A few months ago, I got a call from a dentist who had been working as an employee for three years.
She was making close to $200,000 a year, had no major complaints about her job and wanted my professional opinion on a crossroads: Should she buy a practice now, or wait a few years until she felt more confident running a small business?
I asked her a different question first. What does waiting cost you?
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She didn’t know. Almost nobody does, because almost nobody runs the math before they decide to wait. When smart professionals think about buying a business, they evaluate the decision entirely in terms of visible risk:
- The debt
- The staffing responsibilities
- The fear of something going sideways
What gets left out of that calculation is the compounding cost of staying put.
I work exclusively with buyers on the acquisition side of dental practice transitions. My team has advised on more than 1,500 deals across 49 states, and the most expensive mistake I see isn’t a bad purchase.
It’s a highly capable, well-qualified buyer who waits years longer than the financial numbers support, because waiting feels like the responsible choice.
It isn’t.
What the delay costs
The American Dental Association’s Health Policy Institute tracks net income for dentists who own their practices vs those who work as employees. Practice owners netted an average of $217,781 in 2024. Associates netted $160,891. That’s an annual income gap of roughly $57,000, and it has held steady for years.
To see how that plays out over a career, picture three professionals who start practicing at age 36 and retire at age 65:
- The early buyer buys a practice at 38
- The hesitant buyer waits five years and buys at 43
- The career employee stays an associate for the entire 29-year career
When you model realistic income progressions, business equity and tax structures, the outcomes look very different. By retirement, the early buyer accumulates roughly $10.8 million in cumulative career earnings. The hesitant buyer accumulates $9.7 million. The career employee finishes around $6 million.
That’s a $1.1 million penalty for a five-year delay, and a $4.8 million gap between buying early and never buying at all. Every year a capable buyer waits is a year of wealth compounding they can’t recover.
The number most people miss in this calculation is the financial inflection point. A business owner’s income jumps sharply once the initial acquisition loan is paid off.
The dentist who bought at 38 hits that milestone at 48. The one who waited until 43 doesn’t get there until 53. Those extra five years, spent at a lower income level while carrying acquisition debt later in life, are where most of the seven-figure gap comes from.
It’s not one bad year. It’s a decade of smaller numbers that never have the time to catch up.
Why capable people still wait
The professionals I advise aren’t reckless. If anything, they’re the opposite. Clinical fields attract people who are cautious, detail-oriented and trained to avoid mistakes. That instinct produces excellent patient care, but it works against the same people at the negotiating table.
The hesitation I hear most often isn’t about money. It’s about competence.
- Will I know how to manage payroll?
- Will the staff quit on me?
- Will I make a leadership mistake I can’t undo?
These are fair questions, but buyers routinely overstate the real operational risk. When my firm tracked patient retention across hundreds of transitions, the data showed that the average practice gains 4.1% more patients in the six months after a sale than it loses. The fear tends to be larger than the reality.
Ownership income is almost always the fastest path to paying down that debt, because a $57,000 annual income gap closes a six-figure loan significantly faster than a flat employee salary ever will.
A framework for anyone weighing this decision
The issues at play here aren’t unique to dentistry. Any licensed professional who could own the practice they currently work in, whether that’s a veterinarian, an optometrist or a physician in private practice, is working through a version of the same math.
Before deciding to wait another year, three considerations are worth addressing honestly:
What is the actual income gap in your field between owners and employees?
Do not estimate. Most professional associations publish this data the way the ADA does for dentistry. Find the real number.
What does that gap cost you over the years you consider waiting?
Multiply the annual income difference by the number of years you’re thinking about delaying, then add a conservative estimate of the equity you would build in a business purchased today.
The number is almost always larger than people expect. Remember, too, that skills and experience compound just as the numbers do.
Separate the fears that are about your own competence from the fears that are about the specific deal in front of you.
Competence fears are solvable.
Deal fears, such as a practice with declining revenue or a lease with serious problems, are worth taking seriously and leaving behind.
Take heart that at this very moment, within a few miles of you, there is an owner-professional of the business you’re considering buying who is operating a level below what you’d consider “competent” — and they’re not going bankrupt.
The professionals who build strong lifetime wealth aren’t the ones who eliminate every uncertainty before buying. They are the ones who run the numbers, build an unconflicted team around them and move when the math says they are ready.
The question is not whether you feel ready. It is what another year of waiting is already costing you.
