You're an associate dentist. Maybe fresh out of school, maybe five years in. At some point, usually around year two or three, the question hits: what's next?
The two options everyone talks about: open your own practice, or join a group. Both get pitched hard. Both come with people telling you the other option is a mistake.
Neither is a mistake. But they're not the same, and the people pitching each one usually leave out the parts that matter most.
I've been on the group side of this conversation for a while now. This post isn't trying to convince you to do one thing. It's trying to lay out what each path actually costs, what each actually pays, and what the right questions are so you can make an informed call.
Path A: Open Your Own Practice
The dream a lot of dentists come out of school with. You own the chair, you make every call, and eventually you build something valuable to sell. It's a real path. It's also a lot more expensive than most people realize until they're in it.
The purchase price is only the beginning
If you're buying an existing practice in a decent market, you're looking at $500,000 to $1.5 million depending on size, location, and specialty. That number is what shows up in listings and what most people focus on. It's not what you'll actually put out.
On top of the purchase, you'll typically need:
- Working capital to cover payroll and supplies through the transition (usually $50,000 to $100,000)
- Legal, accounting, and lender fees ($15,000 to $30,000)
- Equipment updates or renovations most sellers don't disclose need doing ($25,000 to $150,000)
- Buffer for the revenue dip that comes with any ownership change (often 10-20% for the first six months)
The real all-in number on a $800,000 practice is often closer to $950,000 to $1,050,000.
What the loan actually looks like
Most dentists finance through an SBA 7(a) loan or a bank practice loan. At today's rates, a $720,000 loan (assuming you put $80,000 down) at 9% over 10 years runs you about $9,100 a month in payments. Over the full loan, you'll pay roughly $370,000 in interest on top of the principal. Total cash out over 10 years: about $1.09 million.
That's the number nobody writes on a whiteboard when they're pitching you on ownership.
What your take-home looks like during those 10 years
Here's where it gets more nuanced. A practice with $800,000 in collections typically generates around 20-25% in EBITDA before debt service. Call it $180,000 a year.
Take out the $109,000 a year in debt service. You're left with about $71,000 in owner distribution. Then add your clinical production on top.
The honest take: your take-home in years 1-10 as a solo owner is usually somewhere between $200,000 and $350,000 depending on how the practice performs. Sometimes higher if you kill it. Sometimes lower if things get hard.
That's not nothing. But an associate at a well-run group is typically in the $180,000 to $250,000 range with benefits and zero debt exposure. So the ownership premium during the payoff years is often smaller than the pitch suggests.
What you actually own at the end
Year 10, you make your last loan payment. Now what?
You own a practice worth whatever it's worth at that point. If you built it well and the market cooperates, that might be $1.2 to $2 million on sale. If you didn't build it to be sellable, it might be worth less than you paid for it.
The good news: from year 11 forward, your monthly $9,100 loan payment becomes your take-home increase. That's real money.
The catch: many owners at year 11 are burned out and want to slow down. The equity is real. Whether you get to enjoy it depends on what shape you're in when you finally arrive.
Path B: Join a Group
The other side. Sometimes pitched as the easy path. Sometimes pitched as selling out. The truth is neither. Whether it works depends heavily on the group.
What compensation typically looks like
Associate compensation at a decent group runs on a production or collection percentage, usually 28-32%, with a daily or annual guarantee that protects you during ramp-up. Full benefits (health, dental, vision, malpractice, retirement match) add another $15,000-$25,000 of value on top.
A first-year associate producing $600,000-$800,000 typically takes home $180,000-$250,000 all-in. A five-year associate with a full patient base often gets to $250,000-$350,000.
The real question isn't what you make in year one. It's what happens in year five and beyond.
What the group takes off your plate
The best case for a group isn't the paycheck. It's the paycheck plus everything you don't have to think about.
At a well-run group, you don't build the business systems. You don't hire the front desk. You don't negotiate insurance contracts. You don't worry about payroll on Friday. You don't cover for staff callouts. You don't sit in HR meetings about the assistant's schedule. You don't call the AC repair person when it breaks.
That time doesn't show up in a P&L. But if you'd spent your evenings and weekends on those things as a solo owner, that time is what you get back.
What ownership at a group actually means
This is where most group pitches get vague fast. "You can become an owner" is often the phrase. What that actually means varies enormously.
At a well-structured doctor-owned group, ownership means:
- Real equity in the group as a whole, not just your individual practice
- A vote or voice in group-level decisions
- Value that grows as the group grows
- A path to sell your stake back at exit without finding a buyer yourself
At a poorly-structured group, ownership can mean:
- Profit share that looks like ownership but doesn't build equity
- Equity only in your individual practice, which you have to sell separately at exit
- No voice in how the group is run
- Restrictions that make it hard to leave with your value
These aren't the same thing. The word gets used interchangeably. Ask for specifics.
The Right Questions to Ask Any Group About Ownership
Whichever direction you lean, the group you evaluate matters more than which category it falls into. Before you sign anything, run every group you talk to through the same short list of questions. The questions are designed to separate real ownership offers from marketing ones, and the answers tell you almost everything you need to know about whether a group is actually built the way it says it is.
The full list, along with why each question matters and what a good answer sounds like, is available as a printable checklist. Grab it below and take it with you into every conversation.
Where Bluetree Sits (Honestly)
I run business development for Bluetree Dental. We're a doctor-owned dental group with 45+ practices across Nevada, Oregon, Washington, Idaho, and California. So obviously I have a point of view.
The short version:
- 45+ doctor-partners hold the majority of the equity. Not a minority next to a bigger stake. The majority.
- We have a minority private equity partner (Clairvest, joined 2023) that provides growth capital. They do not set clinical direction, hiring, or treatment philosophy.
- Associates who want partnership are typically offered it within 1-2 years. We've walked 45+ providers through that door.
- Buy-in is a fraction of what buying a solo practice costs, and you end up with equity in the whole group, not just your chair.
- When you exit, you sell back to the group. You don't have to find another dentist to buy your slice.
Whether we're the right fit for you depends on what you want. If you want to be the sole owner of your building, buying a solo practice is still the right call. If you want ownership but not the loneliness and financial exposure of doing it alone, a group is worth looking at. Which group specifically is the harder question, and the questions above are how you separate real ownership from marketing ownership.
If you want to have a conversation about any of this, Jeanette Purdy leads Provider Growth here. Call or text her at 775-336-7550. Worst case you leave a call more informed. Best case you find the right fit.