It is difficult to start a solo dental practice. Many graduate from dental school with $500K or more of personal debt and facing a capital investment of $1M-$1.5M or more to start a new practice. For this reason, buying a practice and acquiring both the patient roll and physical infrastructure makes sense.

Once the practice is up and running, dentists are often annoyed and/or overwhelmed with taxes and insurance issues for which they may have had little or no preparation for during dental school. Also, due to insurance and billing procedures, patients tend to pay late, making it difficult for dentists to manage cash flow in the practice.

Another challenge is attracting and maintaining patients. Many dentists I've talked with see patients leaving the practice because their insurance won't cover the full cost of procedures. Dentists feel pressured to offer services at prices that will retain patients and correspond to reimbursable rates of insurers. This pressure assumes that the patient they seek is a value shopper (comparing prices for basic services). Yet, from a consumer point of view, shopping for a dentist is not easy. It is not easy to shop price, know reimbursement rates of insurers, or differentiate services of different practices. Often, consumers become patients because the practice is near home or work and visible on the commute. Dentists have a real opportunity to define how their practice is different, organize according to that difference, and then communicate that difference to potential customers. Communicating value is different in more service industries, and dentistry is no exception.

Some years ago, a Dental Economics survey of dentists showed that most thought the easiest way to increase practice revenues was to increase the number of hours worked. While dated, that finding suggests that many dentists may benefit from looking a strategic planning initiative and new organizational models based on patients needs and interest to improve productivity.

If the patients regard dental exams as "routine", they will think of themselves as consumers and judge practices on consumer services. If they have defined oral health needs, then they think of themselves as patients and judge practices on how well they were able to help remedy the oral health problem. In truth, dental practices today must think about the people they serve both as patients and as consumers in order to meet expectations and overcome managing patient relations effectively.