Choose Your Path

Six Entrepreneurial Pathways to Grow and Operate Your Dental Group

By Dr. Eric J. Roman

Dentists are typically, by nature and design, super intense engineers working in micro-millimeters of detail, which can make it hard to have perspective in what we need to do to manage the business side of dentistry. A lot of the skills that make us great dentists can also complicate our transition into the entrepreneurial journey.

After I graduated from dental school in 2007, I built one of the fastest growing practices in the country. We made $2 million in revenue in the first year, $4 million in the second year, and $6 million in the third year. Not even 18 months into being a private practice dentist, I had multiple locations. Each new location was growing faster than the one before it. Things were going great, right up until they weren’t.

I ended up in a multi-year, multi-million dollar regulatory lawsuit in North Carolina. Long story short, I lost everything. But I was not done, and I was not giving up. Real entrepreneurs have this tendency towards serially building businesses, learning how to do so along the way. CarolinasDentist was born out of the ashes of my first DSO experience, and over the course of 5 years, we grew it to nearly $30 million in revenue when I recognized that it was time for a change. 

We often have a belief that we only have one path, and it is going to span our whole career. I realized that CarolinasDentist did not need to be my only journey. While I was grateful for the experience, being authentic to who I was meant that it was time for me to step out of that journey and to create space for everyone else to continue growing. In 2019, a private equity-backed exit allowed me to refocus my energy into a number of other endeavors, including my contribution to the Dentist Entrepreneur Organization.

All that to say, there are multiple paths for entrepreneurs to find success in the dental industry. I am a living testament to the fact that these journeys will hardly ever go forward in a straight line. As a matter of fact, I would like to argue that straight paths are neither likely, nor are they fun. Part of what I do now is informing dentists, both young and old, about the power of choosing your own path. Your path might not look like any other. It’s just yours, and it’s based on your skills, your passions, and your unique life.

Patterns of success

Of course, there are some general patterns of success that we should consider. History provides plenty of examples of dentists that have built incredible companies using any variation of these 6 core entrepreneurial pathways. Each of these pathways requires completely different experiences and skills to succeed, but that is the beauty of it! You are choosing your experience. You pick what you want to go through because there is no one right answer. Choosing what works for you allows you to develop your brand in a way that reflects your values, vision, and goals.

1. Solo practice on cruise control

There is a myth that being a dental entrepreneur means having multiple locations. Please don’t fall for this trap, as this could not be further from the truth! You can put your solo practice on cruise control by building processes and efficiencies that take you out of the mundane day-to-day tasks, whether mundane to you means clinical or administrative. Efficiencies minimize the amount of time that you have to contribute and maximize the output of what you enjoy doing most, whether it’s training other clinicians, rendering exceptional care, or focusing on how to create a more attractive practice.  

Many of the happiest dental entrepreneurs I know are exceptional solo practitioners. They are proud of who they are and what they deliver as a product. Instead of spending tons of energy (and capital) on more locations and more problems, they focus on one great location. Some focus their time on clinical innovation. Others put their energy toward unique, boutique patient experiences. And still others leverage the efficiencies they’ve created to become speakers and key opinion leaders for the industry. The key here is to recognize that being the only doc at a single office address might be a viable path for your continuous entrepreneurial growth.

2. Multi-doctor, single location

In a multi-doctor, single location practice, your responsibility might be more focused on developing other doctors without having to worry about spending time in the chair. You can focus on generating revenue, developing your team, and strengthening your company culture. The multi-doctor, single location group can be one of the most efficient ways to step away from your business and be able to have something that really provides for you. It is ideal for the kind of person that is OK with not being hands-on and providing all the care for your patients. It’s also ideal for dentists that have a penchant for training other dentists. Compared to multiple locations, this is efficient because there are fewer variables, lower overhead, and only a single team to manage. 

There is something incredibly special about being able to develop and lead your team at one location. In fact, some of my favorite years in my career were when my practice had five dentists under one roof. We were really connected, and our culture was healthy and strong. Eventually, our growth strategy resulted in spreading our core dentists out to multiple locations. In hindsight, I missed the cohesiveness and camaraderie of a single team at one location.

3. Multiple locations

If your greatest skillset is not necessarily what you do with your hands, but has more to do with how you manage, develop, and grow other people, then a multi-location approach might be the best journey for you. Not everyone is gifted with the ability to manage multiple locations and dozens of employees. Because that skillset is completely different than that of a traditional dentist, your success in multi-location group dentistry has nothing to do with the years that you spent in dental education.

With a multi-location approach to building your dental practice, you could be managing practices that are 50 to 200 to 2,000 miles away from one another. The leaders that excel at this are skilled in communication, strategic planning, management, capital acquisition, and at adapting to change. Regardless of whether you acquire new locations or build them from the ground up, my rule is that each new location doesn’t result in a merely linear increase of complexity, but rather an EXPONENTIAL increase. That’s right: two isn’t twice as hard as one … it’s 4 times harder.  

4. CEO or COO

Regardless of the growth strategy you choose for your business, you still have to isolate your ideal role in that business. Inevitably, the majority of founding entrepreneurs insert themselves into the CEO role … but is this the right choice? Are you gifted with the ability to manage people and empower them to grow and develop under your leadership? Are you great at motivating others to join your movement? Do you excel at building effective business strategies? Do people see you as a source of energy? If so, you could be an exceptional Chief Executive Officer. The CEO is responsible for setting the course for the practice, defining the culture, and making sure the key leaders are in place for the future. In this role, you need to know a little bit about everything.

But what if your real skill lies in executing a plan, managing departmental leaders, and effectively “making sure the train arrives on time?” You could be an ideal Chief Operating Officer. As a COO (often called an “integrator” or an “operator”), you are making sure that things are getting done inside of the business to assure that the vision is fulfilled. Typically, you love process and systems. You know how to manage checklists. You have incredible attention to detail. And you take pride in managing your other leaders. Historically, while CEOs get a lot more publicity and recognition, the COOs are often the real key to the success of a business.

5. Chief Clinical Director/Dental Associate

Wait, am I saying that you can be an entrepreneur WITHOUT having to be the CEO/COO of your dental company? Yes … and I actually think many dentist entrepreneurs miss out on this awesome role fit. You can own 100% of the company, and hire out the roles of CEO and COO. Part of the reason so many dentist entrepreneurs experience exceptional growth is because THEY are exceptional clinicians and teachers. The best way to harness those skills could be as a Chief Clinical Director with the responsibility for managing the dentists and developing best practices for the clinical teams. When you succeed in this role, your abilities are magnified across all the providers, almost like a set of dominoes. Great Chief Clinical Directors tend to be one of the most in-demand roles for growing companies.

But what if your only responsibility in the growing business was to show up, see your patients, and go home? Did you know that there are dentists that own large, entrepreneurial businesses where they simply fill the role of dental associate? That’s right, they hire out all the other roles in leadership and management and focus on what they enjoy most. They provide great care for the patients, but they do not call all the shots for the whole office relative to growth. This model is extremely common in medical practices, where dermatologists and orthopedic surgeons start great practices but hire out executives to grow the company so they can simply be clinicians again.

6. Advisor/Investor

All this talk about types of dental businesses and specific roles can make anyone tired, just like the journey itself. What if your role in your dental company is simply to collect a check in the mail from your beach house? If so, simply being an advisor or investor could be the fit for you. This means you are sitting somewhere else, whether it’s down the street or around the world, and you are supporting the business indirectly with a seasoned leadership team making all the day-to-day decisions.

It is an option that few of us consider because it is not hands on. We cripple ourselves by saying that we must “be in the practice” and “do all the things” because we have an “If I don’t do it, nobody will do it” mentality. This, my dear friends, is categorically false. There are dentists all over the world that are not working in the businesses that they own or created, but are still cashing in on them and watching their creation grow and serve the community. Heck, some of them are not even the founding dentist. It might not be any different than investing in real estate or stocks, other than it being an industry you know extremely well.

This approach is valuable because of the freedom it gives you. When you are acting as an investor or an advisor, you are as involved as you want to be. As long as the practice is making a return on your investment, you can stay out of the operational details of the practice.

7. All of the Above

Remember that original point about how the entrepreneurial dental journey may have many different phases and is likely not linear? Imagine that your career could include all six of the different possibilities we have discussed above. Consider that we choose our professional journey to help fulfill our personal goals, and if your personal life is like mine, it will have many different phases as well. Use the strategies above like a set of tools. I’ve never met a dentist that only used one instrument to complete all their procedures. Using the approaches we have outlined, you can continually select the right tool to match each phase of your personal journey as a dental entrepreneur. 

Dr. Eric J. Roman

Eric J. Roman, DDS

Eric is a true dental entrepreneur. With his experience as a CEO, executive coach, and founder of multiple dental businesses, Eric is able to deliver uncommon insight from inception through exit. His true passion is helping leaders accelerate life satisfaction, impact, and sustainable team culture, which he delivers through his role in leading curriculum development for the Dentist Entrepreneur Organization (DEO).