The Location Mistake That Traps Dentists—and the 3D Framework to Avoid It

Most dentists choose their practice location the same way.

They pull up some demographic data. They find an area with a good dentist-to-population ratio. Maybe the population is growing. The numbers look solid.

They sign a lease.

And then, three years later, they're stuck. The practice might even be profitable—but they hate their commute. Or they're treating patients who don't match the kind of dentistry they want to do. Or they're working in a community that looked great on paper but doesn't fit their life.

This is the location mistake we see constantly. And it comes from looking at only ONE dimension when you need THREE.

The 3D Framework

After working with over 900 dentists through the startup process, we've developed a framework for evaluating practice locations. We call it the 3D Framework for startup practices:

Desirability — What do YOU want your life to look like?

Data — What do the numbers say is possible?

Demographics — Who actually lives there, and do they match your vision?

All three matter. But the order matters just as much.

Most people start with Data. That's backwards.

Why Desirability Comes First

Before you look at a single spreadsheet, you need to answer some questions about your life—not your practice.

How far do you want to commute?

This sounds simple, but we've seen dentists sign leases 45 minutes from home because "the demographics were too good to pass up." Two years later, they're exhausted and resentful. The commute compounds. Every single day.

Do you want to live in the community you serve?

Some dentists love it. They run into patients at the grocery store, coach their kids' teams, become part of the fabric of the community. Others want separation between work and home. Neither is wrong—but you need to know which one you are before you pick a location.

We call this the "11pm Target test." Do you want to run into patients at Target at 11pm in your pajamas buying emergency formula? Some people genuinely do. Some people find that horrifying. Know yourself.

Where does your spouse work? Where's your family?

If your spouse has a job on the other side of the metro, that limits your options. If you're planning to have kids and your parents live nearby for childcare support, that shapes your geography. These aren't small considerations—they shape everything.

What kind of lifestyle do you want outside the practice?

Do you want to be near the mountains? The ocean? A specific community or culture? Do you need good schools for your kids? Access to an airport for travel?

These questions feel "soft" compared to demographic data. But here's the thing: you can't spreadsheet your way out of a life that doesn't fit.

A "perfect" location with a crushing commute is not a perfect location. A thriving practice in a community you hate is not a success.

Desirability comes first because if you get this wrong, nothing else matters.

Then Comes Data

Once you know what kind of life you want, you can start looking at whether the numbers support a practice in those areas.

This is the spreadsheet part—ratios, growth trends, income levels, competition. But data without Desirability is just numbers. A "great" location on paper might be miserable for YOUR life.

Here's what actually matters in the Data dimension:

Dentist-to-Population Ratio

This is the single most important number. It tells you how many potential patients exist per dentist in an area.

The math:

• 2,000:1 (people per dentist) = solid opportunity
• Below 2,000:1 = getting competitive
• Above 3,000:1 = underserved (worth investigating why)

But even this number is incomplete. It's a starting point, not a conclusion.

The #1 Data Mistake: Focusing on Population Size

We hear this all the time: "There are 500,000 people in this area!"

That means nothing without context.

A population of 500,000 with 400 dentists is very different from a population of 500,000 with 150 dentists. Raw population tells you almost nothing about opportunity.

Growth Trajectory

A solid area today may have bad ratios in 5 years as new dentists move in.

You're not just picking a location for today. You're picking it for the next 10-15 years of your career. You need to know where things are headed.

Look for:

• Housing permits filed (are they building?)
• School enrollment trends (are families moving in or out?)
• Major employer moves (is a big company coming or leaving?)

An area with good ratios but declining population is very different from an area with good ratios and a housing boom.

Red Flag: "Average" Income Numbers

Averages hide bimodal distributions.

An $85K average income could mean everyone makes $80-90K (consistent middle class). Or it could mean half the population makes $150K and half makes $20K (completely different reality).

The first scenario gives you a stable patient base. The second means your practice economics depend entirely on which half walks through your door.

Always look at median AND distribution, not just averages.

Insurance Mix

Two areas with identical income levels can require completely different business models.

Area A: 60% employer-sponsored PPO Area B: 60% Medicaid/HMO

Same income. Completely different practices.

If you want to build a fee-for-service practice, Area B will fight you every step of the way—regardless of what the income numbers say.

The Commute Question Nobody Asks

Where do people in this area WORK?

If residents commute 45 minutes to a job center, they might prefer a dentist near work—not near home.

Data tells you who lives there. It doesn't tell you who will VISIT there.

A bedroom community with great demographics might send all its potential patients to the commercial district where they work. You need to understand the patterns, not just the numbers.

Data's Role

Here's the key insight: Data doesn't tell you what to do. It tells you what's POSSIBLE.

A "bad" area for one dentist's vision might be perfect for another's. An area with high Medicaid population is challenging for a fee-for-service practice but could be perfect for someone who wants to serve that community.

Data gives you information. Desirability tells you what to do with it.

Finally: Demographics

Demographics answers the question: Who actually lives here, and do they match your vision?

This is where the rubber meets the road. Data tells you opportunity exists. Demographics tells you whether the patients in that area are the patients you want to treat.

Same Numbers, Different Realities

Consider two areas with the exact same 50,000 population:

Area A: Median age 29, median income $52K, 80% renters → High turnover, insurance-dependent, likely younger patients needing basic care

Area B: Median age 44, median income $94K, 70% homeowners → Stable population, fee-for-service potential, likely families needing comprehensive care

Same population. Completely different practices.

The Questions to Ask Yourself

What type of patients do you want to treat?

Young families? Retirees? Working professionals? Each requires different demographics.

What type of dentistry do you want to practice?

If you want to do complex restorative work, you need a population that can afford it and values it. If you want to do pediatric dentistry, you need families with young children.

What business model do you want to run?

High-volume with insurance? Boutique fee-for-service? Somewhere in between? The demographics need to support the model.

The Match Matters

The "best" demographics are the ones that match what YOU want to build.

There's no objectively perfect patient population. There's only the right match between your vision and who actually lives in an area.

A high-income area isn't better than a middle-income area—it's different. The question is whether it fits your vision.

All Three. In That Order.

Here's why the order matters:

If you skip Desirability: You might find an area with great data and matching demographics—but you'll be miserable because it doesn't fit your life.

If you skip Data: You might love the area and the patient types—but the market can't support a profitable practice.

If you skip Demographics: You might find an area you love with solid numbers—but you'll spend years trying to attract patients who don't exist there.

All three dimensions need to align. And you need to evaluate them in order, because each one filters the next.

Start with Desirability: Where could you actually see yourself building a life?

Then check Data: Which of those areas can support a practice?

Then confirm Demographics: Do the patients match your vision?

The Mistake That Traps Dentists

The location mistake isn't picking a "bad" area. It's picking an area that's wrong for YOU.

We've seen dentists with profitable practices who are miserable because they didn't think about Desirability. We've seen dentists in areas they love who struggle because they didn't check the Data. We've seen dentists with great numbers and a great commute who can't attract the patients they want because they ignored Demographics.

The framework isn't complicated. But it requires you to be honest about what you actually want—before you look at what's possible.

That's the hard part.

What to Do Next

If you're thinking about starting a practice, don't start with a location search. Start with Desirability.

Write down what you want your life to look like. Be specific. Think about commute, community, lifestyle, family, all of it.

Then—and only then—start looking at whether the data supports a practice in those areas.

It takes longer than just finding a good ratio and signing a lease. But it's how you build a practice you won't regret.

Ideal Practices has helped over 900 dentists start practices from scratch. If you want help thinking through your location decision—or any other part of the startup process—book an Ownership Clarity Call with our team.