Whether you are considering a new associateship or a practice purchase, you have a lot on your plate! Negotiations, shadowing, weighing your options - and licensure if you’re considering relocating.
So what happens when you find a practice? Before you get in the weeds of credentialing or legal and financial review, make sure this is the right practice for you. After all, you want to choose the practice where you can achieve the perfect blend of career satisfaction, financial stability, AND success.
I advise both sides to start with a 15-minute conversation to ensure everyone is on the same page as far as timelines and goals. If both sides agree to proceed, then you should begin exploring whether this practice is right for you – and that means looking at how your practice philosophies align. When two doctors share a similar philosophy, patients and staff experience continuity of care – leading to better retention and a more successful practice transition.
You can assess this alignment by asking several questions, whether through an in-person site visit or a Zoom call. I have included a starting list below, but do not feel like you need to address every single item. Rather, ask enough to decide whether you are interested in requesting the financials with the intent of moving towards an offer. I recommend conducting this evaluation BEFORE you invest in paying for legal and accounting expertise.
Chart review
You can get a great feel for the type of care delivered in the office when you see actual treatment in progress. Ask to see pre- and post-treatment radiographs (often easiest to see by looking at hygiene charts) as well as existing treatment plans and acceptance rates. Discuss different ways of approaching the same case. Remember that there can be multiple paths to a great result, but if you plan to work side-by-side during the transition, you need to respect the other doctor’s work and communicate effectively. Even if you are planning a 100% immediate purchase, a disconnect in treatment styles can be jarring to staff and patients. (See what happened when care quality wasn't quite up to a buyer's expectations.)
Staff training
Ask how often and what type of training staff receives. It may be that the owner and the staff have been together so long that they work like a well-oiled machine. If this is the case, you may want to ask specifics about how patient care is delivered to see if the staff seems to have the capabilities that you will want as you take over.
Patient flow through the office
Ask the owner to walk you through a typical new patient experience and a hygiene experience. You simply want to get a feel for what patients expect during appointments. Make sure it is not completely different from the experience you want for your patients.
Insurance participation
You will do a deep dive into insurance if you decide to move ahead with a sale. At this early stage, you want to get an idea of how involved the office is with insurance companies. If one company is over represented in the practice, ask about the office’s experience with the company.
Fee schedule
Ask how often the fees are evaluated and when they were last updated. You do not want to be in the position of needing to increase fees immediately upon purchase, especially if it has been years since an adjustment. (See the ADA’s Survey of Dental Fees, free to members.)
Referral patterns and procedure mix
You want to see how your ability to provide care maintains current productivity or enhances the bottom line. Ask which procedures are currently referred out and how saturated the local specialist market is.
After hours call and emergencies
Find out how after hours emergencies are handled and how often they occur. What does the “typical” emergency exam entail? What is your ability to handle them? For example, if the typical emergency exam reveals hopeless teeth that require extractions, are you able to provide that care in house or will you need to refer it out?
Appropriate equipment
Seeing the equipment and how well it has been maintained will give you a good idea of whether you will need to immediately invest in things like new chairs, autoclaves, or compressors. (Review the ADA's checklist for maintaining safe dental equipment.)
Retreatment
Every dentist has treatment that fails. Ask how retreatment is handled in the office. How does the seller handle it? How do you handle it?
This list is not intended to be exhaustive. Think about how you want to treat your patients and what matters most to you, and adjust from there. But do take the time to conduct this exercise before you get too far down the path towards an offer. I have seen buyers invest in financial and legal advice, even have a contract in place, and then realize they felt trapped in a practice that was not what they expected.