Check out our latest newsletter!
INSIDE THIS ISSUE
The Exit Nobody Plans For
Why Busy Is Not the Same as Profitable Your Gut Is Lying to You (And Your Data Isn’t) Leverage: The Multiplier Most Dentists Ignore The McDonald’s French Fry Lesson for Dental Practices Servant Leadership: The Secret Weapon of High-Performing Dental Practices Turn an Ordinary Practice Into a Dental Growth Machine If You Want to Stand Out From Every Other Dental Practice ... Why Most Websites Repel High-Value Patients Headwinds in the Dental Practice Sales Market
(703) 298-1690 · DentalGrowthAndExit.com
Year 1, Issue 4
THE EXIT NOBODY PLANS FOR
Here’s a scary truth: You’re one accident, diagnosis, or legal mess away from negotiating from your knees. When a dentist is healthy, focused, and in control, they have leverage. They can choose when to talk to buyers, partners, or associates. They can walk away from bad terms. They can wait. When a dentist is tired, scared, sick, or trapped, they can’t. That’s when deals get ugly, prices drop, and buyers smell blood in the water. A forced exit doesn’t just change your timeline. It changes your position. And your negotiating position is everything in business. Most dentists have a plan that sounds like this: “I’ll think about exit stuff when I’m closer to being ready.” Which is adorable. It assumes you will decide when “ready” happens, that your body will cooperate, that your energy will stay high, your partners will stay sane, your team will stay loyal, and your life will politely follow the calendar you set for it. Here’s the problem … that’s not a plan. That’s a hope wrapped in denial. The average dentist doesn’t exit on the day they once imagined. They exit when circumstances force the conversation. And the later that happens, the fewer good options remain.
No dentist puts “medical emergency,” “burnout,” or “lawsuit” on their five-year plan. You plan for growth, maybe a new scanner, an associate “someday.” You plan for retirement … eventually. What you don’t plan for is the exit that shows up uninvited. And yet, that’s the one that hits most often: the forced exit. The one caused by a stroke, a back injury, a lawsuit, a partner implosion, or the slow emotional erosion we politely call “burnout.” The kind of exit that doesn’t ask for your opinion. It just arrives, kicks the door in, and starts rearranging your life. The problem isn’t that these things happen. Life has always been rude like that. The problem is that most dentists run their practices as if none of it ever will.
Bucket List
Has the DSO Window Closed … or Just Shifted? The Associate You Should Be Grooming Right Now Why Mastering Persuasion Makes Your Practice More Valuable to DSOs
Continued on Page 2 ...
Stan Kinder has over four decades of experience serving the dental profession in a variety of roles. He has helped dentists with every type of practice transition, traditional brokered transactions, consulting on associate-to-partner buy-in/buy-out agreements, and, for more than 15 years, as a senior mergers and acquisition executive with several different DSOs. Along the way, he consulted on practice management and growth. He is a one-of-a-kind resource for the practice owner seeking the optimal exit. Parthiv Shah is a growth strategist, entrepreneur, and bestselling author who helps professional practices scale with clarity, systems, and purpose. He is the holder of two U.S. patents, reflecting his long-standing commitment to innovation and practical problem-solving. Parthiv is the author of two bestselling business books and the recently released “ Dental Growth Machine,” published by EDRA, which outlines a proven framework for building sustainable, scalable dental practices. Through his writing, consulting, and advisory work, Parthiv is known for blending strategic insight with real-world execution to help leaders grow smarter, without burning out.
Avoiding Litigation in Dental Practice Transactions
Monthly Rant
How the DG&E Team Steps In
Stan Kinder - (703) 298-1690 · 1
... continued from Cover
Everyone imagines dramatic exits: heart attacks, lawsuits, disasters. In reality, most forced exits are boring. They look like chronic exhaustion you stop noticing, pain that “isn’t that bad yet,” a partner who slowly becomes a problem, a team that starts running you instead of the other way around, and a practice that feels heavier every year. Nobody wakes up and says, “Today I will destroy my leverage.” They just keep going until they can’t.
When a forced exit shows up and you’re not prepared, the same pattern repeats.
You don’t choose buyers; you take whoever shows up. You don’t negotiate structure; you accept what you’re offered. You don’t control timing; you react. And here’s the cruel part: Buyers know when you’re stuck. They see it in your urgency, your tone, how quickly you start saying “sure” instead of “let me think,” and your sudden obsession with speed. And here’s the truth: Speed costs you money, and preparation makes you money.
Most dentists judge their success by how full the schedule looks. If the day is packed, it feels like a good day. If it’s light, it feels like trouble. That instinct is understandable. But it’s also misleading. Busy measures movement. Profitable measures outcome. A packed schedule can still lose money. A lighter schedule can quietly outperform it. The difference is not how many patients you see. It’s what kind of dentistry fills the hours. Throughput is about volume. How many patients. How many procedures. How many hours used. Margin is about what’s left after those hours are paid for. High throughput with thin margins feels like running hard in place. You’re exhausted, but nothing really changes. Low-margin work uses the same resources as high-margin work: chair time, staff time, supplies, scheduling, billing. When that time is spent on low-yield procedures, the business works harder for less. That’s why some dentists feel like they’re grinding every year just to stay even. Their activity level goes up, but their profits don’t follow. Profit doesn’t come from being busy. It comes from being intentional about what fills the day. A single high-value case can do more for your practice than a full day of low-yield dentistry. It creates breathing room. It reduces dependence on volume. It lets the practice grow without pushing harder every year. Busy is about motion. Profitability is about direction. One can exhaust you. The other can free you. If your days feel full but your numbers feel tight, you don’t need more patients. You need to make better use of the time you already have. Why Busy Is Not the Same as Profitable
Exit planning is not about quitting dentistry. It’s about refusing to be trapped by it.
A prepared dentist has options. They can sell, partner, or bring in associates by choice — not because they’re trapped. They can work less without destroying the value of their practice, take time off without everything falling apart, and even handle getting sick without panic. Most importantly, they negotiate from strength, not fear. Preparation gives you options. Options give you power. Power keeps you out of bad deals. Here it is, clean and simple: If you wait to prepare until you “need” to, you’re already late.
If you plan only for the exit you want, you are exposed to the exit you’ll get.
The safest dentists are not the youngest, the healthiest, or the happiest. They’re the ones who built their practices as if life might interrupt them. Because it will. The question isn’t: “When do I want to exit?” The real question is: “If I had to exit in 12 months, would I be proud of my options, or scared of them?” If the answer makes you uncomfortable, good. Discomfort is cheaper than desperation. You don’t plan for forced exits because you expect disaster. You plan because you respect reality. And reality has never cared about your five-year plan.
2 · DentalGrowthAndExit.com
YOUR GUT IS LYING TO YOU (AND YOUR DATA ISN’T)
When it comes to decisions inside the practice, a lot of dentists rely on their gut. Even more just look around and do what they think everyone else is doing. That’s not strategy, it’s herd behavior. It feels safe, but it rarely leads to the best outcomes. Now, before you push back, there’s a reason this happens. Dentistry is built on standards, protocols, and doing things the “right” way. That mindset works very well clinically, and it’s part of what makes you good at what you do. But when it comes to running a business, that thinking can hold you back. Business rewards something different. It rewards people who think independently, measure what’s actually happening, and make decisions based on evidence instead of comfort. Unfortunately, comfort is what most people default to. And that’s where problems start to creep in. Many dentists assume that if everyone else is doing something, it must be the right move. If others are buying a piece of technology, joining a PPO, or hiring a consultant, it feels like a safe bet. But there’s a risk in following the crowd that doesn’t get talked about enough. Sometimes, the crowd is wrong. You see this clearly with big technology purchases. A dentist attends a meeting, hears a few colleagues talking about a new system, and suddenly it feels like a must-have. The internal conversation shifts quickly from curiosity to justification. And before long, a very large check gets written. What usually doesn’t happen is a disciplined analysis. There’s no real cost- benefit breakdown, no time comparison, and no honest look at whether the practice can actually support the investment. It’s a decision based more on belief than numbers. And that’s where things go sideways. I’ve seen plenty of expensive equipment sitting unused in practices. It ends up in a corner, collecting dust, quietly reminding the owner that enthusiasm and economics are not the same thing. That’s what happens when decisions are driven by instinct instead of data. It feels right in the moment, but it doesn’t hold up over time. Now let’s talk about something even more common: the front desk. Ask almost any dentist how their team handles incoming calls, and you’ll hear the same answer. “They do a great job.” There’s almost always complete confidence in that response. But when you look at the numbers, the picture changes. Across the industry, roughly one-third of incoming calls go unanswered. That means one out of
every three potential patients simply disappears. And most practices have no idea it’s happening. It gets worse when those answered calls are actually reviewed. In many cases, staff provide incomplete information, fail to answer basic questions, or never even attempt to schedule the caller. Yet the dentist still believes everything is running smoothly. The belief isn’t based on data — it’s based on perception. This gap between perception and reality is one of the biggest issues in dentistry today. Not because dentists don’t care, but because they’re operating without clear visibility. If you don’t measure something, it’s very easy to assume it’s fine. And problems that stay invisible never get fixed. The most successful practice owners operate differently. They track things most dentists never even think about measuring. Call conversion rates, case acceptance, hygiene reappointment intervals, and production per hour all become part of the picture. They don’t rely on guesses, they rely on numbers. Once you have the data, something interesting happens. Decisions become easier and more obvious. You stop making moves based on what feels right and start making them based on what actually works. That shift alone can completely change the trajectory of a practice. You stop buying technology because it’s popular. You buy it because the math makes sense. You stop assuming your team is performing well and start managing performance with clarity. And over time, that creates consistency and control. The takeaway here is simple. If you rely on assumptions, gut feelings, and what everyone else appears to be doing, you’ll likely end up where the crowd ends up: somewhere in the middle, blending in with everyone else. And that’s not where you want to be. But if you’re willing to measure, track, and face reality, even when it’s uncomfortable, you gain something much more valuable. You gain control over how your practice actually performs. And in business, control beats gut instinct every single time.
Stan Kinder - (703) 298-1690 · 3
LEVERAGE: The Multiplier Most Dentists Ignore
treatment presentation, insurance verification, or case acceptance. But in many practices, these activities are handled informally. Everyone does things slightly differently. Knowledge lives in people’s heads rather than in documented processes. The result is predictable: inconsistency, inefficiency, and daily chaos. Operational leverage is created when you identify the best way to perform critical tasks, document those methods, train the team to execute them, and hold everyone accountable to the system. Systems produce predictable outcomes. Predictable outcomes produce reliable revenue. And reliable revenue creates a practice that grows without requiring heroic effort from the dentist. 3. Financial Leverage The third category is financial leverage. This is about making your dollars work as hard as possible. Every practice generates cash flow. The question is how that capital is deployed. Some expenditures merely maintain the status quo. Others produce a multiplier effect. Examples might include: • Advanced clinical technology that increases productivity • Marketing systems that generate a steady flow of new patients • Team training that improves case acceptance • Facility expansion that increases operatory capacity The key is intentionality. Every dollar leaving the practice should ideally return with friends. Money invested wisely becomes another lever pushing the practice forward. The Bigger Picture The central lesson here is simple but powerful. Without leverage, your practice is essentially a high-paying job , one that depends entirely on your continued presence and effort.
Most dentists believe the path to success is working more hours, performing more procedures, and sacrificing more personal time. Grind it out long enough, and prosperity will appear. That belief is a trap. If the success of your practice depends primarily on how hard you work, then your business has a built-in ceiling. There are only so many hours you can practice dentistry before fatigue, stress, and burnout begin collecting their due. And eventually, they always do. The real escape hatch, the thing that lifts the ceiling, is something businesspeople have understood for centuries but dentists often overlook: Leverage. Entrepreneur Codie Sanchez has recently popularized this idea for a new generation of business owners. Her focus is what she calls “Main Street businesses,” everyday companies that generate wealth across America: laundromats, home service companies, car washes, trash hauling operations. Her background is in investment banking and private equity, where she analyzed businesses for a living. What she observed was fascinating. At the same moment millions of people were becoming disillusioned with traditional employment, tens of thousands of baby- boomer-owned small businesses were reaching the point where the owners needed an exit.
“Give me a lever long enough and a fulcrum on which to place it, and I will move the world.” In business terms, leverage is a force multiplier . It allows you to increase outputs without increasing your personal inputs. In other words: earning more without working more. In a dental practice, leverage generally appears in three forms. 1. Labor Leverage The first, and most obvious, is leverage through people. This is the strategy of accomplishing more through the coordinated efforts of others. A well-run dental practice is not a solo act. It is a team sport. Hygienists, assistants, front desk personnel, treatment coordinators, and office managers all exist to extend the productive capacity of the practice. Every task someone else can competently perform is one less task requiring your direct involvement. But many dentists sabotage themselves here. They cling to control. They micromanage. They refuse to delegate. They treat team members as helpers rather than as productive assets. The opposite approach is what creates leverage. Empower your team. Train them well. Establish clear responsibilities. Then allow them to perform at the highest level possible. Eventually, this progression leads to the most powerful labor leverage of all: associate dentists who can absorb clinical workload and expand the productive capacity of the practice. That shift alone changes everything. It allows you to spend time working on the business instead of being permanently trapped in the chair. 2. Operational Leverage The second form of leverage is operational. This is where systems enter the picture. Almost every activity inside a dental office has a “best way” to be done — whether it’s scheduling, patient intake, hygiene recall,
Opportunity met necessity.
With leverage, it becomes a business .
Sanchez began writing a newsletter about buying and operating these businesses. At the beginning, it was just her, one person, one laptop. But the business exploded. Not because she worked endlessly, but because she built the enterprise using leverage. And the concept is just as applicable, arguably more so, to the dental profession. The idea itself is ancient. The Greek mathematician Archimedes famously said:
A business can grow beyond your individual capacity. It can produce a higher income while you operate it. And ultimately, it becomes far more valuable when the day arrives that you exit.
4 · DentalGrowthAndExit.com
And because of that, two really important things happen.
First, they don’t depend on any one person. Let’s say your star fry guy, call him Brad, has been doing it perfectly for years. Great. But what happens when Brad leaves? If the whole operation depends on Brad’s skill, you’ve got a problem. But if Brad was just following a system, then it doesn’t really matter. The next person steps in, follows the same process, and the result is basically the same. The system, not Brad, produces the outcome. Second, systems eliminate inconsistency. Without a system, everyone does it their own way. One person adds too much salt. Another barely adds any. One cooks them a little longer. Another pulls them early. Now you’ve got unpredictable results. But when there’s a clear process, that variability disappears. That’s why those fries taste the same no matter where you are. Predictability is designed. Now, let’s bring this back to your practice. Most dental offices operate the exact opposite way. They rely heavily on people, usually very good people, who carry everything in their heads. The scheduler “just knows” how to fill the day. The treatment coordinator has a “feel” for getting patients to say yes. The hygienist has her own way of handling recalls. In other words, the practice runs on what I call tribal knowledge. And that works … right up until it doesn’t. When that scheduler leaves, the schedule starts to fall apart. When a key assistant quits, procedures slow down. When your front desk veteran retires, your phone conversion quietly drops. It’s not really a people problem. It’s a systems problem. Every important part of your practice should have a defined process behind it.
The McDonald’s French Fry Lesson for Dental Practices
Scheduling. Phone calls. Hygiene reappointments. Case presentation. Accounts receivable. New patient flow. Confirmations.
These shouldn’t live in someone’s head. They should be written down, taught, measured, and improved over time. When you do that, a few things happen. First, training gets easier. Instead of hoping someone figures it out, you hand them the playbook. Second, you can actually measure performance. You see what’s working, and what’s not. And third, and this is the big one, you get stability. The practice stops swinging based on who happens to be working that day. Great practices aren’t built on heroic employees saving the day. They’re built on simple, repeatable systems that produce consistent results. Just like those fries. So, next time you’re holding that red carton, take a second before you eat them all, which, if you’re anything like me, you will. Because inside that little box is a lesson in how to run a business. And if McDonald’s can systemize a french fry to that level, there’s no reason you can’t systemize your schedule, your hygiene program, your case acceptance, and your patient flow.
Have you ever really thought about a McDonald’s french fry? I know … sounds like a ridiculous question. But stay with me for a minute. As someone who’s eaten more of them than I probably should admit, I can tell you there’s actually a great business lesson sitting in that little red carton. And it applies directly to your practice. Let’s start with something simple. It doesn’t matter if you order fries in Baltimore … Natchez … Omaha … or Sacramento. They’re going to taste almost exactly the same every time.
Same texture. Same flavor. Same salt. Same color.
Now stop and think about what that really means.
Small hinges swing big doors. And sometimes … the hinge is a french fry. 🍟
There’s over 40,000 locations, staffed by people with completely different levels of experience. One place might have someone who’s been there for years. Another might have a kid who started last week and still hasn’t figured out how to wear the uniform properly. And yet … the fries come out the same. Why? Because McDonald’s doesn’t rely on people. They rely on systems. There’s a very specific process behind those fries: temperature, cook time, salt, how long they can sit, and when they get thrown out. Every step is defined.
Stan Kinder - (703) 298-1690 · 5
Servant Leadership: The Secret Weapon of High-Performing Dental Practices
Most dentists were trained to be clinicians, not leaders. But the success of your practice depends far more on your leadership skills than on your hand skills. You can be a brilliant dentist and still run a mediocre, stressful, low-profit practice because your team is disengaged, defensive, or checked out.
That’s where servant leadership comes in.
At first blush, “servant leadership” sounds like something for church groups, nonprofit boards, or corporate HR retreats, not a competitive dental practice trying to survive PPO pressures, staffing shortages, rising costs, and patient expectations that get higher every year.
But in today’s dental marketplace, servant leadership is one of the most powerful profit strategies you can adopt.
Because it works.
In a traditional dental office, the doctor sits at the top of the hierarchy. Hygienists, assistants, front office staff, and managers exist to support the dentist. The unspoken message is: “I am the revenue generator. You are here to serve me.” That mindset is exactly backward. In a servant-led practice, the dentist’s job is to serve the team by giving them clarity, support, autonomy, and the tools to do their best work. When the team wins, the practice wins. And when the practice wins, the dentist wins bigger than ever. Start with morale. Most dental teams are overworked, underappreciated, and emotionally exhausted. They absorb patient complaints, insurance frustrations, scheduling nightmares, and daily chaos, often with a smile that hides burnout. An authoritarian dentist sees this as “part of the job.” A servant leader sees it as their responsibility to improve the environment. They listen. They
TURN AN ORDINARY PRACTICE INTO A DENTAL GROWTH MACHINE
DENTAL GROWTH MACHINE By Parthiv Shah, President of eLaunchers This book reveals the framework Parthiv has used for more than 20 years to help dentists
You didn’t become a dentist to work harder every year and keep less. But that’s exactly what’s happening inside too many successful practices. The schedule is full. The team is busy. The days are long.
And somehow … the margins keep shrinking. Better dentistry is no longer the growth lever. Better systems are.
uncover hidden opportunity inside the practice they already own, so growth feels calm, repeatable, and intentional. GET THE FREE PREVIEW See the framework before you commit. Request your free preview mini-book at: DentalGrowthBook.com Your next breakthrough won’t come from working harder. It will come from seeing your practice differently.
The dentists who are winning right now understand where profit quietly leaks out of a “busy” practice, which patients are most likely to say yes to high-value care, and how to use their own data to create predictable growth, without running faster.
6 · DentalGrowthAndExit.com
remove obstacles. They protect their team from unnecessary drama. They fix broken systems instead of blaming people. When staff feel supported instead of squeezed, productivity rises, turnover drops, and patient experience improves, all of which directly impact profitability.
In a servant-led culture, people feel psychologically safe. They speak up about clinical concerns. They support comprehensive care. They communicate better with patients. They take pride in outcomes. Better culture equals better dentistry. Better dentistry equals happier patients. Happier patients equal more referrals, higher lifetime value, and stronger growth. The facts are simple: When you lead as a servant, you create leaders around you. Your office manager becomes more confident. Your lead assistant takes more initiative. Your hygienists feel empowered to educate patients rather than just clean teeth. Instead of everything funneling through you, the practice begins to run with shared leadership, which gives you more freedom, less stress, and greater scalability. Contrast that with ego-driven leadership, where everything depends on the doctor. That practice collapses the moment you step away.
Next comes trust, the most valuable currency in any dental practice. If your team doesn’t trust you,
they won’t tell you the truth about what’s really happening in your practice. They won’t flag problems early. They won’t surface bottlenecks. They won’t challenge bad decisions.
Servant leaders build trust by owning their mistakes. If a schedule blows up, they don’t hunt for someone to blame. They ask, “What did I miss? How can I help?” That single shift changes everything.
A servant-led practice thrives even when you’re out of the office.
Basically, if your team dreads coming to work, your practice will never reach its full potential. If your team loves working in your practice, you gain a competitive advantage that no marketing strategy can buy. Servant leadership is not about being soft. It’s about being smart, increasing influence, and building a system where everyone, including you, wins. You can rule your practice through fear, or you can lead it through service. One gets you compliance. The other gets you excellence. Your production numbers, your profit margin, your patient retention, and your quality of life will tell you which path you chose.
Now consider retention, arguably the No. 1 crisis in dentistry today. Hygienists and assistants are in high
demand. Great front office people are rare. Every time you lose a key team member, you lose momentum, morale, and money. People don’t leave good practices. They leave bad bosses.
Servant leadership is your best defense against turnover. When people feel respected, valued, and fairly treated, they stay, even when recruiters come calling. Then there’s patient care. In a fearful environment, team members avoid difficult conversations. They don’t advocate strongly for treatment. They rush through appointments. They play it safe.
If You Want to Stand Out From Every Other Dental Practice BE PREPARED TO DO WHAT MOST WON’T If something is easy … convenient … comfortable … and fits neatly into your normal routine, it’s probably not a real competitive advantage. Why? Because if it were easy, everyone would already be doing it. Dan Kennedy has talked about this for decades. The harder something is, the more discipline and effort it requires, the fewer people are willing to do it. And that’s exactly where the opportunity lives. Most business owners, dentists included, are always looking for the shortcut. The automation. The marketing trick that magically fills the schedule. But the truth is that the real advantages usually sit somewhere else entirely … in the things that take a little more effort, a little more thought, and a willingness to do something different. And most people simply won’t go there. Dentistry, whether we like it or not, is largely a commodity marketplace. The average patient can’t really tell the difference between dentists based on clinical quality. They don’t have the training. They don’t have a frame of reference.
Similar websites. Similar insurance participation.
So, how do they actually decide? It usually comes down to something much simpler: how they feel. The experience. The interaction. The relationship.
So, from their perspective, most practices look about the same.
The same services. Similar claims about technology.
Continued on Page 8 ...
Stan Kinder - (703) 298-1690 · 7
... continued from Page 7
Patients remember how your practice makes them feel, and that becomes the foundation for trust, which drives everything you want: case acceptance, loyalty, referrals, and long-term value. I was talking with a dentist recently who shared something interesting. He implemented a system that, quite honestly, almost no one else bothers to. Every time a new patient schedules their first visit, he calls them personally before the appointment. Not a team member or an automated message, him. The call is simple. He introduces himself, thanks them for choosing the practice, asks if there’s anything they’re concerned about, and tells them he’s looking forward to meeting them. That’s it. Five to 10 minutes. But here’s what stood out to me. Almost every patient says the same thing: “No doctor has ever called me like this before.” Think about that for a second. One short phone call, less time than most people spend scrolling between patients, and suddenly you’re in a completely different category in that patient’s mind. And he doesn’t stop there. When the patient arrives, they get a small welcome gift. After the visit, they receive a handwritten thank-you note. And if they have any significant treatment, they get a follow-up call to check in. Now compare that to the typical experience. Appointment reminder. Clinical visit. Front desk checkout. And that’s where it ends. Then we wonder why patients behave like shoppers instead of loyal advocates. Over the years, I’ve suggested something as simple as a post-treatment phone call to many dentists. And you’d think I was asking them to do something extreme based on the reactions.
Most dental websites look fine on the surface. You see smiling patients, photos of the office, and pictures of the team in matching scrubs. Everything looks clean, friendly, and professional. But the problem isn’t how they look, it’s what they’re saying, and whom they’re saying it to. Scroll through most practice websites, and you’ll see the same story repeated: years of experience, advanced training, awards, technology, credentials, and “we care.” It reads like a resume. Dentists think that makes them impressive, but that’s not how patients decide. Patients don’t wake up thinking, “I hope I find a dentist with 15 certifications and a 3D scanner.” They wake up thinking, “Why does my tooth hurt?” “Can I trust this place?” “Am I going to be embarrassed?” “Is this going to cost more than I can handle?” High-value patients are no different. They still want clarity, confidence, and reassurance. They just want it delivered in a way that respects their intelligence. When your website opens by telling people how great you are, it forces them to do the hard work of figuring out if you’re right for them. Most won’t. They don’t leave because you seem bad; they leave because you didn’t give them a reason to stay. Great marketing translates what you do into what it means for them. Instead of saying, “We use the latest technology,” say what that means: fewer visits, more comfort, better outcomes, less guesswork. Instead of listing credentials, explain how those years of experience show up in their chair. Instead of bragging about how much you care, show how caring changes their experience. Websites that attract high-value patients talk about problems, not trophies. They talk about fear, time, trust, outcomes, long-term health, and what it feels like to be taken care of. High-value patients don’t want to admire you; they want to see themselves in your message. If your site reads like a resume, you’re not impressing anyone; you’re asking strangers to do the work of connecting the dots. Most won’t. The fix is simple but uncomfortable: Stop leading with you. Lead with the patient you want. Speak to their concerns. Name their fears. Describe their desired outcome. Show them what life looks like after they choose you. You can still talk about your skills, but only after you’ve shown them you understand them. High-value patients don’t choose the most decorated dentist. They choose the dentist who feels like they were speaking directly to them. Why Most Websites Repel High-Value Patients
“I don’t have the time.”
“It’s not necessary.”
“My staff can handle it.”
Maybe. But that’s not really the issue. The real reason most don’t do it is because it’s uncomfortable. It requires personal involvement. It pulls you out of the routine. And that’s exactly why it works. The market isn’t crowded with people willing to do small, thoughtful, slightly inconvenient things for their patients. In fact, it’s pretty empty, which means the bar to stand out is much lower than most dentists think. You don’t need a brand-new marketing strategy or the latest piece of technology. And you definitely don’t need another cookie-cutter website. What you need is the willingness to do what others won’t. Make the call. Write the note. Follow up. Spend the extra few minutes. Because those small actions, done consistently, create something that’s very hard to compete with … real relationships. And in a business such as dentistry, that’s about as close to an unfair advantage as you can get. If you want extraordinary results, you have to be willing to do the things ordinary practice owners won’t.
8 · DentalGrowthAndExit.com
What’s Slowing Both DSO and Private Transactions Headwinds in the Dental Practice Sales Market
4. Costs are up and margins are feeling it. Expenses have gone up. You already know that. Staffing is tighter, especially with hygienists, and wages have followed. Supply costs have increased. Some materials are more expensive due to tariffs. At the same time, insurance reimbursements haven’t kept up. All of that puts pressure on margins, and margins are what buyers are looking at first. Even a strong practice can get discounted if a buyer feels those margins aren’t stable going forward. 5. Deals are getting more complicated. This is something I spend a lot of time talking through with doctors. Deals today are often more complex than they used to be. Instead of a straightforward sale, you’re seeing things like: • Earn-outs tied to performance • Equity rollovers • Multiyear employment agreements
For a long time, this was a very easy conversation to have.
For more than a decade, the dental practice sales market had a great run. Private equity money poured into dentistry. DSOs grew quickly. Valuations kept climbing. And for many owners, selling a practice became very attractive. That’s still true today, but it’s not quite as simple anymore. Strong practices are still getting strong valuations. But there are some real headwinds right now, things that are slowing deals down on both the DSO side and the private buyer side.
Let me walk you through what’s really going on.
1. Interest rates changed the game. This is probably the biggest factor, and it affects everything. A few years ago, money was cheap. DSOs could borrow easily, and that allowed them to be aggressive when buying practices. That’s a big part of why valuations climbed the way they did.
In many cases, part of your payout depends on what happens after the deal closes. That can work well in the right situation, but it also introduces uncertainty. And for doctors thinking about retirement, the idea of staying on for several more years can change how attractive a deal really is.
Then interest rates went up. Now the same practice has to support a more expensive loan. That means buyers simply can’t pay what they could before. So, what are we seeing? More discipline. More scrutiny. Sometimes lower multiples. And more deals structured with earn-outs or equity instead of large upfront checks. Private buyers feel this, too. A young dentist today is looking at much higher monthly payments than someone buying just a few years ago. That alone can shrink what they’re willing, or able, to offer. 2. Buyers are being pickier. Another shift I’m seeing pretty clearly is that buyers are more selective. DSOs, in particular, are focusing on practices that are already running well with strong margins, good systems, and clear growth potential.
6. Tax and regulatory changes add another layer.
There’s also some uncertainty on the tax side. Changes to deductions, surtaxes, and pass-through structures all play a role in what you actually keep after a sale. And since your practice is likely your largest asset, even small changes here can have a meaningful impact.
A Market That’s Slower, but Still Moving Now, with all that said, I don’t want this to sound like the market has stopped. It hasn’t.
If a practice is outdated, has a weak hygiene program, or depends too heavily on one doctor, it’s going to have a harder time attracting attention. This is where the gap is widening. Top-tier practices are still commanding strong multiples. But average practices? They’re seeing more modest numbers and fewer buyers competing for them. The days of “just about any practice” getting multiple offers are mostly behind us. 3. Fewer dentists want to own practices. This is a quieter shift, but it’s a big one. Fewer dentists today are choosing ownership. We’ve seen private practice ownership steadily decline over the years. And that changes the exit landscape quite a bit. It used to be common to bring in an associate and eventually transition the practice to them. That path is still there, but it’s less reliable than it used to be. Younger dentists are carrying more debt. Many prefer the stability of working within a DSO or group rather than taking on the risk of ownership. And with more than half of graduating classes now female, and statistically more likely to work part time, ownership just isn’t the default goal it once was. What that means for you is simple: If you’re hoping for a private buyer, the pool may be smaller than it used to be.
There is still strong demand for high-quality practices. DSOs are still buying. Deals are still getting done. But the environment has changed. Buyers are more careful. Financing is more expensive. Deals take more thought and more structure. And because of that, preparation matters more than it ever has. Strong numbers. Efficient operations. A solid hygiene program. These aren’t “nice to have” anymore. They’re expected. If you’re thinking about a transition, the biggest mistake you can make is assuming the market will carry you. It won’t. But if you prepare properly, understand what buyers are looking for, and go into the process with the right guidance, very good outcomes are still available. Just be ready for it to take a little more time and intention than it did a few years ago.
Stan Kinder - (703) 298-1690 · 9
BUCKET LIST When you sell out, you will probably walk with a bucket of money. Quite possibly more money than you’ve ever had unencumbered, liquid, yours to do with as you please. You earned it. You deserve to use it. relatively fearless about investing knowing he could recover from any
mistake and loss because he had a high, regular income. Now he realized there was no new money coming in to replace losses. He had routinely treated himself and his family to several great vacations a year, maintained a seldom used vacation home and boat. Now, suddenly, all those expenses had no offset from earned income.
But ...
Everything is changed once your regular income faucet is turned off and disconnected from its source. No more paychecks. No more bonuses. No more personal expenses justified as business expense and paid with gross dollars. It all stops. This can be a shock, not just to you but to your spouse and family. Late last year, I helped a client engineer and complete the sale of his company to a competitor for millions of dollars, paid in cash. A bucket of money. But it wasn’t even two months before he was complaining about having no income! I reminded him that he had sold the income for the millions now in his bank account. While he acknowledged that and knew it intellectually, emotionally he missed his 1st and 15th paycheck. He had been
Yes, he would be getting interest and dividend checks from whatever portion of the millions went into his investment portfolio, but that didn’t feel like a certain paycheck twice a month.
Life after exit suddenly seemed very expensive.
This is why it is not enough to succeed at the sale of and exit from your practice. That IS a big achievement. The way it is structured financially is very important. But it is a “solution” that creates many “problems.” Family members will want money they weren’t asking for before. Friends will appear with business plans and slide stacks, asking you to invest. Sales agents from your local bank’s wealth management office to Goldman, your CPA, your brother-in-law the stock broker will all have advice for you. You won’t want to hurt anybody’s feelings by saying No. You’ll quickly be restless and too easily seduced by new opportunities. If you’ve ever seen the Alfred Hitchcock movie “The Birds,” you are now the target. First, a few birds show up. Then a lot. Then they all surround you, chase you, peck at you all at once. One of my clients, Ted Oakley, is a wealth management professional who works exclusively with sellers of businesses, $20 million and up. You will do this once. He has ridden along with hundreds and hundreds of sellers. I’ve been involved with many entrepreneurs’ exits and post-sale adjustments and lives. From Ted and me, here is some advice: 1. If at all possible, develop a financial and life plan for after the sale before you make the sale occur. Not just a financial plan. A life plan. It’s okay if it’s not all perfectly planned. But it’s common to be so focused on making
10 · DentalGrowthAndExit.com
Dentists are often frustrated with associate docs who just won’t bring in patients, but if you have the right marketing “machine” in place, you don’t need them to do that. To this end, my client and friend Parthiv Shah’s “Dental Growth Machine” warrants a full reading. One last point: Force yourself to do “blank slate thinking.” How your practice operates now is almost irrelevant. Figure out what kind of new relationship you’d like to have with it, then try to build that into your exit plan. What you think of musts are probably, frankly, just habits.
the sale that, after doing so and popping the cork on a bottle of champagne, people look at each
Many sellers who agree to hang around for two or three years are quickly frustrated and unhappy doing so. That is often not the fault of the buyer. The seller makes two mistakes: First, unreasonable and unrealistic emotional attachment
other and say, “Uh-oh. Now what?” 2. Encumber most of the proceeds for a full year. Untouchable. Put it in dull, boring, safe places, like T-bills or money market accounts. DO NOTHING with it. 3. Study up. You were running a practice. Now you are running your investment and income portfolio. 4. Politely say NO to everybody showing up hat in hand. Steel yourself against manipulation, guilt, seduction. Explain that the proceeds from the sale, after taxes, have been “locked up” as the foundation of all your future income. 5. Do NOT do dumb stuff: divorcing, marrying half your age, buying fast depreciating assets on a lottery winner’s buying spree. Investing in something you know nothing about. 6. Get qualified, reputable help and advice. I can recommend reading some of Ted’s books, like “$30-Millions and Broke” and “Crazy Times,” and watching his YouTube videos. Visit OxbowAdvisors.com. 7. Carefully test some waters. Maybe mentoring, consulting. Work with a charity of your choice. Rent (don’t buy) anything big, like a giant RV or a new home by the beach. Maybe You Shouldn’t Exit After All There is a big assumption that, at a point, you sell. It’s sort of what you’re supposed to do. Given that the peak price-paying has stalled and it is more a buyer’s than a seller’s market, and considering other factors, maybe you’ll be better served “almost-retiring rich, in practice.” Instead of leaving, you could creatively grow your practice to be more profitable and more “set it and forget it” with successful marketing automation.
to everything as-is. Second, not putting the same thought, care, and specificity into the post-sale working relationship agreement as went into the sale agreement. —Dan S. Kennedy
Dan S. Kennedy is a much sought after direct marketing strategy consultant and copywriter, helping build brands and businesses like Perfect Smile® and Proactiv®, America’s #1 acne treatment, MiracleEar®, and Medicare Express. He is the author of the bestselling series of “NO B.S.” books, including the most recent “No B.S. Guide to Succeeding In Business by Breaking ALL The Rules.” As a speaker, his long career includes nine years on the largest public seminar tour in America, alongside four former U.S. presidents, countless Hollywood and sports celebrities, great marketing founder-CEOs like Debbi Fields (Mrs. Fields Cookies) and Jim McCann (1-800-Flowers), and legendary speakers including Zig Ziglar, Brian Tracy, Jim Rohn, and Tom Hopkins. His own seminar events have featured celebrity-entrepreneurs like Gene Simmons (KISS), Joan Rivers, George Foreman, and Kathy Ireland. The entrepreneurs’ organization he founded can be looked in on at MagneticMarketing. com. Over 30,000 dentists, chiropractors, and other health care professionals have been in his audiences.
Stan Kinder - (703) 298-1690 · 11
Unless you’ve been completely tuned out from the news lately, you’ve probably noticed the constant drumbeat of economic uncertainty. Every day seems to bring a new prediction about what’s slowing down, breaking down, or heading in the wrong direction. And if you’re thinking about selling your practice, it’s only natural for that noise to get your attention. It creates hesitation, maybe even a little anxiety. The best way to deal with that isn’t to ignore it. It’s to understand what’s actually happening. You’ve likely seen the headlines suggesting the DSO wave has come to a stop. In my view, that’s not accurate. Has it slowed? Yes. Has it adjusted course? Absolutely. But it’s still moving forward. And if you look at what’s happened over the last several years, it starts to make a lot more sense. In the late 2010s and early 2020s, interest rates were extremely low. Money was cheap, easy to access, and that fueled a rapid expansion of DSO activity. Private equity groups were moving quickly, acquiring practices at a fast pace. A big part of the value creation during that time came from arbitrage, buying at one level, growing, and then recapitalizing at a higher level. Growth through aggregation was the name of the game. And for many groups and their investors, it worked very well. Then interest rates rose, and that changed the entire equation. Financing became more expensive. Lenders became more cautious. Buyers started paying closer attention to risk. At the same time, some DSOs found themselves carrying more debt than was comfortable in a higher-rate environment. HAS THE DSO WINDOW CLOSED … OR JUST SHIFTED? What to Really Expect in Today’s Dental Transition Market
Most practice owners say they want options someday to slow down, step back, sell, partner, or transition without stress. But very few owners are actually building those options inside their own practice. The smartest succession strategy is often already standing in your building in the form of an associate who grows into ownership the right way. Internal succession is not about paperwork. It’s about people. It’s about identifying someone who does not just want a job, but wants a future, someone who doesn’t just clock in, but cares what happens to the practice when you’re not there. THE ASSOCIATE SHOULD BE GRO RIGHT NOW
Not surprisingly, the pace of acquisitions slowed.
But here’s where things get interesting. The focus has shifted. Today, the most attractive DSOs aren’t just the ones growing quickly. It’s the ones that can actually operate well: those that can improve revenue, increase profitability, and create consistent year-over-year performance across their practices. In other words, execution now matters just as much as expansion. We’re also starting to see activity pick up again. Deals are getting done. Interest remains strong. And many insiders expect that pace to continue increasing, especially if and when interest rates begin to ease. And that makes your role as a seller more important. Just like there are excellent private practices and average ones, the same is true with DSOs. Some are well-run, well-capitalized, and focused on long-term success. Others are still figuring it out. Knowing the difference can have a major impact on your outcome.
That kind of associate doesn’t happen by accident. You shape them.
The associate you should be grooming right now is not necessarily the most productive one. It’s the one who thinks like an owner before they ever own. They ask questions about systems. They care about patients staying, not just being seen. They notice when the schedule breaks
So, where does that leave us?
Is the DSO model over? Not even close. Is it under pressure in certain areas? Yes. Did you miss your opportunity? Absolutely not.
Are DSOs still buying practices? Without question.
12 · DentalGrowthAndExit.com
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16Made with FlippingBook Ebook Creator