Root Cause: A True Story of an Endodontist’s Misstep—and His Comeback

By Lisa Radman White

You’ve invested a great deal of time, money, and perhaps even blood, sweat, and tears into your education. Becoming an endodontist is a significant accomplishment—one that typically is only an option if you finished at the top of your dental school class. But after the hard work of earning your credentials, one of the most critical decisions remains:

Where will you work?

Will you become an associate in a private practice or in a corporate setting? Will you narrow your search to a particular location? Will you purchase a practice or attempt a startup?

Let’s explore the true story of Dr. A (not his real name), and how a major career decision set him on a difficult path—and how he ultimately turned things around.

The Dream: A Startup in a Competitive City

I met Dr. A during a “Life After Residency” Lunch and Learn presentation at his endodontic program. By then, he had already decided to open a startup practice in a large, competitive metropolitan city—his wife’s hometown.

Confident in his training and compassionate personality, Dr. A fully expected to succeed. He was the kind of clinician you’d bet on: well-spoken, personable, kind, and highly competent. On paper, he was the perfect candidate for a thriving solo practice.

But reality didn’t cooperate.

Despite his strengths, Dr. A struggled to gain traction. The general dentists in the area had entrenched referral patterns that they were unwilling to break, no matter how good Dr. A was. With patient volume low, he turned to insurance plans to boost numbers. Unfortunately, the insurance companies didn’t need him—and they knew it. They added him at reimbursement rates even lower than what other local endodontists were receiving. His molar root canal fee through insurance hovered around $500.

The Struggle: Overworked and Underpaid

While accepting insurance plans did increase his collections to over $500,000/year, it wasn’t enough. After factoring in practice loans, student debt, and living expenses, Dr. A’s take-home pay was around $100,000. His wife had to keep working, which wasn’t part of the life they had envisioned. The city had been her choice—but not under these circumstances.

Two years in, Dr. A called me with a new request:

“What’s the most profitable practice you have for sale right now?”

The Pivot: A Strategic Move to the Midwest

We had just listed a practice in a mid-sized Midwest city with an overhead of only 26%. It was 100% fee-for-service, and the current owner was netting $850,000/year working four days a week.

Dr. A wasted no time. He flew out to see the practice on a Friday and by Monday had submitted a full-price offer.

Thankfully, his startup had been built on a tight budget, and even though he sold it for just $125,000, the remaining loan balance didn’t prevent him from securing financing. Why? Because banks in the dental space primarily care about cash flow. If a practice is priced correctly and cash flow is strong, they’ll finance 100% of the purchase price, plus working capital—and in this case, even enough to pay off his remaining startup loan.

The Outcome: Redemption and Relief

Relocating to the Midwest meant:

• Lower cost of living
• Lower staff costs
• Significantly higher income
• Mrs. A could now stay home with the kids

While they no longer lived near her family, they could afford to travel anytime. Life stabilized. Their financial future looked bright again.

The Takeaway

You might not be planning a startup in a highly competitive market—but I hope Dr. A’s story makes you pause and reflect. Your career decision after residency is one of the most important ones you’ll make.

Some considerations:

• Associateship: You may not control your schedule or the insurance plans you’re required to accept, but you should have clinical autonomy.
• Practice Ownership: Your net income (after covering practice expenses and loan payments) should still meet or exceed what an associate makes.

You’ve chosen a great profession. Now, make sure you build a great career with it.

Lisa Radman White is the president of Radman, White & Associates, Inc., a firm dedicated exclusively to endodontic practice transitions. The company was founded in 1998 after her father discovered firsthand how difficult it was to sell his endodontic practice.