Startup vs Acquisition: Don’t Make the 5-Year Mistake

Startup or acquisition... how do you choose? Between horror stories and conflicting advice, it’s hard to get a straight answer. This episode breaks them down in a way that actually helps you decide (and avoid getting set back years). You'll learn what to look for during the due diligence process, the non-negotiables that determine success, and the number one factor for growth.

Topics discussed:

• The pros and cons of starting a practice from scratch
• Why acquisitions can turn into “pseudo startups”
• Due diligence and red flags most buyers miss
• Important factors that drive practice growth
• Leadership challenges and turnover after an acquisition
• What matters more than location, capacity, and team culture

This episode was produced by Podcast Boutique https://www.podcastboutique.com

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Transcript

Framing Startup Vs Acquisition

Paul Etchison 1:22

If you're debating startup versus acquisition, you probably are doing that thing that we all do. You keep asking everybody you know who has already chosen a side. And the startup people, they're gonna tell you that the acquisitions are a nightmare and that you're buying someone else's problems. And then the acquisition people are gonna tell you that startups are a slow, painful grind, and you're gonna be eating ramen for the rest of your life. And meanwhile, you're just sitting there thinking, I just want to make a smart decision that doesn't set me back five years. Because this choice is not just theoretical. It will affect your stress, it will affect your income, your schedule, and whether you actually like owning your new practice. So today we're gonna break down startup versus acquisition in a way that is actually useful, not only for the people thinking about going into practice ownership, but for those who are already there. We're gonna talk about what's great about each path, what can blow up in your face, and what due diligence really needs to include. How should you think about location, capacity, and new patients so that you're not making this harder than it has to be, as well as what to do once you get rolling. Now you're listening to the Dental Practice Heroes podcast, where we teach you how to step back from the chair, empower your team, and build a practice that gives you your life back while still being insanely profitable. I'm your host, Dr. Paul Edgison, author of two books on dental practice management, dental coach, and the owner of a large five-doctor practice in the south suburbs of Chicago. If you want to make smart growth moves without gambling your future on guesswork, then you are in the right place. Today I am joined by my DPH coaches, Dr. Henry Ernst, the owner of an 18-op practice in North Carolina, and Dr. Steven Markowitz, the owner of six practices in the Boston area. And what I love about both of them is that they're not just giving opinions, they've actually built the exact kind of practices we teach inside DPH, team-driven, systematized, and scalable, without the owner being the bottleneck. All right, let's dive into this episode. And we're talking about the age-old question that has been discussed since I'd say, like at least like the, you know, the 16th century. It's a really old discussion. But startup versus acquisition. Why one versus the other? And I think people get really dug in on this. And I think it's there is a tendency for us to always recommend what we've done because it's worked for it. But you know, I was a startup. Henry's did a startup, 18 ops in the Carolinas. You know why I always say the Carolinas, Henry? Because I can't remember it's north or south. It's north, but I live in South.

Henry Ernst 3:54

So Carolinas is great.

Paul Etchison 3:55

Is there a thing like North and South? Like kind of like the Chicago, like the White Sox versus the Cubs, North Side, South Side, where we're like, eh, F them. Does that happen in Carolina?

Henry Ernst 4:03

We're kind of all put together. Like we got the Carolina Panthers, right? They don't even say North Carolina Panthers. They say Carolina Panthers. It's Carolina's team.

Paul Etchison 4:10

It's very inclusive.

Henry Ernst 4:10

Yeah, we're very inclusive here.

Paul Etchison 4:12

Well, yeah, so what's going on in the Carolinas with startups versus acquisitions? I'm not keeping up on this.

Acquisitions Becoming Pseudo Startups

Henry Ernst 4:18

Well, like you said, I mean, I've done startup, but I've got a unique perspective, and you do too, Paul, is because we help clients who also, you know, did the acquisition route. And I would say that if I had to go back in time knowing everything I know now, I would definitely do the startup route again. And I know you said, yeah, we just kind of used to what we're doing, but I look at it like this as a startup is a blank canvas. I'm making it my own from the very beginning. One of the biggest issues that I see, and you see this too, is with our clients that did acquisitions, is there's that false pretense I'm gonna walk in here, it's already got cash flow, I'm buying the cash flow. But what happens oftentimes is the new doctor comes in and it turns into within a couple months what we call a pseudo-startup because team members leave, people don't like change, even if it's a little change, and then you're basically faced with having wanting to change things, but now it's hard because people are so used to the already made Canvas. So there's pros and cons to each. I love startup, I love doing the due diligence. This is the most important thing that people I saw somebody online that said, hey, I'm opening my startup in six weeks. What marketing company should I use? And in my head, I said, Holy shit, you don't have one already? Right. So I love this startup. I love doing all of the due diligence on the front end to make sure you're successful because the biggest thing that people are nervous about is big risk, right? There's no patients on day one. I still love to this day to show my team day one opening startup. We had like five patients on the schedule, and it was nothing opened down, it was totally gray, right? But I made it my own. As things grew, I grew it my own. I just love doing the startup route and making it my own because I've seen how much hesitation you can get from buying an existing one and it's not what you expected.

Culture Shocks And Patient Attrition

Paul Etchison 6:07

Yeah. That's the transition is like you're buying into an existing culture of team that if you want to do something differently, you're going to have these feelings of, oh man, like people are quitting. I'm a bad leader. I'm not doing this right. And oh my gosh, like I I have a client right now, and we're looking at he's about, you know, 20 months into his acquisition, and we're looking at attrition numbers and they're astronomical. And he feels so horrible about it. But I'm like, dude, like you're 18 months in. So like you're starting to see like the 18-month attrition, how many patients haven't been in in 18 months. You're gonna lose people. Like, you're not the other doctor, like people don't they're not vibe with you. Maybe they just decided time to look for a new dentist anyway. You don't know what it is, but I think there's a you have to have a thicker skin when you're doing that acquisition, and you've gotta take control over the the team. You gotta do it.

Henry Ernst 6:56

We have another client that is part of our mastermind, and his practice, they weren't even taking x-rays for years. Yeah, no x-rays. So, like now, he's the weird one. I'm doing air quotes, he's the weird one because he wants to take x-rays, and they're all there's so much hesitation for that.

Paul Etchison 7:11

So, what is this voodoo magic he's doing with his magic gun?

Henry Ernst 7:14

X-rays? What is that? Oh my god.

Paul Etchison 7:17

Yeah, Satan worshiping.

Henry Ernst 7:18

From day one in my practice, we always take interoral photos, and everybody understands this is a crown, right? This is this, this is that, as opposed to like, oh, now the big bad new doctor's coming in here, and he's recommending a crown for this tooth with a broken amalgam and all this stuff. And the other doctor was just kind of on his last legs and he was just watching stuff for years because we see this also. You buy an acquisition, and the doctor knew he or she was on their way out. And what did they do? They just sat on their laurels and they watched lots of teeth, and now you have to be the one to come in there and change this culture and have all these conversations about why they need something. So you could do it, but it is a challenge in itself.

Seven Acquisitions And Lessons Learned

Paul Etchison 7:58

Well, it's like anytime you're on your way out or you got a plan to leave, you're definitely gonna behave a little bit differently. Maybe you're gonna like go into chill mode. I remember at my associateship, this was my very last day at my associateship. And so it was like my practice was already opened. And I'm sitting there in the operatory and this patient's name is Peg, and I don't like Peg. I just can't wait to this is the last time I got to see Peg. But Peg is leaning back in the chair and she goes, I don't want to lay back. I don't want to lay back. I was like, What's going on, Peg? She's like, There is a fly in that light. I need you to get it out before I lay back. I think it's gonna fall in my mouth. I'm like, it's not gonna fall in your mouth, Peg. I hope. I promise you it won't. She goes, You need to get the ladder and get that out before we could do this with my teeth. And I said, Peg, you know what? Today's my last day here. I'm not moving the fly. It's not coming out. Do you want to reschedule? And she was like, oh, fine. So, you know, you know what screwed up. Peg was so rude. Peg hated every ounce of my being. Peg followed me to my new practice. I couldn't believe it when she showed up. I was like, what the hell are you doing here? I'm like, wait till I show you my lights, girl. No flies. But anyway, what do you what do you say, Steve?

Due Diligence Beyond The P&L

Steve Markowitz 9:04

Paul, you should have opened the light and had the fly fall on her. That would have been your like my drop moment. I'm out. Maybe like a balloon drop? Like had the string. Yeah, maybe Peg wouldn't have followed you to your wildly successful practice down the road. Yeah. I've done. Sorry, that was my non-Segador. I have done seven acquisitions in my life. And that is definitely the path that I would take. I have learned a ton, and each one has gotten a little bit smoother than the last. And I'm very particular with what that acquisition will look like. I find comfort in knowing that there's cash flow. I find a lot of comfort in knowing that there may be opportunity to take better care of patients because the x-rays haven't been taken. So, yes, that's a very difficult conversation that we're going to need to have. But what else do I know when the doctor hasn't taken x-rays in two years? There is probably disease everywhere. And that is how we get, we get compensated for curing and treating dental disease. When a practice has a lot of active patients and they aren't meeting what we know to be the standard, I have to go in and reset the culture and reset the standard of care. But that also means that there's going to be a quicker path to upside. Maybe not as much of a return on as a startup. But I can, for me, there's a lot less risk from the on the acquisition side.

Henry Ernst 10:30

So what are the what are the things that you do? This could help a lot of people, because I've seen people who, oh man, I didn't do the due diligence on this startup. It's like a bleep show, right? Or I've even had people, and Paul and I have seen somebody like this who paid an quote unquote expert to do the due diligence for them before they bought a practice, and it was still a shit show. What specific things do you do in your experience that can prevent that?

Valuing Goodwill And Upside

Steve Markowitz 10:54

There was a practice that I acquired, I don't know, six five or six years ago at this point. And this particular doctor didn't like getting patients known. So he really didn't. He rarely got anyone known. But the patients loved him. And when I remember when we were having one of our first conversations, I asked him, I was like, so congratulations on getting to this point. He's like, I'm a horrible businessman. And I was like, okay, why do you think that? He's like, I just I never looked at the numbers. I I'm sure there's so much dentistry here. And the first question I asked him, I said, How long has your team been here? And he said, Well, the person who's been here the least has been here 16 years. And I was like, Sounds like you're the best businessman I've ever met. And the reason why I'm sharing that story is when you are acquiring someone, yes, the philosophy of dentistry may be slightly different. Or the or his willingness to have have difficult conversations with his patients clearly was not something in his wheelhouse. But what I did know from that conversation is he loved people. He loved his team. He just couldn't get over the fact that he had to hurt them to get them healthy. And I think that was that's something that in my when I'm meeting with that doctor and trying to understand the goodwill that I'm acquiring, I truly need to understand what the fabric of that person is. And then I need to couple that with all right, how many operatories does this practice have? How many patients does this business practice have? Where is the location? How easy is it going to be for me to acquire new patients? A book out is the practice. What does the PL look like? I can get into all those things. But where I find there to be the biggest challenges is like when someone misrepresents themselves, like you said, Henry. They're trying to sell this thing because they, for whatever reason, they are, but they're not a good person. I've had one failed practice. The reason that practice failed was not because I did anything different than the seven others. It was because the person that I bought that practice from was not a good person. And they did the same thing.

Paul Etchison 12:46

So what you're saying is you will look at like the numbers on paper, you'll look for the opportunity, but you're basing on the attitudes of the previous ownership.

Steve Markowitz 12:55

So to know the goodwill that I'm purchasing that practice for. So if I'm gonna buy it for a four, five, six X, that's expensive. I need to make sure that what I'm buying, which is mostly the goodwill, I have really understand what that is. And that doesn't always mean that they were a great dentist, because if they're the perfect dentist who treatment plans everything, has amazing case acceptance, there's probably not a ton of opportunity in that practice.

Paul Etchison 13:20

Good point.

Capacity Limits And Chair Count Reality

Steve Markowitz 13:21

So when I'm looking at these acquisitions, it's yes, I love what you've built, but I also need to know how I can take it from where it is to get a return on that investment and be able to provide an opportunity to help more patients grow, grow a larger practice and build more team members. So for me, that path has always been easier for from an acquisition standpoint if I'm diligent and careful with what that acquisition looks like.

Paul Etchison 13:47

I think the similarity between an acquisition and startup is essentially you're looking at for me, it's like, what is the opportunity for new patients? What is my competition doing? Can I generate new patients? I feel like if you can generate new patients, you can pretty much do anything. But then, like you said, Henry, you know, you're buying an old practice typically. What I see a lot is people buy a three and four op practice and they reach out to me and they say, I want to practice like you. And I say, Can you get any more ops? No, it's not gonna happen, dude. It's just not gonna happen. You functionally can't do that. I mean, you can do the best you can out of that man operatories, but you're not gonna get the same results as my 11-op practice out of your four-op practice. And I think three ops, man, that's trouble. That's hard. Tough. That's tough. Yeah. I mean, will you work out of one chair or you only have one hygienist? Like that model doesn't work for me. I guess it's one of those things. Go ahead, dude. Do you, but I mean, I don't know why some dentists want to make it hard on themselves.

Henry Ernst 14:40

What would you say if you had to ask that question? If you had to go back in time, would you have done a startup again or would you do acquisition?

Would You Choose Differently Now

Paul Etchison 14:46

Yeah, good question. Because you know what? I did the startup, it went really well. I found a great location. I loved the empty canvas. I loved designing it. I loved like doing all that stuff. It was really cool. But I think if I was to do it, if I was to do it again back then, I would do a startup. If I was to do another practice now, I think I'd do an acquisition. Just because I don't think I have the patience of being the dentist. That's what it is. If I do another practice, I'm not going to be the operating dentist there. And I think it's hard to find an associate to sit at a startup. I mean, you'd have to compensate them pretty well. And you got to find the right person. Because I mean, you're very dependent on that person and their personality and their soft skills in the way that they present things and their leadership skills as well. So I'd say acquisition for me now. I mean, what do you think, Henry? You going back, would you still do the startup? And then what would you do if you opened another practice today?

Henry Ernst 15:39

Probably the same answer, right? Because it does take a lot of energy, a lot of time. It is, there's something gratifying about it. We've had this conversation sometimes when we work with clients and they're like in that just growth phase. And sometimes I look at those people, I'm like, you know what? I'm envious of you right now. There's a little part of me that's envious of you, like the struggle, or what does Goggin say? Embrace the suck, right? You're in that moment right now. But sometimes with age comes knowledge. With age comes, you know, what would I do now that would make it more efficient? I could see myself, if I was to do it, I could see myself doing a, you know, an acquisition and making it my own, right? As far as being a pseudo-specialist right from the get-go, kind of thing, right? But if I was younger and I was just getting out of school a couple of years, I would learn business, learn the business of dentistry. Too many people, it's great, right? How to do crowns efficiently, how to do root can that's great. But you need to learn to be a business person and learn the due diligence. And even if you do an acquisition, listen to somebody like Steve, right? Steve has messed up. You learn from your mess ups, right? He'll never do that again. So do the due diligence. We talk about it with so many things, but with due diligence, whether it's a startup, whether it is with the acquisition, the due diligence can kill you. It can set you back a few years.

Leadership, Expectations, And Turnover

Steve Markowitz 16:54

If someone has a a four-hour practice, sorry to go back to that, and they want to have a practice like yours, Paul, they can't let the space dictate the business. Why don't they just move to a bigger space? You can have both.

Paul Etchison 17:07

I think you can move to a bigger space, but that's a big commitment. You know, it's like you've already got everything there. It's like the path of least resistance is to stay there. I think you could still do a fairly good practice out of four ops. I mean, I was doing, I mean, you know I feel like we got to talk about inflation now, but like in 2015, I was doing 3.4 million out of five ops. But if you're out of the same thing out of four ops, it's gonna require you coming in really early. You're gonna have to stay really late, you're gonna have to split shift it. It's the only way you can fit multiple doctors in there. Otherwise, you're kind of just you're limited by the space. But yeah, you could do a really efficient thing. And I don't know if you guys have noticed this too. I feel like it's hard to get people to work late because the the labor market's tough and it's like it's easier to go that eight op route where you can get two dentists there at the same time versus having a split shift.

Henry Ernst 17:51

Sure. We started that from the beginning. So my team is just used to working to eight ever since the beginning. But same with me, right? But what I would also say is like understand your why. If my why is I want to make a lifestyle practice and I'm just gonna make it cash flow and it's gonna provide a nice life for me, great, right? Maybe you can make the four operatory practice work. If I want to build this thing and build it, build it, build it, and build it to sell and build it to get a huge multiple, a huge exit, then I'm gonna need the multiple ops, then I'll, or I'm gonna need to do lots of things like you're talking about, Paul.

Bonuses, Raises, And Clear Standards

Paul Etchison 18:21

You know what like comes to mind for me is like that with the acquisition, and Steve, you can speak to this. We've got a client in our mastermind who had just it was an acquisition. He's about a year and a half in, and he's going and talking to his office manager about, hey, like, you know, she wants a raise. And he said, Hey, I'm I'm down with a raise, but this is what I need you to do. I actually need you to actually act like an office manager. Now, that's not how he presented it, but he gave a list of like, this is the responsibilities I want you to take on. I want you to be responsible for these metrics. I'm happy to give you a raise. I'll bonus you if you hit these goals. This is what I want. And she was just like, No, I don't want it. And the question I had for him is like, she said, I don't like what you're doing here. I don't like what you're the new where this practice is going. And my question for that is, what exactly are you changing at this practice that is not in like the best interest of the patients or the team? Because there's nothing, not a single thing that we recommend that is like I think there are things, some things that help the owners, but there's not ownered focus. Like everything we teach is foundationally rooted and it's a good thing for the patients. It's win-win-win. So as far as I'm concerned, if somebody's upset with the changes you're making, you're not presenting them correctly. And I think anyone getting an acquisition would go through that. What do you say, Steve?

Location, Visibility, And New Patients

Steve Markowitz 19:34

Yeah, I've never had an acquisition that we didn't have some type of turnover. And most of the time, dentists as particularly are wildly guilty of this. We love giving people what they want. So I've gone into a practice where one hygienist stopped at 12, one hygienist stopped at two, one started at 11, and everyone was doing coming and going when they wanted. And if when I went to ask the doctor, I was like, why? Why is the schedule like this? It's like, oh, she needed to um a couple years ago, she had she had childcare issues, so she needed to do this. And so everyone has their own story, and all of a sudden, there's no clear boundaries because we've given everyone what they want. What happens when someone changes their own approach and starts being clear with their expectations, not and gives people what they need to succeed in the job? Now they're feeling, oh, this has changed. You've changed. I don't like the direction. I'm out of here. I would say that's perfectly fine because what I would tell your client, Paul, is you've just hit a new plateau and your leadership, you're growing. This is fun. Discomfort that you're feeling of your office manager quitting or or you fight, whatever happened, that's great. That means you're just being so much more clear in the expectations. And the next person that comes in that role is gonna have an even better chance of succeeding. I've seen that only every time we've done an acquisition.

Paul Etchison 22:45

You ever seen this? I'll follow up. I'm gonna go a little forward in the story. So office manager puts the notice in, two total people at the front, office manager and the other person. Other person comes to owner and says, Well, now that she's leaving, I don't have to take on more responsibility. I'm gonna need a raise now too.

Data For Site Selection That Works

Steve Markowitz 23:00

Uh yes, that goes, but it's the of course, when there's an environment created of everybody gets what they want. And if I ask for it, they're gonna get something. And most business owners, not just dentists, but most business owners come from a place of fear, of like, oh man, if this person leaves, then I'm screwed. So let me just give them a little bit extra a couple extra bucks without having them have a full understanding of the picture that it'll be two weeks and then you're gonna have somebody here or whatever it is. So as soon as you you start to make compromises as the leader to give people what they want, you have to also understand the repercussions of that. And for that, for that doctor, I would say, look out. Because yes, what I would do in that situation is I totally understand. Yeah, we're all gonna we're all gonna work together. And if we're able to keep this, I wouldn't tell this the employee this, but if we're able to keep production at the same level with one less person, well, that's also telling. But at that point, I could probably give you a nice bonus. And then it's it's you earned this as opposed to I gave this to you because you wanted it.

Paul Etchison 24:06

It's exactly what we're doing. It's we're doing a bonus. That's a bonus getting through the transition, these are the goals. And we'll see how uh she takes it. Because right, you're working against a history and a culture and the way things have been going. You know, I just thought about is that startup versus acquisition, we got to look at this and say, hey, can I generate new patients? Can I generate growth? And a lot of that's with like location. I mean, Steve, I mean, you're looking at practices, like you said, I already mentioned what you thought was important, but like what kind of part is location?

Lease Strategy And TI Allowances

Steve Markowitz 24:36

Yeah, what you share all the time is just new patients. And patients need to be easily accessible to you. So if you're thinking about doing a startup in the second or third floor of a medical building, that is not something I would want to invest in. But if you're looking to open a startup on a really busy road where you can get some a giant sign, you have an advantage over most other dental practices that may not have that same visibility. So if you're gonna go the startup route, make sure that it is a high traffic area. Where I've had the most success, my startup works. Was when I went to a super busy plaza that's probably the busiest grocery store in town, right on the other side of the parking lot. And anytime someone goes to the grocery store, which is only every week, they get to see my sign in Neon Mites.

Paul Etchison 25:28

What's your best sign out of all your practices? Do you have like one with a big toothbrush and like a I can't pick a favorite?

Steve Markowitz 25:34

They all have the same green and greeny.

Paul Etchison 25:36

Do you have anything unusual or anything? Anything cool?

Steve Markowitz 25:39

No, it's uh it's a tooth that I made on PowerPoint.

Final Framework And Clear CTA

Henry Ernst 25:43

Yes! Graphic design. You literally described my startup, right? High traffic area, great signage, right next to a grocery store. Metrics that we looked at is people too often, I think this is a mistake people make. They look at their town, there's always that popular area of town, really popular area, highly populated and stuff, and they go, they put their dental practice right there. And one of the metrics that we looked at before we started was how many families that make, I think it was $70,000 or more, families make $70,000 or more per dentist in this area. And I think I dropped, just to do some research, I dropped pins like at these really popular areas in town in Charlotte. And it was like one dentist for every 120 families, right? As one example. And then I looked at my practice, which was kind of like on the outskirts of Charlotte, but still accessible, a lot of working families. And our potential practice was one family, one dentist for every 6,800 families that made that amount of money. So that was like, this is ripe and ready. You need to find that pocket that's ripe and ready for a dental practice because the number one reason why people pick their dentist is what's close to me. Then obviously they look at reviews and all that stuff, but the number one thing they look for is what's close to me.

Paul Etchison 27:02

Yeah, I feel like it's people when they're finding good startup locations, it's always at the edge of the suburban sprawl of some large city where they're just that's where people are moving to to, you know, new suburbs and it's growing. I didn't know how much it was going to grow around my practice. I had a good idea. You know, I mean you can't predict the future, but I mean, it's grown a ton around my practice. The whole street is neighborhoods that weren't there before. So that's just been great for me. But yeah, why make it hard for yourself? Why not just follow what's worked for other people? And same thing with like the acquisition. Everybody's got that restaurant in their town that has changed ownership and that restaurant just keeps changing. And it's like, well, they went out of business and somebody looks at that and said, I bet I could make that work. And then they go in there and then I go out of business and they say, Well, I know the past three restaurants didn't work, but I can make it work. You got to ask yourself if someone's doing, you know, 300, 500K a year at a practice, is there a justification for it? What are they doing? Because they you've got to treat it like a startup. Like, hey, can I generate something out of this? Or is this thing tucked away in a medical plaza? We've got a I'm in the Orland Park area for Chicago listeners, but there's this one place that's on 191st and LaGrange Road, and there's there's like a McDonald's and a White Castle and a bunch of restaurants and stuff, and it's all around that corner, super busy corner. And then tucked up right behind there is it kind of goes into like the interstate, and there's this shopping plaza that's below like road level, and you can't see it, and I don't care what goes in it, it ain't staying. That thing has been empty since I've been six years old, and it's not visible. So these things matter for sure.

Henry Ernst 28:39

The cool thing was when I opened my practice, my space had been vacant for nine years. Imagine a commercial, you know, 3,000 square feet of space that was empty, nothing. So nobody else, I just saw, you know, I'm not a magical person. I just did the metrics and saw that this would work, and it worked.

Steve Markowitz 28:58

How long was that initial lease that you guys signed? 12. 12 years. Wow, 10 years. Awesome. That's crazy.

Henry Ernst 29:04

Yeah.

Steve Markowitz 29:05

Did they give you a tenant TI allowance?

Henry Ernst 29:07

I think I got about a hundred and something, maybe 120. When I built my practice, it was it was bigger than I wanted to be. The space was 3,000 square feet. I was looking to do like a six, seven practice. So when I did that, I built intentionally two-thirds of it. So I built two-thirds of it. The rest of it, we just kept like a looked like a garage. It was just empty, nothing back there. But I got the full tenant improvement allowance. I want to say it was like $105,000 or something like that. So I got that full thing, but I didn't build all of it, right? There's no rule that said you had to build all of it. You just have to take it. So that helped me with my cash flow initially.

Paul Etchison 29:43

Yeah, that's it's always helpful. I think I had a year of free rent too. That was nice as well. But same thing, like Henry, like my building was very vacant. I mean, there was only like two or three things in my building. Now it's full. I wish I would have bought it. It got sold like two times while I was there, and I never even considered purchasing it. But hey, what are you gonna do? Hindsight's 2020. Startup versus acquisition is not a moral argument, and it is not a personality test. It is a risk decision, a timeline decision, and a control decision. And either path can also wreck you if you go into it with the wrong expectations. So here's what I think we should remember is first, startups give you the blank canvas, but you need to create a real plan to create that momentum and get new patients as quickly as possible. Second, acquisitions give you the cash flow up front, but you're also inheriting that culture, the systems, and sometimes some really weird stuff that the previous dentist was doing and has just ingrained into that culture that you are gonna jump in and just be like, what the hell? Third, pay attention to the capacity things, the location, how many chairs there are, the visibility, all those things matter. And lastly, no matter what you choose, if you can generate new patients consistently, you can fix anything in either situation is going to be amazing. So if you're deciding between these two right now, or maybe you've already bought or started your practice and you just want some help in doing it the right way, growing it and scaling it so that you can step back and live an amazing life, please go to dentalpracticeheroes.com/slash strategy and book a call with me. I would love to hear your story, give you some advice, and also if we can help you, I will tell you what we can offer. And before you go, if you feel like this podcast has been helpful, please leave a five star review. It is the easiest way to support it. It takes about 30 seconds and helps other dentists find the show. And I'm extremely grateful for it. Thank you so much for listening today, and we will talk to you next time.