Outside The Box: Practicing In a Small Town or a Rural Area

A majority of today’s dental graduates gravitate towards practicing in urban or suburban areas especially around major cities. These graduates at times find limited opportunities in their targeted cities along with lower salaries, fewer practices for sale, and limited growth opportunities. Granted these areas may provide more or different social and cultural opportunities than smaller towns or rural areas, but from a professional point of view, it may make good business sense for a young dentist to reconsider their strategy. Here are some points to consider.

More Economic and Buy-in Opportunities

It goes without saying that many young graduates are having a harder time finding associate buy-in opportunities in this current economy in the suburban and urban areas. As many established doctors have deferred their retirement plans for several years due to the economy, the opportunities in these areas for practice purchases have diminished, thus frustrating more and more associates who want to own their own practice. However this is not the care in small towns and rural areas. Most dentists in these areas are doing quite well economically, as many communities do not have enough dentists, and consequently, patient demand is quite high. So less competition means more economic opportunity.

Accelerated Loan Forgiveness

In certain states where there are dental shortages the states are offering loan forgiveness programs based on the number of years a doctor practices in a shortage area. Practicing in these locales can accelerate your ability to fully or partially retire your student loans. Moreover, if you decide to purchase a practice in a less competitive market, chances are you will be able to purchase an excellent practice at an attractive price. As a result, you’ll get a better return on your investment than you would, buying a similar practice in or near a bigger city.

High Net Profit

When valuing rural practices, we find that most practices rarely have overhead exceeding 50-55%.   This is true for two primary reasons. The first is the lower cost of labor. The second is the lower occupancy costs. Therefore, purchasing a professional building in these areas can be a great financial investment even for a newer doctor wishing to purchase a practice with real estate. If you decide to rent, your facility expenses will still be significantly lower. So higher net profit can build your wealth more rapidly by having the cash flow to save more and retire debt more aggressively than your classmates in urban and suburban areas.


Practice Start-up or Practice Purchase

In a rural environment you can either purchase a practice with a low multiple of gross receipts, or conversely, you may elect to start your own practice in the same area and be quite busy from the outset! We find that in many small towns and rural areas, practices are selling between 45%-55% of last year’s gross and in some cases even lower than that. So, it is even possible to buy an extremely successful dental practice for a relatively low price.

Life Style Change

I have talked to some dentists who are tired of the competition and tough economy in the urban areas, and year to simplify their lives. So, for someone in practice who wishes a change of pace, to increase income, and reduce stress, relocating to a small town or rural area may be the best solution. You should consider a small town or rural area as the place to begin or end your career!


For those dentists who can be open-minded and not follow the herd, there are fantastic opportunities out there. They may not look like the exact picture they may have had in their mind years before, but they may actually be even better. Many of these opportunities offer better professional options with better economic returns. What’s more, they often come with wonderful lifestyles, healthier lives, a better standard of living, and greater happiness. You just have to be willing to look outside the box.


Thomas Snyder, DMD, MBA