Want a Lucrative Practice With Great Work-Life Balance? Go Rural!

An illustration of rural dental practice sold

Most dental practice buyers want the same thing: a financially sound practice where they can do the type of dentistry that excites them and keeps them engaged.

However, as they go through the process of considering potential practices, I see many would-be buyers turn down practices that could be a great fit.

Often, it comes down to a single factor: location. Many buyers assume that they can only have the lifestyle and practice they want in a big urban center or its immediate suburbs. The reality is different, however. While they may find a great practice in a city, it can come with costs: a higher price tag, tougher competition, more expensive housing, and a more hectic lifestyle.

Over the past several months, we’ve been speaking with some very successful dentists, including several on the ADA’s New Dentist Committee. Each of these dentists has built a satisfying, lucrative career — beyond the big city. Each has also attained a comfortable work-life balance. They practice dentistry the way they want to while living a lifestyle with plenty of time for family, community, travel, and other interests.

In the coming weeks, we’ll feature their stories.

Dr. Sara Stuefen: The Best of Both Worlds: Rural Practice, Urban Lifestyle

Dr. Kala Foster: Living and Thriving in Vacationland

Overall, we heard some common themes:

Small-market practices are very lucrative

Based on data from ADA Practice Transitions (ADAPT) participants, small market dentists do very well. Many discover that they can buy a house AND a practice in these areas. Some even do so while working part-time.

Annual starting salaries are generally $200,000 or more in rural areas — and with a lower cost of living, that paycheck goes further.

Would-be owners often find that they can easily afford a less-expensive rural practice. Urban practices are typically valued at about 85 to 100% of collections, while in rural areas, practices often sell for 50 to 66% of collections. These days, rural sellers are more willing to negotiate, especially if it means ensuring continuity of care for their patients. Overall, a smaller loan will allow for faster payback while giving you the financial flexibility to expand the practice as you like.

Rural overhead is lower, too, often as low as 50% compared to 75 or 80% in urban areas. That’s in part because lower land values make it easier to own the building than in urban areas, which protects the practice’s future while keeping costs low and stable. And when you own the building, you can outfit the practice exactly as you like without worrying that a landlord might sell the building out from under you. Some practices in small downtown areas even have an upstairs apartment that draws rental income. And most smaller market practices don’t need to spend much, if any, money on advertising or marketing.

Less competition also gives you more leverage with insurers. You can choose which ones you want to work with and negotiate better reimbursement rates.

Small-town practices are ideal for work-life balance

Most smaller markets have a significantly lower cost of living than urban or suburban areas. You can do “geographical arbitrage,” like one of our dentists who is now debt free after only a few years of practice, or pursue the Financial Independence, Retire Early (FIRE) lifestyle like another pair of dentists. Many rural dentists take advantage of the lower cost of living to live quite comfortably on a part-time schedule or a single household income — which makes for an ideal work-life balance.

Rural and small-town practice owners typically set schedules that allow them to attend their kids’ activities, travel frequently, and participate in organized dentistry and other passions. In fact, many have “permanent” three-day weekends. Others only work half days. And while occasional emergencies arise, patients tend to be overly concerned about bothering the doctor when the office is closed — in part because they know the doctor as a person with a life.

Living in small towns typically means short, stress-free commutes. One dentist we spoke with said her door-to-door time is just three minutes, or seven if she drops off her kids. Those who live in a larger nearby town talk of enjoying their 30-minute drive on quiet country roads.

The schedule flexibility is endless. One dentist we spoke with bought a plane to whisk her family away on vacations — and we’ve heard several similar stories!

Plus, many of these smaller markets are also vacation destinations for city dwellers. As one of our dentists noted, she enjoys doing “vacation things” like boating and snowmobiling every weekend, and often after her workday.

Have you ever wished you didn’t have to head home after a vacation? Perhaps you should check to see if the local dentist is looking for an exit!

Practice dentistry your way

Some dentists love being able to focus their energies on perfecting a narrow set of treatments. However, many prefer more variety in their days and weeks to stave off burnout.

When you practice in a busy urban or suburban area with tons of other dental professionals, you’re more likely to refer procedures to local specialists. In smaller markets, though, patients appreciate having access to extractions, root canals, or other treatments right in town — especially if you can save them a long drive to a specialist. That’s why small market dentistry is ideal for someone who likes todo a wider range of treatments.

For less experienced dentists, this needn’t be daunting. In many cases, a senior dentist is willing to stick around and mentor you to help you learn. Dedicated CE can help, as can your local dental community. (These new skills will add to your bottom line, too.)

You can also team up with your nearest specialists to streamline referrals, or even host them in your office once a month. And 77% of rural providers use teledentistry to diagnose and triage patients.

Get involved in your community

I often hear D3s and D4s worry that moving to a small town will hamper their social lives. But the opposite seems to be true: if you want to know your neighbors and build a strong, active network, a small town is the place to be.

A dentist is often a pillar of the community in small towns. After all, you’ll likely know a good percentage of the population, whether as patients or through your day-to-day activities. Maybe your kids are in school or gymnastics together, you shop at the same grocery store, or you see each other while walking your dogs.

This familiarity builds relationships and can make it feel like you’re part of something. All of the dentists we talked to mentioned how much they enjoy making a difference by participating in the local hospital board, Rotary, history museum, school board, and so on. The possibilities are endless! Doing so gives you a stake in your community while building trust with your patients — trust that increases treatment acceptance.

Be part of a close-knit group of professionals

Smaller market dentists often form their own community, connecting with other local healthcare professionals to share resources, brainstorm solutions, and serve patients more holistically. Whether it’s through a local component or an informal group, many of the dentists we interviewed talked about how supported they feel by their peers.

And since fellow dentists are not in direct competition, many cover each other for vacations, even parental leaves. Others get together frequently to discuss tough cases or offer mentorship and camaraderie. One dentist we spoke with even has a weekly lunch date with other local general dentists, an oral surgeon, and an endodontist — perfect for swapping stories, integrating care with local medical professionals, and offering support.

Serve an area that needs dentists

Baby Boomer dentists are retiring in droves, leaving practices to fill. Meanwhile, many of their Boomer peers are relocating to quieter areas where they can retire away from urban congestion. This presents two opportunities.

First, dentists selling practices are willing to negotiate to keep a dentist in town, caring for their long-term patients. I’ve seen practices valued at $800,000 sell for just $500,000 — or sometimes just the cost of the building. Plus, small-town banks are willing to work with would-be buyers if it means keeping a dentist in town.

Meanwhile, federal programs like the National Health Service Corps offer loan repayment to dentists willing to work in underserved markets. Many states and localities offer similar programs. Some chambers of commerce are even willing to offer grants to help an incoming dentist buy or update a practice that protects local access to care. And as remote work opens up new possibilities, some communities are even offering down payment assistance, relocation expenses, or other creative incentives (such as festival tickets) to people willing to relocate.

Second, these relocating patients need dental care in their new year-round or snow-bird homes. Many have failing dental work that can be more lucrative than simple cleanings and preventative care.

Serving an area that would otherwise be without a dentist can be incredibly rewarding — while giving you the leverage to do things exactly as you like.

If you’ve ever considered buying a practice, now is a great time to do so. And when you keep your options open, especially with some location flexibility, you’re more likely to find exactly the right practice where you can build a great career — along with a successful, comfortable lifestyle. That might just be in a small town you never considered.