{"id":29731,"date":"2025-09-23T08:51:38","date_gmt":"2025-09-23T13:51:38","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=29731"},"modified":"2025-09-25T10:13:37","modified_gmt":"2025-09-25T15:13:37","slug":"root-cause-a-true-story-of-an-endodontists-misstep-and-his-comeback","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/root-cause-a-true-story-of-an-endodontists-misstep-and-his-comeback\/","title":{"rendered":"Root Cause: A True Story of an Endodontist\u2019s Misstep\u2014and His Comeback"},"content":{"rendered":"

By Lisa Radman White<\/em><\/p>\n

You\u2019ve invested a great deal of time, money, and perhaps even blood, sweat, and tears into your education. Becoming an endodontist is a significant accomplishment\u2014one 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:<\/p>\n

Where will you work?<\/strong><\/p>\n

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?<\/p>\n

Let\u2019s explore the true story of Dr. A (not his real name), and how a major career decision set him on a difficult path\u2014and how he ultimately turned things around.<\/p>\n

The Dream: A Startup in a Competitive City<\/strong><\/p>\n

I met Dr. A during a \u201cLife After Residency\u201d 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\u2014his wife\u2019s hometown.<\/p>\n

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.<\/p>\n

But reality didn\u2019t cooperate.<\/p>\n

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\u2019t need him\u2014and 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.<\/p>\n

The Struggle: Overworked and Underpaid<\/strong><\/p>\n

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\u2019s take-home pay was around $100,000. His wife had to keep working, which wasn\u2019t part of the life they had envisioned. The city had been her choice\u2014but not under these circumstances.<\/p>\n

Two years in, Dr. A called me with a new request:<\/p>\n

\u201cWhat\u2019s the most profitable practice you have for sale right now?\u201d<\/p>\n

The Pivot: A Strategic Move to the Midwest<\/strong><\/p>\n

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.<\/p>\n

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

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\u2019t 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\u2019ll finance 100% of the purchase price, plus working capital\u2014and in this case, even enough to pay off his remaining startup loan.<\/p>\n

The Outcome: Redemption and Relief<\/strong><\/p>\n

Relocating to the Midwest meant:<\/p>\n