The Long Road to Start-Up City
A first-hand account of my journey from residency, through associateship and attempted buy-outs, and into the adventure that is a start-up and partnership. Please join me as I learn while I go!

Start-Up Year "Zero" - From Conception to Opening

Start-Up Year "Zero" - From Conception to Opening

11/18/2017 9:33:56 AM   |   Comments: 0   |   Views: 74
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As of this week, my new office will have been open for a full eight weeks.  When I look back on the months, the meetings, and the anxiety leading to today, I'm somewhat shocked to find that I'm actually here.  Some part of me never thought it would happen, and an even bigger part of me thought that when and if it did, no one would ever call or come in.  Well, it's not exactly like the patients have been beating down our door, but by now we have at least seen several new patient exams, and even put braces on a few patients, and I'm starting to wonder if maybe, maybe this is going to work out after all.  We're far, so far, from being in the black, but every day it seems that we're slightly less likely to fail.  I meant to write this entry a long time ago, but I finally have the time and presence of mind to start recording my thoughts on the year that led to our start-up.  I hope it's interesting or useful to someone.

I plan to go into the individual steps in more detail in follow-up posts, but here's a quick summary of the timeline of our progression from Point A to Point B.

As I mentioned, this whole project began last summer as a kind of last resort after thinking about and considering several practice purchases.  I was so burnt out and depressed after evaluating and assessing several options and finding none of them to be quite right that a start-up didn't sound so bad in comparison.  At least I would finally have something of my own.  Is a start-up anyone's first choice?  Or does every start-up doctor find themselves there only after exhausting all other options?  These are the questions I've contemplated since.  (Side note - two months into my start-up, those buy-in/buy-out opportunities that weren't "quite right" do look a little rosier in retrospect... Grass is always greener? )

In any case, here's what our timeline looked like!

August 2016

After deciding to move forward with our start-up, we paid about $600 for a demographic report in the area we tentatively hoped to settle in.  Results were promising - it was still a competitive area, but not quite as intimidating as lots of other areas in the city.  We met with a realtor for the first time and described our plans.  He began a property search for us.  

September 2016

We had a phone meeting with our realtor to rule out some of the many spaces he found and narrow down which ones we wanted to visit.  In the meantime we started having phone meetings with bankers to determine how we were going to pay for all of this.  Back then, we labored over every single decision, thoroughly investigating all our options.  Looking back, it seems hilarious.  As we got closer to opening our doors, our time was so limited, and the decisions were so many that the new way we evaluated options looked something like this: "Oh, so you'll handle everything that has to do with our paychecks and compliance?  And we can just give you money for that and it'll happen?  Wonderful.  Where can we sign?"

October 2016

We visited a couple of potential office spaces, and as luck would have it, the very first place we visited ended up being the space we fell in love with.  We continued our lending conversations, and we learned an interesting quirk of the start-up process.  We entered what I like to call The Circle of Impossibility.  In order to secure a lease, we needed to obtain a pre-approval from a lender.  In order to obtain a pre-approval from a lender, we needed to provide detailed estimates of our anticipated expenses including our rent and the cost of leasehold improvements.   In order to calculate the cost of leasehold improvements, we had to select a contractor and discuss floor plans and get estimates.  Obviously no one wants to do all this work for a "hypothetical" office.  So in reality, what happened?  We made up estimates based on hearsay because there was no better way to do it, and we obtained a pre-approval from Bank of America who was most flexible even though we didn't know whether we would ultimately borrow from them.

November 2016

Our realtor drafted a letter of intent for the space we wanted to lease.  We actually began interviewing contractors and dental supply companies.  We engaged a lawyer to draft a partnership agreement.  We seemed to wait weeks for a response from the landlord.  Do they actually want to lease the space or not??  I anxiously ruminate, certain that this will be yet another failed attempt at practice ownership.

December 2017

We sign our partnership agreement and form our LLC!  Our company official exists!  We will consider this the official anniversary of our partnership - the first of many "marriage" moments we'll experience.  And after SO MANY WEEKS of waiting, we finally receive a signed letter of intent from the landlord.

January 2017

We have one million meetings at the cafe in the Whole Foods Market, making lists of things to do, discussing preferences like bracket prescriptions, software programs, etc.  We settle on a completely random bracket prescription that neither of us has ever used before because we just like the sound of it, damn it.  We begin researching web designers and spend an inordinate amount of time debating their various merits.  We write a business plan in order to apply for loans through lenders other than the expected BoA.

February 2017

We continue to wait impatiently for a lease agreement.  In the meantime, reassured by the LOI, we take steps forward nonetheless, selecting a contractor, one of the biggest decisions we needed to make.  (We learned that they had a pet raccoon, and we thought to ourselves, "These are our people.")  We begin drafting floor plans.  We find ourselves with two pair of scissors, sitting at our regular table at Whole Foods cutting tiny dental chairs out of pieces of paper and arranging them on top of our blueprint.  We think we've done it!  Only to discover after several iterations that we were working with an inaccurate blueprint.  And we go back to the drawing board.

March 2017

We select a dental supply company based on their promises of affordability and personal attention and finalize our decision on lending.  We choose an IT company to handle our computers and phones.  (As I mentioned, we're getting faster and less thorough about our decisions... )  All of the loan offers we received were comparable, so we chose a guy we liked.  We receive a signed lease from our landlord!!  With the lease hot in our hands, we are advised to stall our own signing until all other details are finalized and we're literally ready to set our contractors into motion.  

April 2017

We finally sign our lease!!  We immediately follow this activity with glasses of champagne and dinner at a Mexican restaurant - the only way to celebrate.  We engage the services of a CPA/advisory firm, and we head off to the AAO meeting in San Diego, California, eager to do some learning shopping.  We attempt to sit through several lectures then quickly learn that our list of vendors to visit is going to take more time than we thought, and we spend most of our time in beautiful San Diego inside the conference center.  We buy a digital pan/ceph machine, we put a deposit on a software program, hire a web design company, and we make a commitment to purchase an intraoral scanner.  We go home with a pair of loupes and two headlamps.  We sit in and test several dental chairs to confirm our satisfaction with our tentative choice.  All said and done, it's a highly productive trip.  When we get back home, we pick up the keys to our office!  Then we hire another lawyer to draft a new partnership agreement because we are advised that ours is insufficient.  So much for checking that item off the list in a cost-effective manner.  How incredibly frustrating to not do everything perfectly the first time around.  

May 2017

We hesitantly start our social media accounts and awkwardly try posting.  Several details and permits are worked out between the contractor and landlord.  The landlord performs agreed-upon work related to the HVAC system prior to our contractor beginning demolition.  Our contractor organizes a big team meeting with our major contributors (dental equipment, decor, and IT).  We begin meetings with the decorator to choose some finishes.  These decisions are required of us much sooner than I expected, and we find that we're relieved to have a decorator.  The space hasn't even been touched, and we already need to know what carpet we want?  Did not see this coming.  If we had been left to our own devices, we may have just had a concrete floor on opening day.

June 2017

On the eve of "demo day" we gather at the office for pizza and beer and to vandalize the interior walls while we have a chance.  We spray paint our logo on a wall that will be torn down the next week and then punch some holes in it for good measure.  Our contractors begin work on schedule, and by the end of the month, it's a shell with framing outlining the rooms.  That happened really fast.  We sample a hundred outfits, then have a photographer take some photos of us for our website and find it eerily reminiscent of taking engagement photos - we realize that we're almost as married to each other as we are to our husbands at this point.

July 2017

We reverse our decision about the intraoral scanner and choose a different company at the last minute.  We have a lot more boring decisions to make.  We spend an entire day flipping through product catalogs trying to come up with lists of necessary supplies.  We pepper this work with dips in the pool to take some of the drudgery out of it, but talking about cotton rolls really puts a damper on an otherwise relaxing day.  We work on website copy.  We interview potential assistants.  We have t-shirts and a few other promotional products printed.  We begin to look up marketing and advertising opportunities.  We have our first software training session.  Things are happening so much faster now, we can barely keep track of them.

August 2017

We participate in our first marketing event!  We have a booth at a local food and business festival and learn that old people really enjoy a quick drive-by chapstick grab, and they're all happy to let you know how happy they are to be DONE with orthodontics.  Our phones go live and we receive the occasional voicemail from an interested patient!  We schedule four appointments this month!  Most of these patients have heard about us from friends of friends who learned about our practice by word of mouth or social media.  (Maybe social media does have some merits.)  Others have seen our office when driving past - helping us validate our decision to lease an expensive high visibility retail space.  We have our second software training session!  (These are painfully boring.)  We place final orders for supplies, pliers, HIPAA/OSHA training, etc.  We hire our very first employee!  

September 2017

WE OPEN OUR DOORS!!  We start two cases!  One of them is a dentist's child and not technically a paying patient, but hell, at least we put braces on someone.  We start to visit dental offices and introduce ourselves to potential referring dentists and staff.  We experience a heavy guilt burden over having not begun networking better already and we realize we have no idea when we would have squeezed this into our already-jam-packed schedules.  We acknowledge that we are simply imperfect humans doing our best, and we move forward.  

October 2017

We sign up for Quickbooks, a gigantic quagmire of accounting, another skill we didn't intend to develop but are now learning about.  (I constantly have a google page open explaining how to define debit and credit.)  We spend what probably amounts to an entire day trying to tabulate and categorize the expenses we've already paid through our personal accounts and prepare a request for reimbursement from our lender.  (Meanwhile, we greedily anticipate seeing our savings accounts return to healthier levels again.)  We host an open house peppered with friends and family, sponsored by our vendors and contractor.  Through a great deal of laughter, we cut and feed each other cake like a true married couple.  We start three cases and record more new patient phone calls this month!  (And despite offering heavy discounts, at least they are all paying patients.)

November 2017

We grapple with the development of systems to simplify our lives, and I struggle with the challenge of delegating work that I desperately want to cling to myself.  (Why do I feel the need to be the one who answers every phone call?  Micro-managing much?)  We meet with our accountants and establish some plans for the future.  They reassure us that we're performing very normally for where we ought to be, remind us that we won't be paying ourselves for a while still, but encourage us to hang in there.  And off we go into the abyss... With lots of trepidation and doubt - wondering if this was a good choice, wondering if we'll ever come out ahead financially or if we're set up for a lifetime of struggle, we continue our commitment to the office and the partnership and to continuing this grand adventure!  

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