Should You Start A Practice Or Buy One?
Should You Start A Practice Or Buy One? Put A Date On The Calendar And Work Backward
This week on the Dentelligentsia Podcast, we were thrilled to be joined by THE Stephen Trutter, CEO of Ideal Practices and author of the best-selling book, “The Startup Dentist”.
Prior to launching Ideal Practices 9 years ago, Stephen had a career in sales at Bank Of America, where he learned about the process and challenges dentists face when opening the doors of their own dream practice. This experience inspired him to take action and become a resource to educate dentists everywhere with their ultimate goal of opening a practice to call their own. Specifically in his book, Stephen describes his proven 13-stage process, which has now helped thousands of associate dentists either buy a practice or start a new practice from scratch.
Associates spend years hunting for the perfect practice to buy while collecting a paycheck from a job they’ve already decided to leave. Nick and Remy sit down with Stephen Trutter, CEO of Ideal Practices — part of roughly 900 dental startups — who reframes the whole decision: pick the date you want to OWN, subtract 18 months, and let the calendar force the startup-versus-acquisition choice. He walks through today’s real startup numbers ($600–800K+, 100% overhead on day one, average break-even around six months, and ‘Freedom Day’ — leaving your associate job — at four to six months), and why you should chase the opportunity instead of the real estate. “Quit looking for space. Find an opportunity — the right demographics, the right competition, the right patient base — then find real estate in that defined zone.” He also explains the rural-practice myth, why the demographic circle on the report is not a site map, and why your first 100 patients are on you, not your marketing agency. Plus the vision-first process: practice, profits, and purpose.
“One of the common misconceptions of commercial real estate: ‘if I do it by myself, I’ll get a better deal.’ No — you’ll get the worst deal ever, because you’re not experienced.” — Stephen Trutter, CEO, Ideal Practices
For more on our interview with Stephen Trutter, check out our article, “Should You Start A Practice Or Buy One? Put A Date On The Calendar And Work Backward.”
And follow Stephen Trutter on Linked In or check out the Ideal Practices website.
How long does it take to open a dental startup? The timeline, backward from opening day
Ask an associate dentist when they plan to own a practice and you’ll usually get a season, not a date: “in the next couple of years,” “when the right one comes along.” Then two years pass, the right one never quite comes along, and the paycheck from a job they’ve already decided to leave keeps clearing.
Stephen Trutter, CEO of Ideal Practices, has walked roughly 900 dentists through startups, and when he joined us on the Dentelligentsia podcast he offered the reframe that breaks the stall: stop asking when to start looking. Pick the date you want to own — then subtract 12 to 18 months, because that’s what a startup or an acquisition actually takes. The calendar, not the mood, forces every decision that follows. His favorite version of the finish line has a name: Freedom Day, the day you leave your associate job. Here’s what those 18 months look like, worked backward.
Months 18–14: opportunity first, real estate second
The instinct is to start touring spaces. Trutter’s rule runs the other way: “Quit looking for space. Find an opportunity — the right demographics, the right competition, the right patient base — then find real estate in that defined zone.”
This stage is research: trade areas, patient ratios, competitor mix, growth patterns. Two traps live here. The first is the empty-map fallacy — “Congratulations, you found a space with no dentists and no competition. There are no patients there either.” The second is treating the demographic circle on a report as a site map. The circle says a market exists; it says nothing about whether usable real estate exists inside it, at workable terms, with the parking and visibility and zoning a practice needs. Connecting the data to actual property is its own discipline — it’s the half of the problem we work on daily.
Months 14–9: the site, the lease, the money
With a defined zone, the real estate search gets fast and specific. Then comes the document Trutter calls “the most important document they will ever sign in their professional lives” — the lease. Not the loan, the lease. It outlasts the loan, it sets the terms your practice sale will someday depend on, and it’s negotiated once, at the moment you have the least experience.
Which is exactly why he torches the do-it-yourself instinct: “One of the common misconceptions of commercial real estate: ‘if I do it by myself, I’ll get a better deal.’ No — you’ll get the worst deal ever, because you’re not experienced.” The landlord across the table negotiates leases for a living. Financing runs in parallel — today’s startup budgets run $600,000 to $800,000 and up, and lenders respond to a real plan, not a dream.
Months 9–3: buildout, systems, and the marketing you can’t delegate
Design and construction eat the middle of the timeline, and alongside the buildout comes everything the practice will run on: software, systems, staffing plans, insurance strategy.
And marketing — with Trutter’s least popular rule: “Your first 100 patients are on you.” An agency can build the machine, but a startup in a new market grows on the owner’s face, name, and legwork — the community presence, the introductions, the events. “If you think an agency is the solution to marketing for a startup, you will not succeed.”
Opening day — and the math nobody warns you about
Day one, the overhead of a startup is 100 percent. No patients yet, so every dollar is expense. That sounds terrifying, and it’s also temporary: across Ideal Practices’ startups, average break-even arrives around six months, and owners leave their associate jobs — Freedom Day — at four to six months. Trutter’s larger point is aimed at the rite-of-passage myth: “I don’t understand this rite of passage — ‘I’ll feel better if I struggle for two or three years.’ What if you could have a profitable practice in two or three months instead?” Struggle isn’t a requirement. It’s usually just the residue of a missing plan.
His favorite Freedom Day story isn’t about a practice at all. A client called to say: “I paid off my student loans today. Of all the goals, I never thought I’d be able to get to that one.”
Hear the full conversation with Stephen Trutter of Ideal Practices on the Dentelligentsia podcast — the 13-stage process, the rural-practice myth, and the vision-first framework of practice, profits, and purpose.
When your timeline reaches the real estate stage — the zone, the site, the lease — that’s where we come in. Tenants and buyers only, so nobody at our end of the table has a listing to fill. Talk to us.
For more on our interview with Stephen Trutter, check out our article, “Should You Start A Practice Or Buy One? Put A Date On The Calendar And Work Backward.”
And follow Stephen Trutter on Linked In or check out the Ideal Practices website.
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What Our Clients Are Saying
Remy was very helpful and straight forward with me about the challenges of starting a practice. He kept me well informed and was very proactive, a professional in every aspect of the real estate business. I could not have navigated this process without him; I will definitely use Remy for our future growth needs.
Dr. Kevin Semma, OD
Remy has been an indispensable part of my journey to build a veterinary practice. I had another commercial realtor that was not familiar with veterinary profession when Remy reached out to me. When I decided to stay with my previous realtor, Remy was willing to answer any questions I had or help in any way, even though I was not signing with him. I felt he genuinely wanted my business to succeed and wanted to help. Soon I realized the importance of having a realtor who has special knowledge of the healthcare field when choosing a space and decided to reach out to him. Remy is very professional, relaxed, and inviting. He brings his own expertise as well as others to consult about different aspects of building a practice. Remy is available, thoughtful, supportive, and assists in problem solving concerns that arise. The process was less stressful, because he was a partner in the process, not just a realtor. I have and will continue to recommend him for any commercial real estate needs.
Dr. Katie Boatman, DVM
Working with Mirlo Real Estate Partners was a great experience, and I could not be more impressed with the level of service I received. From the very beginning, Nick and Remy helped me establish my preferences and outlined the best strategy for my specific situation. Not only werethey able to find the PERFECT space for me in a brand new medical office building, but due to the tight deadline, they were also able to find me an OUTSTANDING temporary space to occupy during the construction period to minimize downtime for my practice. Their hard work and dedication really made the transition seamless. Their knowledge of my needs and the market was STRONG and helped me achieve VERY FAVORABLE terms. I would highly recommend them to any healthcare provider for their commercial real estate needs.
Dr. Alon Kahana, MD, PhD
We are incredibly grateful to Remy Isdaner for guiding us through the challenging journey of starting our veterinary practice. Remy’s knowledge was deemed invaluable from the outset, assisting us in every aspect of the startup process. Remy found just the right building, and it wasn’t even on the market. He contacted the owners and successfully negotiated a favorable deal, making our dream of owning a practice a reality. Remy’s professionalism, persistence, and genuine care for our success truly set him apart. We highly recommend Remy to any business owner needing support with their business endeavors!
Dr. Krysten Andrews, DVM & Dr. TJ Vernaci, DVM
As an established oral surgeon, I can wholeheartedly recommend Remy Isdaner and Mirlo Real Estate Partners to any medical professional seeking to start or expand their practice. Not only did Remy advocate and fight for my best interest, but he also demonstrated an unparalleled understanding of my industry, exceeding my expectations and making the process as smooth as possible. With Remy taking so much off my plate I was able to focus on building and marketing my business, allowing me to open my doors with a full schedule of patients. I could not be more satisfied with my experience working with Remy and my new, state-of-the-art oral surgery practice.
Dr. Robert John, DDS, MD
I am thrilled to share my experience with Mirlo Real Estate Partners. As an oral surgeon, the thought of handling a commercial real estate transaction and the subsequent buildout of my new office was daunting. However, Mirlo made the entire process seamless and efficient. From the outset, they were attentive to every detail of my requirements. Their knowledge and professionalism were evident as they guided us through each step, ensuring that every aspect of the deal was executed at the highest level. Nick and Remy worked hard to advocate for us and were committed partners in our success. Thanks to their exceptional service, I am now operating in a state-of-the-art facility, perfectly suited for my patients and staff. I wholeheartedly recommend Mirlo Real Estate Partners to anyone looking for a reliable and highly competent commercial real estate partner.
Dr. Jeffrey Wasielewski, DDS, MD, MBA
