There's a version of dental practice ownership that looks like success. Larger office. Multiple doctors. A full schedule across eight or ten chairs. Staff filling every role. Revenue numbers that sound impressive at dental conferences.
I built that version. I know what it costs.
What nobody tells you about running a bigger operation is that the complexity compounds faster than the revenue does. You hire more staff, which means more HR issues. You bring on associate doctors, which means managing producer relationships, production splits, patient continuity, scheduling conflicts, and personality dynamics — on top of actually treating your own patients. Your overhead climbs to match your gross. The insurance contracts get renegotiated. The payroll grows. And somewhere in the middle of all of it, you realize that you are no longer a dentist who owns a practice. You're a manager who does dentistry between fires.
I'm not saying larger practices can't work. They can — with the right systems, the right team, and the right operator. But here's the honest question I wish someone had asked me earlier:
What are you actually building this for? Because if the answer involves the word "life" — time, freedom, health, relationships — then optimizing for revenue before optimizing for overhead is the wrong order of operations.
The lean practice I ran told a different story. Four operatories. One front office coordinator. Two dental assistants cross-trained to help with front office tasks when needed. One part-time hygienist — which, in today's labor market, is already a win worth protecting. That's it. Four people who knew the systems cold, cared about the patients, and didn't need to be managed every day because we had built the infrastructure that let them operate independently.
The math is what surprised people most when I laid it out. A well-run $1M practice at sub-50% overhead takes home roughly $500K. A $1.5M practice running at 65-70% overhead — which is exactly where most larger practices land once you account for the full cost of a bigger team — takes home between $450K and $525K. The delta in take-home is marginal. The delta in lifestyle is enormous.
One version has you reviewing production reports on Sunday evening. The other has you not thinking about the practice on Sunday at all.
I've been on both sides of that line. I know which one I'd choose.
The reason I feel strongly about this — and why I've built a whole philosophy around it — is longevity. Dentistry is a demanding career. The physical toll is real. The emotional toll of running a business most people don't understand is real. Burnout doesn't come from the clinical work. It comes from everything around it. The practices I've seen sustain the best outcomes over time — for the dentist and the patients — were not the biggest ones. They were the most intentional ones.
A small, systems-driven practice doesn't just protect your income. It protects your passion for the profession. And if you lose that, none of the revenue numbers matter anyway.
This is why the first free resource I put out through DCA is a practice metrics sheet benchmarked to the lifestyle model — not the industry standard. The industry standard was written for group practices and DSOs. It was never designed for the dentist who wants to own a quality business, take home a meaningful income, and still have a career worth showing up for twenty years from now.
If you're thinking about ownership, expanding, or just trying to figure out what structure actually makes sense for your goals — I'm happy to talk through it. This is exactly the kind of conversation that should happen before you sign anything.
— Kal Shah DDS
