The hidden cost to acquire a dental practice

hidden cost of acquiring a dental practice

By: Bruce Bryen

A dental school graduate that has worked as an associate and learned from a mentor or owner may now be looking for that first dental practice acquisition. There are many things to think through before buying a dental practice, since this is probably the largest purchase and borrowing step that has ever been taken by the associate. 

What are some of the areas of concern? What advisors are needed to help make this transition as smooth as possible?

Let’s start with whom is needed for guidance, so no material mistakes are made that may cost thousands of dollars. An associate who has probably never spent much money on advisory services will now be investing a lot into the transition process. 

Who Should Advise on the Acquisition?

If the attorney is not the first advisor to call upon, then who is? It’s the dental CPA. Few attorneys understand the dental world. Dental CPAs have seen many contracts for transitions, they know taxes from a dental perspective and they are eager and ready for this type of work. 

Benefits of Working with a Dental CPA

The dental CPA can assist the attorney and points out various points to remind the attorney about what should be in the contract of sale. The dental CPA can explain the hidden cost to acquire a dental practice, which will be discussed later in more detail.  If the attorney listens, there will be a good synchronization between the attorney and the dental CPA. 

The charges for someone who understands and can implement what needs to occur are not inexpensive. They are cheaper in the long term than a non-dental CPA who may know a lot about business but little about a dental practice.

Finding the Right Dental CPA 

Finding the right dental CPA is not as difficult as you may think. The dental practice broker can be a big help in referring the right dental CPA to the prospective purchaser of the dental practice since they will probably have a lot of experience from other transitions in dealing with both sides of the transaction, meaning the buying dentist and the selling dentist and each of their dental CPAs.

The Hidden Cost of Acquiring a Dental Practice

The buyer of a dental practice may not realize it but there is a hidden cost involved with the acquisition of a dental practice.

Asset Allocation

Most times, the seller of the practice is insisting on capital gains treatment when discussing the allocation of the purchase price of his or her dental practice. 

Without using sophisticated means for the deferral or elimination of a material amount of the taxes due, the cheapest tax rate for a seller is the capital gains rate.  It can be up to 50% cheaper for the seller to report goodwill and other capital type assets upon the transition as the rates can be as low as 20% to him or her compared to 50% if that same income was reported as ordinary. 

An example would be the reporting of goodwill consisting of patient lists, addresses, phone numbers, location, and other items compared to receiving a consulting agreement or a gross-up in salary.  The debate between the dental CPAs will provide each with reasons to use the method of choice that will resolve the issue and allow the transaction to occur. Each of the dental CPAs will learn more about the other side’s offering of reasons about why his or her method of asset allocation is reasonable and will assist in getting the job done. 

Taxes

There is usually not much talking about the taxes that the buyer will incur upon the transition. These are the hidden costs that should be discussed so the buyer of the dental practice is ready when the taxes appear.  An example would be the loan amortization used to acquire the practice.  It is important to note that any time a payment is made against the loan balance, that person making the payment only has two ways to do so. 

One way is by reporting the income necessary to pay the loan, which creates income for the payer of the loan and there is a tax subject to that income.  The other way is to refinance the loan and pay it down with another loan.  That payment would not come from income and would not be subject to tax. 

These are critical points for the buyer to understand because he or she will have to report the income and unless other steps are taken, there will be a tax on that loan payment. 

Understanding the Hidden Cost to Acquire a Dental Practice

Probably one of the best examples to use to assist in understanding the buyer’s taxes on an acquisition is to use something familiar to almost everyone. When paying the home mortgage, most look at the payment each month and know that almost 100% of the payment is allocated to interest expenses.

This allows the buyer to “write off,” the interest on his or her tax return subject to certain restrictions. When the mortgage starts to amortize, the portion that is allocated to the loan balance is not something that can be “written off,” since it is a loan payment. 

Where does the money come from that is used to pay the loan balance?  It must come from income that is generated by the payer of the loan.  Since the amortization is such a small amount, most people don’t realize that they are making that portion of the payment by reporting enough income to have the money to make the payment.  When the payment is made, the loan balance decreases but also there is a tax on the loan payment.

As time goes on, the loan payment portion of the mortgage payment gets higher and the tax becomes a larger amount as well.  This is where the dental CPA comes to the rescue of the buyer of the dental practice. 

Photo by Karolina Grabowska

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Testimonials

Rosie, RDH

Rosie, RDH

I had the pleasure of working with Candy as a dental hygiene consultant over the course of several months, and her...
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Rosie, RDH

I had the pleasure of working with Candy as a dental hygiene consultant over the course of several months, and her impact on both our hygiene department and overall practice was exceptional. Candy is highly knowledgeable, approachable, and genuinely invested in the success of the team. She is an excellent listener who takes the time to understand challenges and provide practical, effective solutions. One of the qualities I appreciated most was her accessibility, she was always available to answer questions, offer guidance, or return a call when needed. Her hands-on approach and commitment to helping our team succeed were evident in every interaction. Candy’s focus extends beyond productivity and practice growth; she truly cares about the people within the practice and works to create a supportive, collaborative environment. As a fellow dental hygienist, it was especially refreshing to work alongside someone who shares a similar philosophy and approach to patient care, team development, and practice success. We view many aspects of dentistry and hygiene through the same lens, which made collaboration seamless and productive. Having the opportunity to work with another hygienist who understands the challenges, opportunities, and importance of our role was invaluable. The hygiene modules she developed were incredibly valuable. They were well organized, easy to follow, and provided clear, actionable guidance. The accompanying handouts and resources gave our team the tools and confidence needed to implement new concepts successfully. Her training materials were practical, relevant, and tailored to the real-world needs of a busy dental practice. Candy’s expertise and dedication to excellence have made a lasting impact on our team. I would highly recommend her to any dental practice looking to strengthen its hygiene department, improve systems, and support the growth and success of its team. She is a true asset to any practice fortunate enough to work with her.
Rosie, RDH
Dr. Justin Elikofer

Dr. Justin Elikofer

Our story with IgniteDDS began almost five years ago when my wife and I purchased an established fee-for-service practice. At...

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Dr. Justin Elikofer

Our story with IgniteDDS began almost five years ago when my wife and I purchased an established fee-for-service practice. At the time, we promised the team that everything would stay the same. The practice was thriving, and from the outside it seemed clear they had found a successful recipe for success. Our goal wasn't to change it—we simply didn't want to mess it up.

What we discovered was that while everyone wanted the outcome of success, there wasn't alignment around how we achieved it or measured it. Success in room 1 wasn't the same as Room 2. It took us nearly four years to fully understand that because we were doing well. During that time, we also realized we weren't leading as effectively as we could have been. We weren't communicating a clear vision, establishing consistent standards, or implementing clear protocols. Instead, we allowed people to continue doing things their own way. Some team members appreciated that freedom, while others felt frustrated by the lack of consistency and direction.

After four years, we found ourselves at a crossroads. We felt stuck. Morale was low and we weren't sure we could get the practice where we wanted it to go on our own.

As owners who value relationships as much as results, David immediately stood out to us. His personality was authentic, approachable, and trustworthy. He was someone we could see ourselves learning from and building a genuine relationship with. Being local was a bonus, but what really resonated with us was that his vision for practice growth, demonstrated through his own private practice, closely mirrored our own. He had already built the type of practice we wanted to create.

This stood in contrast to many other consultants we spoke with, whose focus seemed to be on PPO models and increasing volume. David's experience aligned with the type of practice we wanted to build: a high-touch, high-end patient experience centered on quality rather than quantity.

The IgniteDDS team—David, Dawn, and Candy—started by helping us understand where we truly stood. Through discovery, data gathering, and DISC assessments, they helped us identify opportunities for improvement and build a foundation for long-term growth. Rather than jumping straight to solutions, they gave us clarity.

Candy's coaching was instrumental in aligning our hygiene department and our office as a whole with the hygiene department. With her help, we were able to improve the patient experience and new patient process.

We also tackled practical issues that had become major challenges, including an accounts receivable system that was largely out of control. IgniteDDS didn't just point out problems—they provided systems and processes to solve them.

One of the most valuable aspects of the relationship was having experienced coaches to help us navigate team conflict and leadership challenges. As practice owners, those situations can feel isolating. Having a trusted team to walk through difficult conversations and decisions was invaluable.

Another large impact came through our office managers' work with Dawn. Rather than relying on the doctors to drive every initiative, IgniteDDS empowered our office managers to take ownership of the process and lead from within the organization. They embraced that responsibility wholeheartedly. No challenge was too large or too small. Dawn consistently met them where they were and helped them develop the confidence and skills to lead. The answer was rarely, if ever, "no." Instead, it was, "Let's figure out how."

Today, our practice is more aligned, more accountable, and better equipped to deliver the experience we've always envisioned. We have clearly defined protocols, team agreements, and expectations that simply didn't exist before. Our collections have improved significantly, particularly through implementing systems that helped us address and recover outstanding balances.

If we could offer one piece of advice to another practice owner considering IgniteDDS, it would be to identify the team members who are willing to take ownership and invest in their growth. Share your vision with the IgniteDDS team, trust the process, and allow them to help shape your team into the organization you want to become.

Working with IgniteDDS has been one of the most impactful investments we've made in our practice, our team, and our own growth as leaders. Are things perfect? No. Are we closer? Absolutely, yes!

Dr. Justin Elikofer
Dr. Sanjie Jackson

Dr. Sanjie Jackson

I was running on empty, and honestly, everyday I thinking of my exit strategy when I met Dr David Rice. ...
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Dr. Sanjie Jackson

I was running on empty, and honestly, everyday I thinking of my exit strategy when I met Dr David Rice. As the sole owner of two dental practices, I knew I couldn't continue trying to do everything on my own. Not if I wanted to grow and lead at a higher level. Partnering with IgniteDDS has been, hands down, one of the best investments I've made for both my practices and my team. Just halfway through my first year with IgniteDDS, the impact has already been remarkable. The knowledge, systems, accountability, and leadership development they have provided have transformed the way we operate. Not only have I gained valuable tools and insights as an owner, but my entire team is getting empowered with skills and confidence that are helping us elevate every aspect of our patient experience and practice performance. What sets IgniteDDS apart is the genuine commitment they have to their clients' success. Their guidance is practical, actionable, and tailored to the everyday realities of me running two dental practices. I am incredibly grateful for Dr. David Rice, Dawn, Candy, and the entire IgniteDDS team. Their expertise, continuous encouragement, and unwavering support have made me feel like I am not alone on this journey. If you're a practice owner looking to strengthen your leadership, improve your systems, and create sustainable growth, I cannot recommend IgniteDDS highly enough. The value they provide is truly exceptional, and I am excited to see what the rest of this journey brings.
Dr. Sanjie Jackson
Alyse Berta

Alyse Berta

Dawn, thank you for the great advice and guidance you’ve shared as we work on improving our practice's efficiency. I...
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Alyse Berta

Dawn, thank you for the great advice and guidance you’ve shared as we work on improving our practice's efficiency. I truly appreciate your support and the time you’ve taken to help us move forward in a more streamlined and effective way. Your insight has been incredibly valuable and is helping us make meaningful progress.
Alyse Berta
Dani S.

Dani S.

IGNITEDDS has made a real difference in our practice and in my role as office manager. The support I’ve received has...
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Dani S.

IGNITEDDS has made a real difference in our practice and in my role as office manager. The support I’ve received has helped me grow with more confidence and clarity, and our systems and leadership have improved because of it. Dawn has been an incredible support to me personally, always present, approachable, and truly invested in our success. I never feel alone when challenges come up, and that level of guidance and encouragement has been invaluable. IGNITEDDS doesn’t just support practices; they support the people behind them.
Dani S.
Eva B.

Eva B.

Working with IGNITEDDS Coaching has been such a great experience! Having David as a dentist makes a huge difference. He truly...
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Eva B.

Working with IGNITEDDS Coaching has been such a great experience! Having David as a dentist makes a huge difference. He truly understands the day-to-day challenges we face in practice. His insight makes their guidance practical, relevant, and easy to implement. Working alongside Dawn has been such a gift! She’s always available to answer questions, talk through ideas, and help us find the right solutions. Her advice is thoughtful, effective, and supportive. It hasn’t just helped me, it’s positively impacted our entire team and elevated our patient experience. I’m incredibly grateful to partner with Ignite as we continue to grow, strengthen our team, and serve our patients at a higher level.
Eva B.
Kylinn Tucker, RDH

Kylinn Tucker, RDH

I had an amazing experience with the IGNITEDDS Coaching program. Especially since I am a new hygienist, everything...
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Kylinn Tucker, RDH

I had an amazing experience with the IGNITEDDS Coaching program. Especially since I am a new hygienist, everything you guys shared was so helpful. It’s evident that you guys prioritize each individual team member of a dental office and do everything you can to make the environment and schedule run as smoothly and efficiently as possible. I learned so much about treatment planning, Dentrix, scheduling, teamwork, and overall ways to continue improving as a new grad. I wish every dental office had the opportunity to complete this program.
Kylinn Tucker, RDH
Dr Ben Truong

Dr. Ben Truong

It was great working with a team to help bring out the best in each of us. Our team is ...
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Dr. Ben Truong

It was great working with a team to help bring out the best in each of us. Our team is small, but we work closely together to provide a great patient experience, while having fun at work as well! Your team was able to help us learn to work together, with each person having a vital role in providing care to the patient! Helping us all become streamlined and on the same page will help us become an even more successful practice!
Dr Ben Truong
Dr. Ronnetta Sartor

Dr. Ronnetta Sartor

The 90-Day Jump Start has been transformative for our office. Dawn and Dr. Rice guided us through implementing essential systems ...
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Dr. Ronnetta Sartor

The 90-Day Jump Start has been transformative for our office. Dawn and Dr. Rice guided us through implementing essential systems and processes, from new patient calls to treatment planning and case acceptance. Their focus on patient care and team accountability has helped us create better structure, improve work/life balance, and stay aligned with our goals. In a short time, our practice has grown tremendously.
Dr. Ronnetta Sartor
Dr. Chandler Oldenburg

Dr. Chandler Oldenburg

IGNITEDDS has been truly transformative for our practice. Within just a few months, our accounts receivable collections increased by $30K, ...
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Dr. Chandler Oldenburg

IGNITEDDS has been truly transformative for our practice. Within just a few months, our accounts receivable collections increased by $30K, and our operations became far more streamlined. Their clear procedures and policies gave our team structure and confidence, while their step-by-step ownership guidance addressed our specific challenges. Thanks to David and Dawn, we feel more organized, empowered, and aligned than ever before. I highly recommend IGNITEDDS to any practice ready to grow and strengthen its foundation.
Dr. Chandler Oldenburg

Bruce Bryen

Bruce Bryen, CPA/CVA Dental Practice Valuation Analyst, Baratz & Associates, PA

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