Should You Buy or Start a Dental Practice? A CPA's Perspective

Almost every dentist reaches the same fork: buy an existing practice with patients, staff and revenue already in place, or start from an empty suite and build it exactly the way you want. Both paths can create real wealth. They fail for very different reasons.

The financial difference is timing, not size

An acquisition front-loads revenue and front-loads debt. From month one you inherit collections, a hygiene schedule, a payroll and a loan payment. A startup reverses that curve: low revenue, low overhead, and a ramp that typically takes 24 to 36 months before owner compensation becomes competitive.

Where buyers overpay

1. 01Valuing collections instead of profitability, so a busy but unprofitable practice looks strong.
2. 02Ignoring owner add-backs that will not survive the transition.
3. 03Accepting a multiple because 'that's the market' without testing debt coverage.
4. 04Underestimating post-close capital needs: equipment, software, working capital.

What a startup really costs

A de novo is rarely cheaper. Build-out, equipment, marketing and 18 months of personal living expenses often land in the same range as a mid-sized acquisition — but with far less certainty about when the money comes back.

“The broker works for the seller. We work only for you.”

How to decide

• If you need income within 90 days, an acquisition is usually the only realistic path.
• If you have a strong referral base and runway, a startup can produce better long-run margins.
• If the practice you found has clean records and stable hygiene, buy it and negotiate hard.
• If diligence is being rushed, that is information — not an obstacle.