At the recent annual meeting of the Academy for Private Practice Dentistry, I was sitting at lunch with a dentist from Springfield, Missouri. We had just met. Like most conversations at these things, it started casually; where are you from, how long have you been practicing, that sort of thing.
Then he asked me a question.
“I do about $750,000 in production every year,” he said. “But I only take home around $120,000. Is that normal?”
He wasn’t complaining. He wasn’t dramatic about it. He was genuinely curious.
But you could tell something about the situation didn’t sit right with him.
And honestly, I’ve heard some version of that question so many times over the years.
Not always those exact numbers. But the same basic idea.
A dentist is busy. The schedule is full. Production looks respectable on paper. Yet when the dust settles, the personal financial reward doesn’t feel like what the effort should justify.
It raises a question most dentists don’t talk about very openly.
Why do so many high-producing dentists feel broke?
The Freedom That Comes With Ownership
One of the things I’ve always loved about private practice is that it’s still a small business.
And small businesses have a certain freedom built into them.
The owner decides what the business is supposed to look like.
You decide what kind of dentistry you want to practice.
You decide how the team works together.
You decide what kind of patients you want to attract.
In other words, the practice can be shaped to support the life the owner wants to live.
That life looks very different depending on where you are.
A dentist practicing in New York City might need to take home $500,000 a year to feel financially comfortable. Between taxes, housing, and the cost of living, that number can disappear quickly.
A dentist in Ripley, Mississippi might live quite comfortably on $120,000.
Different environments. Different expectations.
There’s nothing inherently right or wrong about either number.
But the key point is that the practice should support the owner’s goals—not the other way around.
Too often, dentists find themselves working inside a practice structure that simply evolved over time. The business grows piece by piece without anyone stepping back to ask whether the economics of the practice make sense.
The Production Mirage
Dentists are trained to think in terms of production.
That’s what dental school measures.
How many procedures did you complete?
How busy was your day?
How many patients did you see?
Production becomes the universal scoreboard.
But production by itself doesn’t tell the full story.
If a restaurant sells $750,000 worth of food in a year but barely makes any money, no one would call that a healthy business.
Yet in dentistry, we sometimes celebrate production numbers without looking closely at what happens after the bills get paid.
And that’s where things get interesting.
Because a practice can be very busy… without being very profitable.
Income Isn’t the Same as Wealth
Another layer to this conversation is something dentists don’t always think about early in their careers.
Income and wealth are not the same thing.
Income is what shows up on your personal tax return this year.
Wealth is what you’ve built over twenty or thirty years.
While the take-home income from a dental practice has to do more than just cover living expenses, it should also allow the dentist-owner to steadily build personal savings and investments for the future.
Otherwise, the practice becomes a machine that produces income but never creates wealth or financial security.
A lot of dentists wake up to this realization somewhere in their forties or fifties.
They’ve worked incredibly hard.
But they haven’t necessarily built the kind of financial foundation they expected.
A successful dental practice is really balancing two outcomes at the same time.
The Number I Pay the Most Attention To
Over time I’ve come to believe that the most revealing number in a dental practice isn’t production.
It’s profit.
Specifically, EBITDA—earnings before interest, taxes, depreciation, and amortization.
It sounds technical, but the concept is simple.
EBITDA tells you how profitable the practice is as a business.
Production measures activity.
Profit measures effectiveness.
Two dentists could both produce $750,000. One might generate excellent profit and steadily build wealth. The other might feel like they’re running hard every day with little to show for it.
From the outside, the practices look identical.
Inside the financial statements, they’re completely different.
Once a dentist begins looking at the practice through the lens of profit instead of just production, the conversation changes.
You start asking different questions.
Why is overhead at this level?
Why do certain procedures feel busy but not particularly profitable?
Why does the schedule feel so full without translating into financial progress?
Those questions almost always lead back to systems.
Systems Make the Difference
A successful dental practice is really balancing two outcomes at the same time.
Clinical outcomes and business outcomes.
Clinical success means patients receive excellent care and experience real improvements in their oral health.
Business success requires systems that make the practice financially healthy—things like scheduling structure, treatment presentation, collections processes, and cost control.
When those systems work well together, the dentist-owner gains something incredibly valuable.
Control.
Control over production.
Control over collections.
Control over profit.
And that’s one of the great advantages private practice still has.
Unlike large corporate systems, the owner can adjust the direction of the business whenever they choose.
If you want to redesign your practice model, you can.
If you want to change your procedure mix or improve your profit margins, you can.
Private practice gives dentists the ability to shape the business around their vision rather than adapting to someone else’s.
Back to That Lunch Conversation
I thought about the Springfield dentist’s question for a while after lunch.
Was his situation unusual?
Probably not.
But it also isn’t inevitable.
Private practice can be one of the most rewarding professional paths in healthcare. But like any small business, it requires attention to both the clinical side and the economic side of the enterprise.
Ignoring either one eventually causes problems.
The practices that thrive over the long run are the ones where excellent patient outcomes and strong financial systems work together.
When that happens, the dentist-owner isn’t just producing dentistry.
They’re building something that works for their life.
A Final Thought
That lunch conversation happened during the 70th anniversary meeting of the Academy for Private Practice Dentistry. One of the things I appreciate about that group is how openly these kinds of discussions happen among dentist-owners.
People talk honestly about the business side of dentistry…the part of the profession most never learned in dental school.
APDP is also beginning a new collaboration with the American Dental Association focused on strengthening private practice ownership.
If you’re thinking about starting a practice, improving the one you have, or eventually transitioning out of ownership, it’s a community worth knowing about.
You can learn more at APDP.net.
Sometimes the most valuable insights in dentistry don’t come from a lecture.
They come from a conversation at a lunch table.
