The 10 biggest Mistakes Start Up Dentists Make…

As you consider making the leap from associate to owner, it's natural to feel both excited and overwhelmed. The path to dental practice ownership is filled with decisions that will impact not just your career but your life for years to come. Jonathan Miller, host of the From Dentist to De Novo podcast, understands this journey better than most. With nearly two decades of experience in practice lending, coaching, and project management, Miller has helped hundreds of dentists navigate the transition to successful practice ownership.

In the second episode of his podcast, Miller breaks down the top 10 mistakes he consistently sees dentists make during this pivotal career transition. His approach focuses on "information over affirmation" – giving dentists the guidance they need, even when it's not what they want to hear. Let's explore these common pitfalls and how you can avoid them to create a stronger foundation for your practice.

  Consistency and Vision: Starting with Clear Direction

The journey to practice ownership often begins with enthusiasm but lacks a consistent roadmap. Miller identifies inconsistency as mistake #10 – dentists frequently jump between different sources of advice without developing a focused vision. You might find yourself asking friends, family, scrolling through Facebook groups, or reading message boards, gathering fragments of information without a coherent plan.

This scattered approach leads to decision paralysis or impulsive choices. While your overall goal might be practice ownership, the specific path to achieve it requires clarity. Are you looking to start from scratch, purchase an existing practice, or pursue a partnership? Each route demands different preparations, timelines, and resources. Without consistency in your approach, you'll waste valuable time and energy on options that may not align with your ultimate vision.

Developing a laser-focused vision means defining not just the end goal but the specific route you'll take to achieve it. This includes understanding your clinical philosophy, financial parameters, lifestyle goals, and timeline. When your vision is clear, you'll make decisions that consistently move you toward your specific version of practice ownership, rather than being pulled in multiple directions by conflicting advice.

  Time Economics and Decision-Making

The second critical area where Miller sees dentists stumble is underestimating time requirements (mistake #9). Most dentists overestimate what they can accomplish in a day while underestimating how long practice transitions actually take. This miscalculation creates unnecessary stress and can lead to rushed decisions with long-term consequences.

Time economics extends beyond just scheduling – it impacts your bottom line directly. Every delayed decision costs money, whether it's continuing to work as an associate instead of building equity in your own practice, paying rent on an empty space during extended construction delays, or losing momentum with potential patients due to pushed-back opening dates. The ability to make timely decisions about banks, equipment, contractors, and team members significantly impacts your success trajectory. Even the time it takes to address staffing issues can drain resources – keeping an underperforming team member too long can damage practice culture and patient experience.

Miller emphasizes that your time can be spent, wasted, or invested. As a practice owner, learning to invest your time strategically becomes a crucial skill. This means developing systems for efficient decision-making, delegating effectively, and recognizing which activities generate the highest return on time invested. By mastering time economics early, you position your practice for more rapid growth and avoid the costly delays that plague many first-time owners.

  Building Your Professional Team

One of the most significant decisions you'll make is assembling the right team of professionals to guide your transition to ownership (mistake #4). Miller outlines the essential players every dentist needs:

● Lender - Choose carefully as this relationship may last 10-15 years

● Attorney - Critical for both startups and acquisitions

● Commercial real estate advisor - Even when buying a practice, the lease terms require expert review

● Equipment representative - Important for both new purchases and evaluating existing equipment

● Contractor - Essential for startups and many acquisitions requiring renovations

● Marketing company - Timing varies but necessary for both startups and acquisitions

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Beyond these core team members, Miller advises being strategic about when to bring on additional professionals. For example, while Certified Public Accountants (CPAs) provide valuable financial guidance, their role differs depending on whether you're starting from scratch or purchasing an existing practice. When acquiring a practice, a CPA can help with due diligence, but only if they understand the business of dentistry – not just the numbers on a tax return.

Your team should be selected not just for their credentials but for their fit with your specific goals and vision. Each professional should understand the unique challenges of dental practice ownership and work collaboratively with your other advisors. The right team will not only help you avoid costly mistakes but will also serve as trusted resources as your practice grows and evolves.

  Financial Framework and Budgeting

Approaching budget decisions strategically ranks as one of Miller's top concerns for dentists (mistake #2). While banks often approve similar loan amounts for general practitioners (typically $700,000-$750,000), how you allocate these funds makes all the difference between success and struggle. The financial decisions you make early on will impact your practice's profitability for years to come.

Miller notes that even with identical loan amounts, dentists invest their money with vastly different levels of strategic thinking. Some make sound investments that generate returns and create long-term value, while others allocate funds poorly, creating cash flow problems and limiting future growth potential. Understanding the appropriate balance between construction, equipment, technology, and marketing expenses requires careful planning and industry knowledge. Additional considerations like tenant improvement allowances, building purchase options, and financing terms further complicate these decisions.

Creating a comprehensive budget means looking beyond the initial purchase or buildout to include working capital for the first 6-12 months of operation. This should account for team salaries, marketing expenses, supplies, and personal living expenses during the ramp-up period. Miller emphasizes that proper budgeting isn't just about keeping costs low – it's about strategic allocation that positions your practice for sustainable growth from day one.

  The Mindset That Makes or Breaks Success

The most detrimental mistake Miller identifies might surprise you – it's not financial or operational but mindset-based. Mistake #1 is the "I'm right" mentality that prevents dentists from seeking and implementing expert advice. This fixed mindset manifests when dentists insist on pursuing plans despite objective evidence suggesting reconsideration.

This attitude becomes particularly dangerous when multiple lenders decline to finance a project, yet the dentist persists using personal or family funds. While determination is admirable, refusing to consider outside perspectives often leads to costly mistakes that could have been avoided. The most successful practice owners balance confidence with humility – they have a clear vision but remain open to refining their approach based on expert guidance and market realities.

Transitioning from "I'm right" to "I want to get it right" represents a fundamental shift that positions you for long-term success. This growth mindset welcomes feedback, seeks diverse perspectives, and values learning over being perceived as knowledgeable. It recognizes that practice ownership involves numerous specialties beyond clinical dentistry, including finance, real estate, marketing, team building, and business operations – areas where most dentists benefit from expert guidance.

  Taking the Next Step: From Analysis to Action

Now that you understand the common pitfalls in the journey to practice ownership, it's time to assess your own preparation honestly. Where do you stand with consistency in your vision? Have you developed systems for making timely decisions? Is your professional team taking shape with the right advisors? Do you have a clear budgeting strategy? Most importantly, are you approaching this transition with a mindset open to guidance?

The path to successful practice ownership isn't about avoiding every challenge – it's about approaching challenges strategically with the right support. Jonathan Miller's insights from guiding hundreds of dentists through this transition offer a valuable roadmap for navigating the complexities ahead.

If you're ready to move forward with confidence, start by defining your vision with greater specificity. Then identify the professional team members you'll need based on your chosen path. Create a realistic timeline that accounts for the inevitable delays and adjustments. And throughout the process, remain open to refining your approach based on expert guidance and market realities.

The difference between struggling through practice ownership and thriving as a practice owner often comes down to these foundational decisions. By learning from the mistakes others have made, you can create a smoother, more profitable transition to the practice you've always envisioned. The investment in proper planning now will pay dividends throughout your career as a practice owner.

Schedule a consultation with a practice ownership advisor today to develop your personalized roadmap to successful dental practice ownership.