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On Starting a New Practice

When asked the question “What do you intend to do after graduation?”, most of the orthodontic residents I have talked to over the past few decades have indicated that they want to find desirable and equitable associateships. Their reasons include an immediate income, the associated job benefits, and the opportunity to learn from a senior practitioner. Last month in JCO, Bob Haeger and Charlene White covered the advantages and pitfalls of associateships in our Management & Marketing article.

Unfortunately, with some 400 new graduates of U.S. orthodontic departments entering the job market every year, there are far more students seeking associateships than there are associateships available. Those who are unable to find workable associate situations have no choice but to seek alternative means of entering the field of orthodontics. Some opt to go into academics, pursuing advanced research-based degrees and eventually entering the professoriate. Others opt for the military or other government dental services. A small minority simply revert to practicing general dentistry until such time as they can fully specialize. Another small but intrepid group of young graduates choose a route that is more difficult but ultimately much more rewarding: starting their own practices.

A couple of generations ago, almost every new orthodontic graduate would simply hang out a shingle and open a new practice. Back in the so-called Golden Age of Orthodontics, students left school with little, if any, debt. Competition was not nearly as intense, and viable practice locations were abundant. In that kind of orthodontic market, banks and other lenders were quite eager to fund new doctors; since virtually every new orthodontist became profitable in a relatively short time, lenders required little or no up-front cash to secure financing.

Times have changed dramatically. Nowadays, starting a practice from scratch is not for the fainthearted. Most of today’s new practitioners will eventually succeed, but the level of success they desire may be years in coming. Some of them, sadly, will fail, forcing them to liquidate their practices and seek employment elsewhere. After watching those scenarios play out for a couple of decades, I had to wonder what the young doctors who succeed do differently from those who do not.

In this issue of JCO, I host a Roundtable in which Dr. Haeger and Ms. White are joined by nationally recognized management consultant Paul Zuelke to conclude our two-month series on the major practice options for new graduates. In addition, our panel includes a special guest, Dr. Ana Luiza Arruda, who has recently opened a new—and successful!—orthodontic practice in greater Chicago, a market that many of us would have assumed was already saturated with orthodontists. Dr. Arruda offers her personal observations and commentary on starting a new practice, while providing the reader with invaluable advice direct from the front lines.

This combination of participants gives us a unique and highly practical overview of the issues surrounding a new start-up. Advantages mentioned by our panel are the opportunity to realize your orthodontic dream as your own boss, the ability to start your own patients in your personally designed practice environment, and the potential to earn more income in the long run than you could as an employee. Obstacles include the lack of an initial guaranteed income, the increased debt load (if you can even secure a loan in the first place, which is no small feat), the painfully slow pace of practice growth, and the need to manage a staff. While such a list of hurdles can indeed be intimidating, I can’t help but admire the bright-eyed, energetic, tremendously gifted young graduates who choose this path every year. More power to them! They truly represent the best our profession has to offer.

I trust all our new orthodontic graduates will find this Roundtable and last month’s article on associateships to be helpful as they enter our great specialty.



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