Dentelligentsia podcast. Trutter has been part of roughly 900 dental startups over nearly two decades, guiding associates through a 13-stage process from idea to open doors. And he was clear about something we didn’t expect from a startup consultant: he refuses to sell anyone on a startup.

“Explore an acquisition and a startup both,” he told us. “See which one is the right fit.” The trick is how you frame the decision — and it isn’t when do I want to start looking.

Ask “when do I want to own?” — then subtract 18 months

A startup takes about 12 to 18 months from idea to open doors in today’s environment — permits, construction timelines, and real estate availability being what they are, plan on the 18. An acquisition search can take that long or longer, and unlike a startup, it can take that long and produce nothing.

So Trutter’s advice is to work backward. Pick the date you want to be an owner. Subtract 18 months. That’s your decision point — and if you’ve been hunting for the right practice to buy and that date is approaching, you draw the line and switch paths. The associates who never set the line are the ones still searching in year three, waiting for a perfect practice that isn’t for sale.

One of his lines stuck with us, about the strange pride dentists take in doing it the hard way: “I don’t understand this rite of passage — I’ll feel better if I struggle for two or three years, and then one day I can say I have a profitable practice. What if you could have a profitable practice in two or three months instead?” Tom Brady had coaches, coordinators, and nutritionists as a player — and hired the equivalent all over again when he became a broadcaster. An associate opening their first practice is doing something they’ve done exactly zero times. Getting guidance isn’t weakness. It’s how experienced people do new things.

The numbers, without the sugar

Trutter’s cost picture for a startup today: $600,000 to $800,000 or more, excluding any real estate purchase. Construction alone runs $150 to $200-plus per square foot before equipment, technology, marketing, and working capital. When he started, $300,000 to $400,000 opened a practice; that number has more than doubled.

And a truth nobody frames this honestly: on day one, your overhead is 100 percent. No patients, no revenue — everything is overhead. It normalizes over the first couple of years, but the early months are a math problem you should see coming rather than discover.

Now the encouraging half. Across Ideal Practices’ clients, the average break-even lands around six months. And the milestone Trutter’s team celebrates — they call it Freedom Day — is the day the new practice can sustain itself without the owner moonlighting as an associate. On average: four to six months after opening. Not two or three years. The difference between those two timelines isn’t luck; it’s whether the demographics, the site, the systems, and the marketing were built in the right order before the doors opened.

His favorite message from a client wasn’t about production at all: “I paid off my student loans today. Of all the goals, I never thought I’d get to that one.” That’s the version of freedom nobody puts in a pro forma.

Quit looking for space. Find an opportunity.

Here’s the part of the conversation that sits squarely in our world, and Trutter said it more bluntly than we usually do.

“If you’ve been looking for real estate for months — stop. Quit looking for space. Find an opportunity. The right demographics, the right competition, the right patient base. Then find real estate inside that defined zone.”

Associates chasing buildings have it backward. The building is the home; the opportunity is the practice. And a wider search area doesn’t help — it hurts. Tell a broker “anywhere within two hours of Detroit” and you’ll never decide anything; you have more options but not better opportunities. Trutter’s analogy: a kid with a whole boring afternoon versus a kid put in front of one good jungle gym. Constraints create action. Define the zone, then get serious inside it.

Two demographic myths he flagged along the way. First, the Facebook favorite: “go rural, there’s no competition.” His answer: do you want to live rural and serve a rural patient base? If not, don’t build your career on someone else’s map. “Congratulations, you found a space with no dentists and no competition. There are no patients there either — or they’re the wrong age, the wrong needs, or they simply don’t travel there.” Second, the circle on the demographic report is not a site map. The ring shows where the people are; it doesn’t say where they’ll actually go. Traffic flows one town over, an exit north, out of the neighborhood rather than into it. That’s the handoff point between the demographer and the real estate team — the data defines the zone, and then someone who knows the market places the practice where those people actually drive.

One more from his real estate file, and we’ll let a startup consultant say what we’re too polite to: “One of the common misconceptions in commercial real estate is: if I do it by myself, I’ll get a better deal. No — you’ll get the worst deal ever.” He calls it the tale of two deals. Same landlord, same space: one lease offered to an unrepresented dentist, a very different lease when someone who’s done hundreds of transactions is on the other side of the table. And the lease itself, in his words, is the most important document you will sign in your professional life — not for today’s rent, but for what it says about the decade ahead: what happens if you need to sell, whether the lease transfers, how you get out. Those get negotiated at signing or never.

Your first 100 patients are on you

The marketing section of the conversation deserves its own article, but the spine of it fits in one sentence Trutter tells every client: your first 100 patients are on you.

Not on the agency. Websites, Google ads, and social media are foundations — necessary, slow, and algorithm-bound. “If you think an agency is the solution to marketing for a startup, you will not succeed.” The first hundred come from the VIP list — family, friends, friends of friends — and from the owner physically showing up: connecting with local business owners (to help them, not to harvest referrals), doing local events, filling every empty clinic day with community work instead of waiting-room solitaire. Get comfortable being uncomfortable.

His favorite proof: a Tampa-area client — his own dentist, in fact — who supports one of the area’s largest animal shelters. A local TV news segment ran on the dentist and the shelter a month before the practice opened. Not an ad; a story. That practice did nearly $2 million in production in its first 12 months, in a competitive suburban market, and has since stacked up 1,700 five-star reviews. The reviews matter for the same reason they matter on Amazon: the household decision-maker reads them before choosing a provider, so you need a system for earning them from day one.

Vision before floor plan

The first call Ideal Practices runs with a new client isn’t about operatory counts. It’s a vision call: who are you going to be in your community, what kind of patients do you want, what will you support and give back to. Trutter’s framework is three Ps — practice (the physical build), profits (the systems that make it a business, not an expensive hobby), and purpose (the reason patients pick you over the corporate office on the corner). “You don’t need me to find space and put in some chairs,” he said. The point is everything that has to be decided before the chairs make sense.

That ordering — vision, then demographics, then zone, then space — is exactly how the best projects we’ve been part of have run. The full conversation with Stephen Trutter is on the Dentelligentsia podcast. And if you’re an associate with a date circled on the calendar and a zone to define, talk to us.