The Numbers No One Shares: Real Pediatric Dentist Start-Up Stories

[MUSIC] >> Set down your sleepy water in your Mr. Wessel. Take off that raincoat and grab a cold beer. It's time to have a real talk about pediatric dentistry. You're listening to Bruce and Tiny Teeth, the unfiltered pediatric dentistry podcast. [MUSIC] What's up, Bruce and Tiny Teeth fans. It's your boy Casey Gets coming at you on a Sunday night. I've got something a little bit different and I've been excited to record this podcast. For quite a while, it's taken some work to get together. It's been a little bit since I've been a little nervous to sit down and kind of over stuff in the podcast. You guys kind of know typically my style is bringing on cool pediatric dentists from around the country. Talking about interesting things in our personal and professional lives. But for this episode, I'm doing it solo style and the theme around this episode that we're going to get into is all about transparent numbers and case studies and 15 startups. So I wanted to do an episode where I had people anonymously send in their numbers. What did they collect their first couple of years of their pediatric dentistry startup? What did they start paying themselves? What did they break even? And nobody really, I found one is to talk about these numbers. None of these numbers are public. You can't find them anywhere for the startup phase of life. And it's really hard when you talk to these startup guests, which I love doing as part of the show, to try to determine how open people are talking about things and to be kind of a bit uncomfortable asking because I'm not sure how much people are willing to share. And so I kind of bond upon me that this would make for a fantastic episode. Trying to derive some information. So I'm getting to the details about what I came up with and we'll go through some of these case studies. But I think this episode is really going to shed a lot of light on what is possible, what is practical, what's achievable when it comes to starting your own pediatric dental practice. But first things first, it's an after hour, Sunday night, had a good weekend. This is the first busy week of the summer, which everybody listening knows is going to be quite the grind. So I am going to crack a beer, true to the theme of the show tonight. I'm drinking a fat Elvis. I think I've had one of these on the show before, but this was the one that spoke to me the most. The Zaburi ad St. Louis. It's like a real dark chocolatey peanut butter milk stout, which typically is not a summer beer recording this in early June. But I'm going to crack this one and work on it with you guys while I go through some of these numbers and talk a little shop. So cheers. I don't quite get in as many craft beers as I would like to these days. So that hits the spot. That's fantastic. Okay, I'm going to start the podcast off before we dive into some of these details and practices, which it might take a little bit to get through it. So I'm going to do the best I can time lies. But I wanted to touch base because I just got back from AEPD. I wanted to give a little spring update there, but AEPD was in Vegas this year. I was able to shoot out there for two days. It was a really good time. I got to, you know, kind of just some of my thoughts I wanted to share about AEPD. When I got out to Vegas, it was a quick two-day work trip. Came by myself and not bring the family. I look forward to that day. I'm a bit jealous when you have the older kids and you can bring the family out and make a full vacation out of it. But sometimes it kind of feels overwhelming. You go out there and it's it's weird being surrounded by so many people that, you know, live in the world of pediatric dentistry. And I think it does kind of refill my social cup, though. Like I love running into people that I met before. Co-residents. I always have lots of people coming up that listen to podcasts, which really is awesome. It makes me feel great when people find me on the floor. I'm not walking around. I was in the elevator. I'm going to wait down from the hotel and, you know, thank God for the badges that we wear. But I've met some cool people in the elevator and ended up, you know, making some friends that way. So just always great to kind of networking connects with people. And I did not have a booth this year. You guys know previously, like last year, I had a booth in the vendor hall for the startup course that I put on. Little smile's practice mastery. I did that last year just we were trying to get the course up and going and promote this startup course for people that wanted to start their own pediatric dental practice. But it was a lot of work. So this year kept it more casual. I went to as many lectures as I could. So it's nice to get around a little bit. But I never feel like I have as much time to get to all of them as what I want. And the week implies by it's definitely not relaxing. But it's really cool to connect with good people all I'm out there. So I appreciate everybody that came up and said hi. And all the people that I got to meet out there. You know, I also thought I had why I was out there. Is it's kind of interesting. You guys may agree or disagree. But I had a realization that there's kind of two families or two different types of pediatric dentists. You have the types that are more like myself that really like going to conferences and CE events, attending lectures, networking, trying to see what's new in the world with pediatric dentistry. And then you have the other side of pediatric dentists who are hardworking in the trenches, pediatric dentists, but they're not really the type that like to travel or go to CE events. And you never see them. It just kind of dawned upon me that there's a lot of good friends and colleagues that yet again, another APD goes by and I never see them there. So it's just kind of interesting and kind of an observation of the above. But there's a kind of encourage if you're a resident, listen to this, which a decent chunk of my listeners are early pediatric dentists and residents. But I think it's important to try to attend the APD or your annual meetings and try to stay up to speed on things just because it's a really good chance to network and see what's hot, see what's new, stay up to date. So try to be the type of person that goes to APD at least once in a while or to your meetings or CE events. I think it's important to keep your skills sharp there. As far as my thoughts on the exhibit hall, just some hot takes there. I was kind of like last year, but I was interested to see the two predominant business entities or types of vendors that I saw out there, really heavy presence of DSOs or people aren't going to label themselves as DSOs because of the bad connotation. But just think vendors that were trying to recruit pediatric dentists through their large practices, they might be large private practices or private equity or non-denous owned bind groups trying to buy practices. I was just kind of impressed at how many of them there were trying to go into buy practices or recruit associate doctors. So my take home from that is if you're an associate and you're not happy with your job or you need a fresh start, just kind of be aware there's a lot of people looking for associates out there. And you know, you could quit your job and probably you might have to relocate, but there's plenty of opportunities for good pediatric dentists to find employment. And you have the upper hats and are in high demand right now. So that stuck out to me. I also, again, similar last year, I thought it was interesting to see how many, how many, how much like AI and software based companies were out there. Even some of them were kind of sales pitchy a bit like you walk up and down the the aisles and people would grab you, "Hey, what are you using for software? Do you have an AI receptionist?" At it was one, they just really pressed hard trying to show you things. It felt like I was being sold a car. But just a lot of, I think that's just going to become, you know, bigger and bigger is the AI trend, kind of grows, finding a way to infiltrate into the industry. And some of them, I think, have merit and some of them, I think, are a bit about the flash in the pan. So things to pay attention to, I don't think any of them are big adopters, but I definitely found some cool products and cool people and businesses that I've made do some partnerships or try out some other products. But very AI-heavy and software-heavy. So other than that, APD was good. Busy summer schedules about ready to get going. In my own office, you know, I'm just kind of grinding the summers. It's the time to pay the bills. I've got a little bit of staff drama and turnover, which is always kind of a bummer. But I've got some, a new hire starting that I'm really excited about. I know anybody that's a practice owner has been in the trenches, kind of knows. You'll go through periods of really consistent staff and life is good. And the whole machine is humming along. And then you'll get a little bit of drama uptick and you'll get a bad apple. And you'll get some hurt feelings and it always just kind of makes me sad a little bit. But I've been through enough of these cycles where I know how to handle them. I don't react as emotionally as I used to do. I don't take this personally. You know, it was just we have one or two staff members leave and we try to make good hires and life goes on. And so if anybody else is going through that, just know it. It happens and I feel you know, I'm going through a little bit of it myself. But you always come out with the stronger practice on the other side, which is good. So those are kind of my updates. I wanted to start with you guys. But let's let's get into it after after the intro here. So I again, I came up with 15 practices that I'm going to share with you guys today. 15 listeners or commenters who wrote in. Basically after I came up with this idea, I got on Facebook on the pediatric dentistry start at page. And I made a post with this idea asking for people to write in, you know, who had done startups write in and share your data of what you. And let me go over the questions that I asked. I asked, when did you open and what kind of demographic were you in? What kind of insurance you took? Number two was what was your projected first and second year collections? And then what did you actually hit? What did you actually collect those first early years? Number three was when did the practice break even? Will become profitable? Number four was when did you start paying yourself? And number five is did you associate and it's so for how long? Some of the responses I got I added or went back and forth, asked more questions, trying to tease out more information. And so there's kind of answers that are constructed all over the place here, but I had a tremendous amount of response. I had tons and tons of people write in and for the sake of time, I picked out the 15 that I thought were the most relevant, but just be aware, you know, that there's these responses are in no particular order. There's no particular favoritism. I try to just take a nice sample from pediatric dental offices from across the country and different demographic types. I pick the answers that were the most complete, but this is not to, but we'll start by saying this not to make anybody feel bad. This is not to make anybody that is not at these numbers or not at these points know that they're doing anything wrong. This is just to give ranges of what's possible and what's expected to hopefully be a helpful resource to those who want to start a practice, but aren't either realistic with one of the numbers that are possible. What should I shoot for what should be in my business plan. I also apologize if the flow is a little off here. I'm going to drink this beer while I go through these. The, you know, I kind of clip that answers back and forth and put them together the best I can, but a lot of it is just screenshotting conversations I had. It took a while to put all this together and obviously I do this on my own in between five days of seeing a ton of kids and my own crazy kids at home. I did the best that I could, you know, putting together a good slow, but I apologize if there's some pauses or I got to check my notes or not to jump around a little bit. So that's where I. I can hit the highlights here. So let's start this off. I'm going to do my own personal practice here. Most of these practices. I believe we're all in the last about five years. So these are all relatively recent numbers. These are not 20, you know, 2005 startups. I started. So for example, off top my head, I started my practice right after COVID. It was October of 2020 in the first full 12 months. I predicted I was going to collect. I think I had set it around five, 50 or 600,000 based off of some simple calculations as far as like projected number of new patients per day. I was going to see 50% Medicaid. These were the rates is for the average Medicaid reimbursements for cleanings basic ops, adding in six months recalls kind of extrapolated out. That's number came up with was around 600,000. I ended up collecting 95, which was I was really happy with, which was a really strong first year that lend itself well because I was the I'm still the only pediatric dentist in a growing county of about 50 or 60,000 people. Very middle class very high carries risk of when the Medicaid and you know, hardworking folks, but in a growing suburb in here in Missouri. In network with just Delta and then a lot of heavy Medicaid. When did I, let's see, when did I break even I broke even probably on month to a three and then reinvested money or profits I had back in the business to put in more chairs. I started with two chairs, but the three went to four hired more staff and just focused on growing practice. I don't think I actually started taking home, you know, cash on my own closer to, you know, a significant amount of cash told months seven or eight. That's when I really started paying myself was was about that point in time. I might have taken home a little bit to pay some bills, but for the most part, like heavy dollars started flowing to the personal bank account for paying off student loans. That was probably month eight or nine and did I associate I attempted to I did some GA cases for a month or so, but I quickly dropped that off. So basically did not associate and I think that was beneficial to helping grow very quickly. Pitting when I say nine eighty five the first year and second year, collected about one point six. And I was already reaching capacity about that point and then it's been slower incremental growth since then it's hard to make those big jumps here over here. So that was kind of my personal story. Again, the rest of these I'm going to start rattling through what I've got these are all anonymous. Hopefully, you know, I don't believe I have anything. You know, I tried to be careful about what I'm going to try to be my best not to what do they call it? You know, spot check anybody. I'm sure if you're detected enough, you could probably figure out who some of these people are, but I did my best to keep this completely anonymous. You know, but also maybe including some locations here and they're just generally speaking. I tried to my best either Midwest or coastal or the South, but some people in their responses were more detailed with where they're at. And so I do my best to kind of shed light on where people are practicing out without, you know, giving away exact practices here. Okay. So pediatric dentist number one opened. This was a recent one around Christmas of 2024. So a little over a year taking major PPO and 20% on membership plan. That's high. That's a good amount of cash being patient. So that's great. What was your projected first year to collections? Answer, I wanted work life balance works 30 hours per week per week doing regular right and butter dentistry. My only goal was to provide the best care and reach out to the communities by ground marketing. I haven't done any social media marketing. I collected 371,000. First year we saw close to 900 new patients in year one. It's a good first start, especially, you know, the first year at a gate. That's great. 371. When did you reach break even? For the fourth month, I only had one team member until three months with no dental experience. I trained myself and her from the ground up on the third month. I hired another team member. They started at $16 per hour, which is great. That's a, I know that can range throughout the country, but that's a very affordable starting wage for a team member. When did you start paying yourself answer is hopefully this year. I feel that. Did you associate and it's so for how long? I was an associate from 2016 to 2024. So in eight year associates did prior to starting a practice. That's great. But when I opened my office, I didn't work as an associate anywhere, which that's the benefit of being a long term associate is I'm going to assume that this doc had a lot of experience and a lot of cash built up that made themselves an attractive attractive to lenders. Put themselves in a good cash position so that they could focus on on the start of purchase awesome. Also, they specified did not use any working capital, but did not have any student loans or any other mortgage just a great husband and awesome two kids and parents and in loss. So that highlights the importance or the benefit of having a strong family support system. A working spouse is huge. I did have a working spouse to help pay personal bills, which let me focus on building the practice as well. So I think that's going to be a trend that we'll see here is a good support system helps quite a bit as well. Okay, let's go to let's go to doctor number two. So this doctor is in the south in a large metro area in the south. Here's my startup numbers to share anonymously. When did you open and what kind of demographic open in December of 2025. Yeah, this is a quick one that's not in so let's be through this. So this is a really new office out of network with all insurances in a large metro area saturated with dense. Each practice holistic and airway focused. I asked what was your projected first year or two for collections. What did you actually hit. Then said to be determined that's fair because we're not even at year one, but now that we're almost halfway through the first year, I project we're going to collect three and 50 K on year one, which is similar to the first office that we looked at. But keep in mind, we said they're in a big metro area. I think Atlanta, Dallas, New Orleans, that kind of vibe. When did you break even my first month of breaking even was on month five. Woohoo. When did you start paying yourself month six or seven projected. That's work in progress, but not a full doctor salary start by paying myself like an RDA and go up from there. I like that. You can just start taking just home a little bit enough to pay for gas and groceries. That's great. Did you associate and it's so how long before opening 10 years in the military plus three is an associate after opening. So after opening associate two and a half days a week for the first nine months and will work solely on my startup. So obviously that doctor hasn't quite gotten at that point yet, but they also noted that they negotiated this already and that was kind of a work in progress. So another case study of a long, you know, decade long working career, a lot of experience. Like we some cash saved up, but then still associating to in a half days for the first nine months. That's pretty typical. That's it's cool to see these doctors that are, you know, switching from, you know, halfway through a long working career is an associate and then deciding to take the plunge and practice ownership. So that's really cool to see. Thank you for sharing. So good one. Let's see. Okay. Doctor number three. This doctor opened April of 2024. So this doc has been open for two years out of network and Medicaid. So not a PPO heavy practice mostly fee for service and Medicaid about 60% Medicaid. When I asked what was your projected collections projected was 300 K from April because open in April until the end of the year. So that's about what three quarters of a year and projected for the second year, second four year was going to be 600 K what they actually collected that very first years is great. Let's see. Gotta read through this actual collected from April 2024 to December 2025 production 613,000 collection 554. So basically route first full year. So January to December of 2025. That's probably more helpful. So this would be, you know, after being open for eight months and then that next full calendar year. Production 1.3 collection 1.23. So that gives a little bit clear just even a full calendar year there. But that's a fantastic start. That's that's wonderful. First broke even around month three started paying themselves around six month in. [BLANK_AUDIO] the stock indicates the associated for six years prior to opening their own practice. That is fantastic. I also wanted to clarify exactly where they were at, but they said that I basically asked in our conversation, "That's fantastic. I'm going to log it. Is this, where is this practice at? What was the demographic fantastic numbers?" They said, "Can't recommend going to more rural or underserved areas enough," which I know you echo that in the sentiment on your podcast. I'm going to small-ish coastal North Carolina town and I'm the only pediatric dentist in the county. The closest other peds is an hour away and 50 minutes in another. One of those offices was just bought my corporate, so a lot of families have transferred care. I feel like this practice has a lot of common with mine not to shift focus on comparing all of these to my own practice, but pretty similar numbers on year and a half in. I would have been writing about that, but rural, not associating long, becoming profitable quickly, and really capitalizing on that ill-geographic arbitrage to get busy quickly without having a lot of competition. So fantastic numbers and thank you for sharing. Dr. Number four, great idea for a podcast, since I'm in the middle of it all, open in February of 2025 in the Jersey Shore area, so in the Northeast, PPO, heavy practice, middle class projected around 250 gross production, and then maybe around 160,000 net ended up collecting about 110, I believe is what we ended at. Yeah, so they projected they were going to collect in this practice, who practiced again guys just a year old in the Northeast, but they projected they're going to collect 250,000 and end up collecting around 110. And this is great. I love how transparent we are. This is why being anonymous is so great because we can talk about these things, but the stocker just indicated that they were a bit frustrated. They wanted to be higher. It seemed like around the one-year mark they started breaking even, but they had a slower spring in there, hoping so time will tell, not paying themselves yet, hoping to take something in Q3 this year, but currently up in the air still associated in two days a week, but have cut down from three days a week until just recently, but but cutting down. Then I wanted some clarification. I thought, you know, could it be helpful to kind of highlight what were some of the teen points that might be the bottleneck to keep this doctor from reaching their goals. It just might be kind of high, I thought we'd be helpful to highlight that to see what had been the struggles in the doctor's bond data combination of a few things. I've been averaging about 25 to 30 new patients a month from day one. I think I had 40 in April, which has been the most one is the things is most patients a lot are first-time parents, so 90% of patients are under five low-carries risk, which means low treatment opportunities. Yeah, that can be a struggle, you know, especially with their PPO heavy to, you know, even more so fee for service. I can see that being an issue, but that's the tradeoff, you know, when I talk to docs in the start of course, and all these young pediatric guys I talk to or younger that are starting practices, you know, there's always a lot of talk about what's your, you know, household income and area practicing at, but that is a tradeoff. If you go to an area that's more competitive during the, you know, during the Northeast, there's a lot of competition. It's a higher socio economic status. A lot of it's likely these kids are going to, you know, the area is going to be pretty well served. You're not going to have a ton of lingering decay and you're not going to have those big operative appointments to get your numbers off and grow quickly, which is a bit plug for the rural side of things, and it doesn't mean it can't be done. It just means it's going to be a slower, a slower burn getting the practice going because you're going to really have to pump and build that new patient base of toddlers in two and three year olds, need in the exams that don't need a lot of treatment, and you're not going to see that compounding effect of all the recalls and more of the restorative sealants coming about for a number of years. But I appreciate that doctor sharing, especially in a challenging situation like that. So yeah, what we got so far, first four offices were approaching a third of the way through and we've got, you know, first year projecting what a 110,000 all the way up to what approximately close to a million so far. This one number five. Hi, I saw your post about the startup numbers. I'm glad you posted it. I'm going to be speaking about my startup and the messages about how long it can take to get up and running. I don't have any evidence, but for most combos with other friends and startups, it seems like the people who are the loudest make a lot of money at the beginning and what that does happen. You can feel super lonely. Do exactly like I'd said at the beginning of this, like again, these numbers are not to make people feel bad. You, you know, people don't openly get on the pito and startup pages and talk about these struggles and how their numbers aren't where they want them to be. You're only going to hear, you know, the people that are having a lot of success talking about it and I get that to be frustrating. So I appreciate this listener highlighting that. And it can be frustrating to isolate. So hopefully we can open the conversation and normalize it a bit. So this doc opened in January of 24. So about two years in an affluent suburb of Atlanta in a saturated area next to a lot of other great practices. This doc opened three days per week with no plans to open additional base, especially since the schedule is not fully booking out. Excepting many ppOs under a prellas, no DMOs are state insurance, not a network with Delta. That's an interesting, interesting variety. So seeing a ton of ppOs, but no Medicaid or no Delta, which is a basic who gates have the opposite of the, you know, I'm like all Delta and Medicaid and the stock is the opposite. But again, it just depends on, you know, if you're in a community that has a lot of patients with different plans, that could be not a bad move in a competitive marketplace. So numbers, 2024, the, let's see, let's see, let me get into it. So this doc didn't have a great guestment, but they were going to collect actual numbers for 2024, which would have been about the first four years since they opened in January, was about 180,000 year two was 274,000 and 2026 so far, which this would have been about five months in 153. So I'm not going to be on track to get posted for this year probably, so probably 400,000. So let's see, then question three, when did they break even year two? Haven't started taking any cash home yet probably could, but had a couple big office emergencies and nervous to take it. So keeping that in the account instead of saving your reinvesting, I don't think there's anything wrong that that can be a smart move, especially, you know, if you're in a competitive marketplace, you're probably in some of that cash to grow, spend it back on on marketing and advertising. So I think that can be a smart move as well. And the stock associated for the first year and a half and then stopped when they became apparent this last summer. So that's great. After number six, so now we're going to move to a suburb of a major Southern city. Major Southern city. Yeah, I don't believe I specified exactly this one, so I can't remember what's up. I had to start your post about start numbers, but you posted it. Let's see, I apologize, guys, I don't know what the project declctions were, they said, but in our first calendar year of being openly collected over one million, not breaking even, I don't know the exact date, but definitely within the first six months, they opened in June of 2024. First pay to myself through payroll was November of 24. So five or six months in at a reduced rate, just to cover personal expenses, but I believe I was writing myself smaller checks to cover main expenses, but also trainees, much of savings as I had. And then for associating almost five years before opening, but did not associate once opening did a slow transition after getting notice, but also I teach part time at a local dental school, which provides some income. That is, yeah, that's killer. And one million first year, big practice, having Medicaid. And yeah, I think I asked some follow-up questions here that can be helpful, but I love it that they went full time and didn't associate. I see it, it seems like the two big trends that were seen so far in this conversation would be going rural, or less competition seems to make a lot of sense, and boost numbers, and then associating minimally or going even full time, and they don't start up purely, bump up these numbers quite a bit. So I thought this this doctor was great, so I asked some additional questions. I said thanks for the response. Fantastic numbers for year one. Could you add a few factors that might contribute to how you had such high collections of first year. I'd like to throw those pearls in for the listeners. So Dr. Responded, part of our success I think is being in an area where Medicaid is an accepted and a place, so that helped us fill our schedule quickly. We have about a 10 mile radius without another pediatric dentist, so we are somewhat underserved. We did very little marketing, just the whole general dentist and had relationships with some of our Medicaid insurance reps. We had a pretty extensive wait list before we opened, so we were able to start with the full schedule quite quickly. Doc also said I think having the full schedule in a low-no-show rate was critical being a Medicaid office. We knew that was going to be a challenge, so we set up strict confirmation in no-show policies. Any unconfirmed appointment we let the patient know that it might be forfeited. we wanted to know our patients aren't continue to come and if they aren't, we're going to fill that spot with somebody who is going to show up. And certainly a good strategy, guys. You could double book those, those unconfirms. Any new patient that no calls, no shows, we don't reschedule. We are also trying to be intentional about enforcing our dismissal policies to build up our deal patient population. Our cancellation rates are about 20 to 30%. But we're able to fill most of those appointments. So our no show rate is close to 3%. That is killer. And I think that reflects on having a good team and good systems to fill those policies. I know in my office, and a lot of other practices, the automated texture miners can really help with that. You can confirm most of your appointments and the ones that don't confirm. The staff gets on the phone the day or two before. And if you're just getting ghosted by a patient who haven't heard from them for six months, double book that appointment. And worst case scenario, you have a really busy hour, and you'll survive. And you'll have a busy or late than normal. But I think that's your part. Okay. Let's see. Otherwise, they said having staff that had some experience in dentistry before was helpful. We try to calculate if there's any co-payment of fees. We collect our estimate before we do treatment. We also offer financing for patients that need it through chair. Our collections are around 98%. We still have a few that slipped through, but it's easy to manage a track of. I feel like our software has helped a bit with that too. We chose Archie as our software. It has a lot of automations built in, like confirmation text in which I just talked about. And patients can text this back to communicate, which I feel like most people prefer to do. And that was great. Let's see. I asked, yeah, I think we, the doctor and I kind of continue to go back and forth a little bit asking what meditative reimbursement was like, which I believe was moderate in miscalculation and sovenia. But great first practice and great parole. So thank you for sharing. Appreciate that. Oh, no, I'm sorry. I did include a little bit more here. I spoke to the next page, guys. I apologize. Yeah, I want to know. Let's see the medicated. I'd say, she said, I'd say we probably are in the OK to good range and PA. One thing I learned from my associate job is to really look at the benefits of the medicated insurance plan and learn what you can build for. Some plans will pay for sealants on primary teeth. And some you can build for every two weeks. So we always touch up sealants at recalls. We have other plans that pay for six fluoride applications per year. That's been it. So when they come for their restorative appointments, we can apply extra fluoride. Or they can come for a fighting visit for an extra application if they are high risk. We have plans that cover nutritional counseling, or hygiene instructions, some do behavior management, as a diagnosis. But learning all of the things I think has helped us be successful as a Medicaid provider, solvers, or things can add up. And we see a good about volume. I've listed your podcast. And then you see more patients than we do right now. We're a triple column for hygiene work column for ops. And the most patients we see a day is 40 to 45 doing IV sedations once a week. That's a really nice patient. Well, I think that's great without putting yourself out. So all helpful information. OK, promised. I'm with my Pennsylvania doctor. Let's move on. Practice eight. We're ready after time. We're about half an hour with this podcast. When the goal was to keep it about an hour or less. So I think we're cruising here. Oh, super. Let's hear. Let's go. All right. So doctor number eight is doctors in the Southwest. When did you open and what kind of demographic an insurance that you take? So this doctor opened in June of 2019. So we're on about year six. Las Vegas, suburb. Well, there I go. I just said Las Vegas. So Southwest, but Las Vegas area, which is obviously a big, big giant metro for everything from Medicaid to HMO to PPO surrounded by GPs and a few pediatric dentists that have been there for decades. For projections, about 200, I love the iconospecific. 224,600 dollars projected. But really collected 187,000 included in the COVID months. Yeah, this is a COVID startup. So this is kind of a-- you always have to have the asterisk behind a COVID startup just because it was so inconsistent. And I think I clarified that. So I'll get to that in a minute what the followers were. So when did you reach break even February of 2021 month? Before the COVID shut down, that's a kick to the crotch. And nice. OK, when did you start paying yourself February of 21? So the following year, once recovering from COVID, getting back under the feet, start paying yourself. And then associating from June of 2019 to November of 23, so about four years of associating when the partner wanted out. Otherwise, I would have kept going to make sure we were the first fighter income. So I messaged and specified with this. And I said, OK, that number's helpful. So that first approximate year, they would have been including the COVID months, just under 200,000. But COVID really kind of messed that up. So I said, let's go to year two and year three. What were the numbers at year two? You have three. Year two, after COVID was 495,000 year three was almost 900,000. So fantastic trajectory, especially given the stress of opening a startup, especially one that just becomes profitable. And then COVID hits and shuts you down. I imagine there's a lot of sleepless nights there. This is a great example of how pediatric dentistry is a resilient profession. There's always going to be a lot of kids with cavity and cavities and just shows how quickly you can bounce back even after a disaster and emergency year two and year three. Great numbers on those second and third years. So appreciate you sharing that. It's great. This Doctor Number 9 is in the Midwest. Hey, Casey, this should be a fun episode. Let's talk about-- when opening opened on-- so this would have been December of 2023-- select PTO insurance in a college town in the semi-rural area, opened three and a half days a week as a solo doc, said, what was your projected first year two for collections? Doctor said the projected 2024 personal high goal of 1 million swinging for the fences, my CPAs projected 500,000. Actual in 2024 was 550. But let's free can go 1 million. I love the high bond. That's fantastic. And then-- see, this might have been-- OK, this must have been year two. Projected for 2025 was 750,000 actual projective. And second year was 1 million dollars. Year three coming in at 1.8 for 2026 is what they're projecting. So I love the lofty goal off the bat, but in summary, ended up doing first year 550, second year 1 million, probably closer to 1.8 here on year three. So that's great. And again, I probably use a similar trajectory where it's cool. Those first couple of years, if you do hit a home run demographically, and you can see your office collection doubling each year. That's really cool to see. But it does also make it harder when you start to plateau a bit. When you're four or five or six, when you're not doubling every year, then it's like, ooh, man, you can-- it just kind of cycle out, you could a little bit talk, but fantastic first couple of years numbers. Asked when did you reach break even? Without paying myself months three, with the ability to pay myself six months. At 11 months in, this doctor said they started paying all the-- they worked acting at practice until that. So up until 11 months, the doctor was profitable, but similar to how we've talked about before, just took all those profits and revamped it back in the practice to grow the business, which is just a smart business principle there. And then it did you associate, and that's so for how long? Six months doing so two days per week is an associate shift. So those are great numbers, especially doing that on what three days a week. That's a really good for-- if that doc would have worked five days a week, I bet they could have got pretty close to that $1 million goal. So that's awesome to see. I'm sorry, this doctor left a footnote here that I was reading. If anything, I would like my story to really stress the importance of demographics. I see over 140 new patients per month underserved communities are the way to go. Crush it. Dr. No. 10, this doctor-- I just wrote down Ohio. So that was about as specific as I wanted to get here. And this is a good practice. So Ohio, here's my story. I started with PPO, demographic, blue collar, lots of teachers. Household income of AB to 90K did not take Medicaid until nine months in when Ohio increased real investments. 100% now I'm about 40% Medicaid. As a sidebar, several states have done this including Missouri. My practice had a big collections boost on year three. That took us well over $2 million. And that was partially because Medicaid increased their rates pretty substantially. So I went from $9.85 to $1.6 on year two. And then year three was like 2.3. But I did a similar amount of dentistry. But if you're in a state that is bumping Medicaid rates, that can make each difference. So that's great. So Ohio started taking some Medicaid. First year projected was 500K. We hit 650,000 second year projected 900,000 collecting 1.1 million. Current year, we are on pace for 1.4 and 1.5. A lot of similar projections in the last doctors. So that's great. And then paying yourself and breaking even was six months for both. So that's pretty cool. Seems like-- yeah, seeing a lot of that three is six months. If you're in an office that's really taking off and doing well, three is six months seems to be a pretty common spot where you start to have a little extra cash, a little more money coming in than money going out, which is nice. And then as far as associating, doctors said they associated two days a week for the first year and then one day a week for the second year. Now expanding to a second location, coming winner of 2026 and third, 2027, dang, that's some fantastic, aggressive growth. So good for them. I'm not in the camp of expanding right now, but I think with these numbers, that's probably a smart move to kind of keep growing equity in the business. So that's great. Dr. said, I asked if that was a competitive area of the doc said that I was the only pediatric dentist in the actual town, but there are large established practices. 15 minutes north and east and me, not rural, but a growing suburb in Ohio. The ratio was 1 to 6,000 pizza patients in the 0 to 11 range. It's been a while since I've had to look at that from my early start of days, but that might be a helpful metric for people. So 1 to 600,000 pizza patients, like, you know, 1 pediatric dentist per 6,000 kids that are ideal range. They'd range there. Okay. Practice 11. This doctor gave me a lot of information here, but this was one of the higher offices that I reported here. So I wanted to get some details. So this doctor is in rural Appalachia, open in September of 2022. Excuse me. September 2022, new from demographics. That's 65% of kids in my area are Medicaid. So I took Medicaid from day one and got busy very quickly. Currently at 60% Medicaid and 40% PPO, only a handful of cash patients. Within six months, I had the same level of staff and patients as my previous associate game that was open for five years. So crazy growth is what he's going to get at here. Projected numbers. I don't know the projecting number. He said, I knew I was essentially opening a duplicate style practice to my most recent associate job and did about 1 to 1.1 million collections there, calendar year of 2023. I did 1. Adjust over a million dollars. So that's good. So if they opened in September, that gave them three months, you know, of a practice run and then that first calendar year did a million dollars in collecting that first year. When did you reach Breakeven month two right off the bat? Love that. When did you start paying yourself month two? Did you associate and how long five years between two offices? What did you associate? Did I read that right? Five years between two offices, bro, that's insane. I know this doctor and I didn't put together that they associate during this time. So they would have not associated that would have just blown the roof off the place. That's insane to collect that and still be associating and not even be full time for real practice. And this doctor is great and he was a little bit more open, so I'm trying to do my best. I don't apologize. I'm going to do my best to just read this. I know this doctor, I don't know how anonymous we want to keep. But basically in rural East, it's the rural Tennessee, the town, which I'm going to keep some of this info out. You know, basically saying it's a smaller town in a medium below household income. There's never been a pediatric dentist. People are used to driving an hour to larger cities for specialty care. So being the first gave us a good start at a first opening. They did some community events. This could fill out a contact card if they wanted to call when we were ready to open. So just from that community event and people calling in, we had 400 potential patients ready to go before opening. We already had a phone number established and had a billboard up and going and I got an extra burner phone and wrote down the info for anybody else that wanted to call prior to opening. I probably got another 200 ready to call that way. I opened within experience assistant, got as much experience as I could get front desk was my wife and a person with three years of dental billing with another office nearby. In November, we added another assistant and front desk and on and on adding staff as we go. But basically adding employees very quickly added an insurance coordinator in another season assistant at year one. Oh, man. So just lots of rapid growth asking more about how did you get to this one million so quickly from a marketing standpoint. This doctor said they worked with Scott shoulders from magnify, which if you went to a TV this year, he would have walked by and met him. He's a pretty well known figure in the SEO space for pediatric dentists and he builds really good websites. So then said that they worked with magnify for SEO and social media. They also spent about $500 a month on Google ads. After the initial three months of the billboards, I went down to only one billboard near the new large public school complex. So multiple billboards they had. A few ways that my patient base grew so fast was definitely taking Medicaid providing oral sedation because not many offices in that area do. And then my previous associate office told all their surgery list patients that they weren't going to go to the hospital anymore in Chicago. That's cool. So they basically gave me an established practice level of surgery wait list almost instantly. I also got to take the majority of my office prior OR dates because I was the one going to the OR anyway and the hospital staff really likes me. Yeah, then some additional info that asked me to exclude. But it's obviously you can tell this was a situation where there was a backstory involved with the associate job. But I lived this doctor lived in the town they practiced in. So the community was open and responsive and appreciative and like that they're local. This was his hometown. And always let parents come back with a child for the ops. So there's total transparency to what I do to show them how hard we try to make the kids appointments positive as possible. And the doctor also took Bobby Elliott's course which shout out I went to Bobby Elliott and and by them had a lecture at a BDI went to those guys were fantastic when it comes to you know office leadership and all of that good stuff. So listen to that. But yeah, Bobby Elliott has a great in person. He started of course that he helps doctrine and get practice off the ground. So the newest challenges have been figured out how to attract and keep an associate. Very nice. Very nice. Okay. Here we go. So that was a great back so a lot of info there from back to number 11. But appreciate that information. That's great. Let's go to doctor 12. Again, guys, I apologize. I have lots of notes that I tried to compile here and they're jotted around a little bit. So I apologize if this isn't quite as fluid as and and polished as I would like. But we got about three left here. So let's keep on trucking through doctor number 12. I believe this doctor is from the California area which my podcast demographics tell me that the majority of the state with the most listeners of the show come from California, which makes sense because there's a lot of pediatric dentists out there. So this one is for my Cali folk about 25 minutes from a major metro area. It was historically an agricultural area, but in the last five to 10 years, it has been moving with the developments and is now considered more suburban. And Costco was built here a couple years ago. Competition has changed in the last few years before there were four other pediatric offices in the 15 mile radius when I opened since opening the last six years, about three more offices have opened up in the local area. Wow. So doctor says they opened in June of 2020. PPO and Medicaid. So they see dental or whatever that is over there. Projections, hard to answer. I didn't do a deep dive on a business plan. I thought that exercise wasn't super helpful since it really depended on so many factors and so many variables. Said I think I just used the buddy's business plan as framework and submitted that to Bank of America. You got to do what you got to do to make the lender happy. I feel that. So actual first collections first 12 months was 550K. Year 12 was 1 million. Wanted to say that they were a month two or three to cover overhead and start paying themselves around six. One to two days for about nine months. That doctor said they open a practice in their startup three days a week from the first year. And then again got to 550K second year to $1 million. So just a good solid startup and it's kind of nice to see that even in a, you know, a good area, but an area that does still have some competition, you can still start and grow practice and have some success there. Number 13, I added some info on the front end here. Small mountain town. Yeah, this is a good practice as well. So doctor said they're in a small mountain town in North Carolina. They are one of trying to summarize what they're saying. So I'm not getting way too much info. But one of the few pediatric dentists to open in the area in a not super competitive area basically, but some of the other doctors in the area are older basically. So it looks like on the map that there's, you know, quite a few pediatric dentists, but a lot of the practices are a bit older, which I think is smart because, you know, not every practice is the same. And I talked about on the show before, you know, even if there's a lot of competition, you can come into an area and offer things like circonia crowns and sedation and free num work and different things like that and just have more of a modern Yacht vibe. You can still be super competitive. So you just can't let the number of doctors there be intimidating. But good people, good, it's a popular retirement area, but has been salty to the earth people and here for a long time. Lots of elementary schools, just public elementary schools, but the city has a lot of the big major retail places, Starbucks, Dunkin, etc. But a nice blend with locally owned pop shots. Dr. said they opened in October of 24, so about a year and a half and saw patients two days a week for six months and then began working four days a week. And then double the amount of days. The office is about 75% Medicaid and 25% BPO and just a handful of self-paid families. The gut projection for a year was 250,000. New to was 650. The first 12 months ended up collecting $399,983. I think that's it. think I'll just like loan you that, I'll give you the extra $17 and we're going to say that you collected 400 thousand that first year. And then the last seven months into the startup, because their one and a half years in was, is currently $468,000. So it kind of makes me think basically set another way. The first 12 months they're at 400,000 and I bet they're going to get pretty close to the $1 million mark or maybe just under this second year, so you're two broke even in December of 25. So that one took a little bit longer, but in have no loans, I could have expanded on that a little bit more, but this doctor opened 10, 10 of 24. So October 24 and in December of 25 broke even, but interesting was able to do the practice without any loads started paying themselves in December. I don't know if I, that might be, that might be a typo, I bet that they meant to say December of 24, because they started paying themselves in February of 25, which if you're paying yourself, then you're above rates of even. So I'm going to guess they broke even a little bit sooner. Worked as an associate since finishing residency in 2019 and worked a slow transition as I started at my office two days a week while I was an associate for three days a week. Only work four days a week in my office and have five team members. Thanks for your leadership and hope to meet you sometime. Very cool. Yeah, that's kind of nice going from two days a week and then making that jump before days a week kind of led to some big drop in numbers there. So that's great. Last two practices guys, where we at for 52 minutes in working on this beer. Okay, office, office 14, open doors, November of 22. The intersection of, and you know, I didn't really specify what part of the country was doctors and maybe it'll say in here, but that is my fault. Northeast, I'm sorry, Northeast here. So Northeast United States think like, you know, New York, New Hampshire, you know, Northeast corner of the state. Again, open November 2022 being household income was 95 to 160K, PPO and fee for service office and Medicaid didn't have any projections, but when all in it got my ass to work, LFG collections in 2023, I did 413,000, 2024, I did 881,000, 2025, I did 1.25. I set a goal to hit 1.75 this year. Went into the black starting January of 23 and started paying myself a small salary. Let me look back at that. So went into the black starting in January of 23, open doors 22. Okay, so shortly thereafter. So let's say three months. We've seen a lot of that guys. A lot of these as I'm talking out loud here and doing the math on the number of months in my head. A lot of doctors, it seems like if you get to work month three to six, you can get, you know, you can reach profitable pretty quickly, which is nice when they're trying to determine do I have enough working capital? Get by. I think that's beneficial to know that three to four months is pretty attainable. Let's see. I went from two days a week in November and paid myself a small salary. I went two days a week in November and December 22 and went to four days a week. Another doctor that doubled their days, you know, the number of days are working like the last one. And they did that in January 1 of 23. So about a year and they added more days full time 32 hours a week. So working four days a week, cut down to three days a week, associating, oh, three days a week associating their job. Man, there's too many dates in here to keep track guys. I apologize. The punchline is they added days and cut down associating in a fairly short amount of time about a year and ended up just associating one day a week for about another year after that. And then went full time in the startup on April of 2023, which would have been, yeah, not long after. So under a year, like went full time and started up until asking more about demographics until March of this year, I had two competing PEO offices four miles away. And March had another similar style practice open six miles away. There are two Medicaid offices four and six miles away also. So it gives a little context that are in a bit of a competitive area. Slightly, I'd say slightly nicer, 95, 160 K, like a slightly higher household income, but even in a competitive area and on the open two days a week, still have pretty good collections born in 13 and then doubled it to 880,000 a year too. That's really, really pretty great for a competitive area and only working to go in three days a week. So good for that dog. Great, great story. Thanks for sharing. All right, last doctor here, doctor number 15. This doctor is from Texas. I ended it with this doctor I wanted to have on this particular pediatric dentist. I'm highlighting because he didn't have a strong startup. He had a strong first couple of years, but not anything outrageous. What impressed me more with this doctor was in talking about where his current practice looks like on year eight, just because his numbers are so outrageous. And so I thought I would get good context into how your growth trajectory can work and what it takes to get to a really super high caliber for production, that high tier of production in a really busy practice. So this doctor is in Texas. Let's see. So I started asking about just giving some context of like what the insurance breakdown was. This doctor started with everything. This was feet years ago in 2018. Move to Texas did a startup in that work, started in that work with Medicaid and PPO and then started dropping plans, started dropping Medicaid. And this happened around year three, dropped Delta at year two, which is great. I know not every practice, including my own can do that. You have to have kind of the right demographics, but they were able to pull it off. Just did the first fee increase last June, which that's also crazy. That's probably something, you know, I say good advice is to revisit your fees every other year. Just make sure you're, you know, at a healthy fee schedule. Copy for another day, but doctor says that they joined a an umbrella plan connection umbrella and went back in with everything except for Delta and guardian. And it then opened eight years. So just kind of shows you can you can play the PPO game, drop ad, you know, drop as needed, and then it's going to be pretty good. But the stock should have been open for eight years. First full year collected 635 from September of 2018 until 2019. Then second year did one million, 22. So right about a million dollars. Your second four year being open. Said I didn't have any projection goals. I just tried to do better than a year before every time. And I think that's great. You know, as long as each year, you try to do a little bit more industry for better systems. That's a great way to process for 2025. So last full calendar year, we did 3.089 million dollars as a solo practitioner, which is bananas guys. Like I've, you know, I've talked to a lot of pediatric dentist off air and just, you know, people that I talked to from the show. And I have a lot of conversations before and after the fact. And, you know, and in my head for a solo practitioner, you know, it's a different category than the group practices that are adding, you know, that they're two different apples and oranges there. But if you stay a solo practitioner, you know, an average is, you know, if you collect one, like 1.5, that's kind of the ballpark. It's like a good busy practice, you know, good average, we're not getting burnt out. Then you've got, you know, a handful of docs that really hustle and like have busy practices and worked a little bit more and are in the two. So anybody that's above two, that's great. Like two, two point five. And say, I think I'm going to land last year was 2.45. And this year I'm going to be at 2.6. But I also work like 205 days a year. So I work a few extra days and I run a pretty busy schedule. So like mid-choose is like a pretty high tier. But I can say, you know, to get to three million, that's probably, you know, there's probably only a handful of solo pediatric dentists in the country that that gets to that level. And he's going to talk about that. But as a sidebarb, it's just, I'm saying this so that, you know, this might not be possible for everybody. You've got to have the perfect blend of really good demographics, really good fee schedules, really good systems. You've got to see a lot of patients. You've got to do a lot of dentistry. You know, it's, this is not something that is easily attainable by just anybody. You've got to have the right perfect blend of ingredients here. So I asked that dentist to extrapolate, you know, how they got to a 3 million collection solo solo practice. Because it's just really impressive and it's fantastic. So we said we worked 17 to 19 days a month. We try to work four days a week, but my family and I travel a lot. So we built in vacation time throughout the year. I'm finally adding my first associate in June and kind of terrified. Dr. said that they broke even with bills on month two. I didn't pay myself because I didn't know how to do it. So I just kept money in the bank and working capital just in case I paid myself for the first time in January 2019 when my CPA said that I could want to dumb as LOL. But I love that. It's like, I'm just going to do a lot of dentistry and the money can pile up and then somebody who knows what they're doing to tell me what to do with it. So probably having a good CPA, then a specific CPA in your corner. You know, that's a good way to do it. I was associating for about six months before it got too busy and I needed to open or days. I was doing Monday, Wednesday, Friday and Tuesday Thursday. at the other office, then the next week we would switch. And at Saturdays, I gave up on Saturday at Portness Quickly because the no shows on Saturdays were extra irritating. We'll never go back. And I would echo that statement personally. It seems like the Saturdays sound getting theory, but oftentimes are a struggle. So the Steadin said that they were in a suburb of Texas, decently competitive, some older offices that are still around a few corporate, a few newer private practice offices, and a lot of family offices. So relatively competitive. But grew very organically. I've never done Google stuff. We used boosted Facebook, but didn't see a lot of ROI. We were pretty much Google reviews, mommy groups, sport and mouth. It's great because my advertising budget is a few school events we sponsor. We haven't gone to any since year two. So in Texas, the Medicaid green person isn't great staying in network with insurances and other form of marketing we do. I basically was suppressing lower forms of pay and then dropping as we got too busy with those insurances, which we talked about in the beginning. We lost a few patients, but then he came back paying out of network or with a new insurance plan. Said, I don't really talk about my numbers. To not intimidate those that are struggling, I know my numbers are pretty outrageous. I've only added the associate because we're booking out a month ahead for treatment and that bothers me. I've been upgrading our practice as we grew, started with one RDA and one front desk. Now we have three hygienists, four front desk, one office manager and five full time assistants and two part time assistants. I think I've hit my limit. We only have seven chairs. So managing the next growth phase with the new doc is going to be our biggest challenge. Which that's, yeah, you know, you think of big office, big headaches, little office, little headaches. I had an old pediatric dentist and I say, old pediatric dentist, tell me that in residency. And I think that's true. When you build a monster of a practice like this, it takes a lot of support staff. I think, yeah, you tell me this up was at 15 employees. So, you know, I, again, I would say similar practice, but I am not quite there at these numbers. But I run off seven employees, which is nice. We have a pretty lean team. I also started, I think I've mentioned this before, but I started outsourcing all my insurance billing, which I think this, you know, would be interesting to see if this doctor does that. Probably not with having four front guest staff, but when you get to, you know, above two million, you know, in my opinion, you start to have such volume that outsourcing a lot of things like insurance billing. Like I started using Pito Billing, which is a really great company that only works with pediatric dentists, but I started outsourcing Pito Billing several months ago. Like that would have been probably eight months ago. And that really jumped up my collections and let's me keep staff a little bit lower. But, you know, when you get to an office at this size, you just have to be smart about managing overhead because, you know, it's easy to hire a lot of employees like this, but the nice thing is having this, you know, such a robust staff should make it in theory easy to bring on an associate without needing to train a bunch of new staff members. So it sounds like he's kind of crying to bring in this other, you know, a new doctor. And I can't imagine that he's not going to be a bit successful with bringing his associate into the crowd. So very, very impressive practice. Yeah, he says that managing the next growth phase within the doctor's kind of be the biggest challenge, but I think he's just going to continue to crash it and appreciate it sharing that information. So that's what I got for you guys. 15 killer offices, you know, and some rate seems like we've seen everything from, you know, 100,000 up to a million collected that first year. The average is, you know, the norm is probably going to be in that, you know, four to five hundred, is probably where a lot of people are going to wind up, but the purpose of this is, doesn't really matter necessarily exactly where you're at or how you start, you can make mistakes, but, you know, there's such a demand for pediatric dentistry services. If you're a good dentist, you know, you work hard, you're ambitious, you problem-solve, you're a people person, you know, there's, it's going to be unlikely that you're going to be anything but successful and keep having bigger years and fine success. So I think this conversation is just kind of exemplifies, you know, what's possible out there. So I hope, I hope you guys thought this was helpful. I'm happy to do more projects like this in the future. Hopefully I can get this podcast out to a lot of docs that are considering startups to make it a little less intimidating, you know, a lot of big numbers getting thrown around, but in the world of ownership, you know, you get rewarded for taking the risk and starting the business and taking care of a lot of kids and there's a lot of big numbers here, but it's ultimately a, it can put you in a better spot personally, professionally here. So thank you guys for tuning in. I know this longer episode, I'd love to make it, got a lot of good guests coming up. So stay tuned if you like the show. Follow me. I do post some updates on Facebook, but I've dropped these episodes every other week. And if you ever have, anybody listening ever has any really good guests that they want me to potentially interview, I always take suggestions. I do kind of curate who I do and don't have on. But certainly open if anybody has any suggestions for content in the future that I can work on. But appreciate it guys. Thanks for joining me and have a great busy summer season. Cheers. [MUSIC PLAYING] Thanks for listening to the Bruce and Tiny Teeth Podcast. Be sure to DM our host, Casey Gatz, on social media with any listener questions, comments, or tough clinical situations. We'll see you next week for another unfiltered episode. [BLANK_AUDIO]