If you're a pediatric dentist, I can point you to what might be the best ratio in the country. It's in Central Florida, a little north of Orlando, and it's called The Villages. Hardly any pediatric dentists. The circle on the report looks perfect. Please don't book your flight. The Villages is the largest retirement community in the country, a collection of small towns full of 55, 60, 70-year-olds driving golf carts everywhere. Not a lot of kids. The ratio was telling you the truth and leaving out the part that mattered.
That's demographics in one story, and it's the topic I sat down with on a recent episode of The Startup Dentist Podcast. I've been part of nearly 1,000 dental startups, and I still get associates coming up to me at our events saying, I've got a lot of numbers and a lot of opinions from online, and I don't know where to begin. If that's you, this one's for you. This is the written version. Whether you're starting a practice or buying one, demographics has to be one of the first items on the grocery list, before you go looking at real estate, before you talk to a bank, before you tour a single practice for sale. Grab your notepad.
Start with the patients you love to treat
Before you chase a single ratio, sit back and think about two or three of your favorite patients. Who are they? Age, gender, the procedures you did for them, blue-collar or white-collar, what you talk about when they're in the chair. I'd bet you find some common threads. That's your ideal patient, and it's the thing I talk through with every client, in the book, and at every Startup Practice Blueprint™. Everything else comes after that.
If you've only been out of school a few months, you may not have an answer yet. You've been treating whoever residency or the school clinic put in front of you. That's okay. It's one of the reasons I think working in a few different environments, a DSO, a private practice, is worth it before you own: you learn who you actually love treating, and that answer drives every location decision you'll make.
A report tells half the story
I'm not going to knock the companies that sell demographic reports. There are good ones. The challenge is that a report tells half the story, and most of the time it's the ratio half. Think of it like an X-ray. I've been to the dentist a few hundred times in my life and I still can't read one. My dentist can, because he looks at hundreds of them a week. You haven't looked at hundreds of demographic reports, so don't try to diagnose one yourself. That's the difference between a report and a study: a study factors in your personal elements. Someone presses a button and hands you a report, you look at a page of numbers and go, cool, I don't know what these mean for me. Then you either stay confused or make a bad decision.
A few of the ways reports go sideways. They draw circles, a two-mile or three-mile radius, and roads aren't circles. You find a three-mile circle with no dentists in it, and 3.1 miles out there are 20 dentists on one road everyone drives. In Manhattan, you're not pulling patients from three miles; you're pulling from three or four blocks. So I look at drive times and how people actually move through an area. Reports also tend to count practices instead of providers. One four-doctor DSO office is four dentists in your marketplace, not one. And for pediatric dentists, a general dentist who treats a lot of kids might count as half a provider. I walk through the full location analysis before you ever call a broker in another post; the point here is that the ratio on page one is a starting line, not an answer.
Live in the now. Don't bank on tomorrow.
There's plenty of data on growth and potential new employers. My advice is always the same: make decisions on known factors, not speculation. I'll pick on one of our clients, Dr. Adrian. She has a fantastic practice in the New York area, and a few years back her city was in the running to land one of Amazon's new sites. Tons of jobs, the whole thing. One day she called Mike, one of our senior advisors, a little freaked out. Did you see the news? Amazon didn't pick her area.
Kind of a bummer, right? Except her demographics still supported her without it. I always say we have cake and we have icing. I love both, together. You can't have icing with no cake. She had the cake: a foundational marketplace that aligned with where she wanted to be, the kinds of patients she wanted, and the numbers to support growth. Amazon would have been icing. Now flip it. What if her area had been wrong, the wrong patients, the wrong fit, and the whole case for it was, but what if Amazon comes? That's a bad marketplace built on speculation, and it's one of the most expensive mistakes you can make before you sign anything.
Life choices come before the numbers
How far do you want to drive to your practice? Where's home? What climate, what schools, what does your family need, or the family you don't have yet? When we moved to Florida six and a half years ago, the first question wasn't where are the great homes. There are great homes everywhere. It was where are the best schools, because family was the priority. Those are life choices, and they come before you ever look at a number.
A lot of people will tell you to just go rural. I grew up in a rural town in Central Illinois. Great living, nice people, like the Cheers theme song, where everybody knows your name. Think about whether you want that. Walking into the grocery store and hearing hey, it's Dr. So-and-so, can feel wonderful, and it also means no buffer between you and the town. Ratio-wise, rural probably holds some of the best opportunities in the country, for the people who want to live rural. I chased opportunities in cities and now the suburbs because that's what fits my family. And one more thing on the just-buy-a-small-rural-practice advice: how many of those are actually for sale? It works for one or two people. It isn't a broad-stroke answer for everybody.
Here's how badly it goes when you skip this step. A client of ours, Dr. Sonny, was getting ready to leave the military and handed us a list of six western states. Where's the best area for me to open in these six states? My answer was, I'll have that for you in about a year. Six states is hundreds of great areas, and nobody can evaluate 500 markets. So we started at the top: what climate does your wife want? He talked to her, she had the answer, and that one conversation narrowed the whole thing down to the schools and the places that fit their family. He was thinking best area to open a dental practice. It's never that simple, folks. Life choices first, then the numbers.
What the ratios actually mean
For a general dentist, the typical ratio people quote is about 2,000 to 1: for every 2,000 to 3,000 people, one dentist. I'll say 2,000 to 1 is a nice place to land. Will you find it everywhere? No. Most suburban areas don't have ratios like that, which is exactly why rural looks attractive to so many people. I've even heard people say never start a practice unless the ratio is 3,000 to 1. After hundreds of markets we've analyzed, I probably couldn't name you a suburban marketplace anywhere in the country that hits 3,000 to 1. By that rule, nobody would ever open in a suburb again.
So look past the number. Who is the competition? Where are those dentists in their ownership cycle? Do they market at all? I used to contrast Boston and Austin. Boston is established, the ratios aren't as pretty, and you may find older dentists sending out procedures you do, with barely a website. There's an opportunity in that. Austin is fast-growing, and the ratios look fantastic, and a lot of startups are heading there for the same reason. Lots of startups means lots of practices fighting for the same eyes. A great ratio in a market where twenty new offices are all marketing for the same patients can be a harder road than a lower ratio with sleepy competition.
Which is why some of our greatest success stories are in areas 25 to 30 percent under that 2,000 to 1 number. They found a market that aligned with them and their patients, and they ran a robust marketing strategy on top of it. A couple more things on the numbers. If you're pediatric, you're counting littles, not total population; I aim for roughly 5,000 children under 17 per pediatric provider. And a high ratio can still be the wrong market. If the area is predominantly Medicaid and lower income and that isn't your ideal patient, you'll end up in a place you don't love with patients you didn't want, which is a long-term bad decision whether you build there or buy there. Marketing data helps here too: the agencies we work with can see who's spending what on Google and Meta in a given market, so you know whether there's a slice of the pie for you. And if the insurance mix of the area doesn't fit how you want to practice, that's part of the same answer.
Demographics tells you where the people are, not where to put the practice
We just had a Vision Call with a husband-and-wife team opening a second practice in the Midwest. They like the practice they bought a few years ago. Great team, good transition. But the patients in it don't line up with their training or the dentistry they truly love to do, and that's the reason for the second location. That's demographics. It isn't where you place the practice, and it may not even be where you buy one. It's where the people you want to treat are, and then building or buying where you can attract them.
Because once you're in, you're in. I've been part of almost 1,000 startups and none of them came with a tow hitch. Practices aren't built on flatbed trucks. You can't haul one to the next town over because you ended up in the wrong area. So find the market with an abundance of the patients you love, understand the competition and the real drive patterns, and then we talk real estate: where inside that market to put the practice, which roads, how people get there. If you want the full method, we teach it in depth twice a year at Startup Practice Blueprint™, and the short version lives in our 3D Demographics course. Next on the list after demographics is funding, and I want banks salivating to give you their best terms by the time you get there.
If you're trying to make sense of a report you already have, or you're staring at six states and don't know how to narrow them down, start with a free Ownership Clarity Call with Jen Gilbert, our Startup Strategic Advisor. Bring your two or three favorite patients. That's where the conversation starts.
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