This article draws from my March 2026 Dental Economics publication, “Beyond the Numbers: What Buyers Overlook in Dental Practice Acquisitions.” After 30 years of dental consulting and hundreds of practice acquisitions, I’ve observed that the most successful buyers focus extensively on numbers and financials while often overlooking intangible factors that ultimately determine whether an acquisition succeeds or fails.
The most sophisticated practice buyers understand that financials tell only part of the story. Yes, you need to verify that the numbers are accurate and sustainable. But the intangible factors surrounding those numbers often matter more than the numbers themselves.
The Culture and Personality Factor
The single most overlooked element in practice acquisitions is practice culture and whether it aligns with your own personality and management style.
Practice culture is the collection of beliefs, values, behaviors, and norms that define how the practice operates. Every practice has a culture, whether explicit or implicit. Culture drives how team members behave, how patients are treated, and how decisions are made.
When you take over a practice, you inherit its culture. If the seller ran a culture of fear and accountability, and you’re a collaborative manager, there’s culture misalignment that creates friction.
Conversely, if the seller ran a relaxed, patient-focused culture similar to your own approach, transition is far smoother.
Assessing Culture Before Closing
How do you assess culture? Observe, ask, and listen.
Visit the practice multiple times, including unexpected visits. Observe how team members interact with each other. Are they laughing and collaborating, or tense and disconnected? How do they interact with patients? Are they warm and engaged, or mechanical and distant?
Talk to team members informally. Ask what they like about working there and what frustrates them. Ask about the current owner. Do they speak positively or with resignation? Are they planning to stay?
Ask patients (if you get a chance to talk to them) what they like about the practice. Do they mention the care quality, the team warmth, or efficiency? Their feedback reveals what the practice is known for.
Meet with the office manager separately. The office manager often has the most honest view of practice culture. Ask about the current owner’s management style, team dynamics, and work environment.
Culture Misalignment Red Flags
Red flags suggesting culture misalignment include:
- Team members who seem unhappy or burned out
- High staff turnover
- Poor communication between team members
- Patients who seem anxious rather than relaxed
- Staff who speak negatively about the current owner
- A practice where everything revolves around one person rather than systems
- Work environment that feels chaotic or poorly organized
The Cost of Culture Misalignment
If you take over a practice whose culture doesn’t align with yours, you’ll spend enormous energy trying to change that culture. You’ll face resistance from team members accustomed to different ways of working. You’ll struggle to implement your management approach.
Many acquisition problems that look like operational or financial issues are actually culture problems. Underperforming practices often have culture issues at the root.
The Team Stability Factor
Beyond whether team members will stay (which many buyers do assess), you need to understand team strengths and potential.
Individual Team Member Assessment
For key team members, assess:
- Their individual strengths and weaknesses
- Their career goals and ambitions
- Their potential for growth
- Their relationships with patients
- Their relationships with each other
- Whether they’re capable of stepping into larger roles
Many acquisitions assume team members are interchangeable. They’re not. Some hygienists are excellent at complex cases and patient education. Others are fast and efficient at routine cleanings. Some front office people excel at patient communication. Others excel at technical tasks.
Understanding individual strengths helps you deploy your team effectively post-closing.
Team Dynamic Assessment
Beyond individual assessment, assess how team members work together. Is there genuine collaboration or underlying tension? Are there factions or personalities that conflict?
Sometimes personality conflicts are subtle but real. You might discover post-closing that two team members can’t work together, or that certain dynamics disrupt efficiency.
Succession Potential
If a practice has been run by one dominant person, assess whether others on the team can step into leadership or expanded roles. Can the office manager step into larger administrative responsibility? Can an experienced assistant step into training role?
Practices where others can step up are more stable and allow you to delegate. Practices where everything depends on one person are fragile.
The Patient Relationship Factor
Many buyers focus on patient numbers without adequately assessing patient relationship quality.
Patient Loyalty and Satisfaction
How loyal are patients? Do they return reliably, or do they skip recalls? Do they switch providers easily, or are they committed?
Practices with highly loyal, satisfied patients are far more stable than those where patients feel indifferent.
Ask: Do patients actively refer others, or do you have to recruit? Do patient satisfaction scores show genuine satisfaction or just acceptance?
Patient Dependence on Specific Providers
In some practices, patients have chosen that practice because of one specific dentist or hygienist. When that provider leaves or changes, patients leave.
Understand whether patients have chosen your practice or whether they’ve chosen a specific provider. This distinction is critical.
Practices where the brand is the practice (not a specific person) are more stable. Practices where the brand is the owner are vulnerable to customer loss when ownership changes.
Patient Demographics and Sustainability
Beyond patient numbers, assess patient demographics. Are there enough young families to sustain growth? Or is the patient base aging?
A practice with an aging patient base might show strong current revenue but declining sustainability.
The Referral Source Factor
Understanding where patients come from reveals the stability of your patient base.
Practices with diversified patient acquisition (multiple referral sources, word-of-mouth, multiple dentist referrers) are more stable than those dependent on one source.
If 60 percent of patients come from one referring dentist, and that dentist-patient relationship deteriorates, your patient base shrinks.
Practices with strong internal referral networks (patients referring friends and family) are more sustainable than those dependent on external referral sources.
The Competitive Environment Factor
The competitive context significantly affects practice viability.
Market Saturation
How many other dentists practice in your market? Is there room for your practice, or is the market oversaturated?
A practice that looks profitable in a saturated market might struggle if you’re competing with practices on every corner. A practice in an underserved market might be more stable despite lower current production.
Competitive Differentiation
What makes this practice special? Why do patients choose it over competitors?
Practices with clear competitive differentiation (specialized services, exceptional outcomes, unique patient experience) are more valuable than undifferentiated practices.
Reputational Standing
What’s the practice’s reputation in the community? Are they known for quality? Are they respected by referring dentists? Are they known for overtreatment or undertreatment?
A practice with a strong reputation for quality and ethics is more valuable than one with a marginal or problematic reputation.
The Market Momentum Factor
Is the practice moving forward or backward?
Growth Trajectory
Beyond looking at the numbers, assess whether the practice has momentum. Are new patients increasing? Is patient retention improving? Are team members energized or discouraged?
A practice with positive momentum is moving toward better things. A practice with declining momentum is harder to turn around, even if current numbers look acceptable.
Owner Engagement
Is the current owner engaged and energized, or burned out and disengaged?
Owner burnout often precedes practice decline. An owner trying to exit because they’re exhausted is often running a practice that’s becoming harder to manage.
The Facility and Location Factor
While location is important, many buyers don’t adequately assess location intangibles.
Facility Adequacy and Condition
Beyond whether the facility is functional, assess whether it’s conducive to good patient experience and efficient operations.
A run-down facility creates a negative impression even if clinically functional. A pleasant facility creates patient confidence.
Location Convenience for You
You’ll spend 40-50 hours per week there. Is the location convenient for you? Will you enjoy the commute?
Many acquisitions falter because the owner quickly burns out from an inconvenient location or unpleasant area.
Neighborhood Trends
Is the neighborhood improving or declining? Are businesses opening or closing? Is property value appreciating or depreciating?
These trends affect long-term practice viability.
The Intangible Factors Checklist
Before closing an acquisition, assess these intangible factors:
Culture and Values: Does the practice culture align with your values? Team Stability: Will key team members stay? Are there team dynamic concerns? Team Potential: Can team members grow and develop? Can others step into leadership? Patient Loyalty: Are patients loyal to the practice or just the provider? Patient Demographics: Is the patient base sustainable long-term? Referral Stability: Is patient acquisition diversified or dependent on few sources? Practice Momentum: Is the practice moving forward or backward? Owner Engagement: Is the owner engaged or burned out? Competitive Position: Is the practice differentiated or undifferentiated? Facility Quality: Is the facility pleasant and conducive to good care? Location: Is the location convenient and stable? Market Context: Is the market growing, stagnant, or declining?
Assess each of these honestly. Where you find misalignment or concerns, dig deeper.
The Financial Numbers Are Important, But
Financial numbers are absolutely important. You need reliable financials to value the practice and assess viability. But financials alone don’t predict success.
The most valuable acquisitions are those where the numbers work AND the intangible factors align. Strong financials in a practice with poor culture, weak team, or disloyal patients often disappoints.
Good numbers in a practice with aligned culture, strong team, loyal patients, and positive momentum often exceed expectations.
The Due Diligence That Matters Most
The due diligence that matters most goes beyond financial review. It includes:
- Multiple practice visits at different times
- Conversations with team members
- Assessment of patient satisfaction and loyalty
- Understanding of competitive environment
- Evaluation of practice culture and momentum
- Assessment of whether you genuinely want to own and run this practice
The buyers who are most satisfied with their acquisitions are those who invested time in thorough intangible factor assessment, not just financial due diligence.
The Role of Professional Guidance
A professional practice consultant can help you assess intangible factors objectively. A consultant experienced in acquisitions knows what warning signs to look for and can help you evaluate whether the practice is truly a good fit.
Don’t skip this assessment because it’s less concrete than financial review. The intangible factors often matter more.
The Bottom Line
Financial due diligence is necessary but insufficient for successful acquisitions. The practices that exceed buyer expectations are those where the numbers work and the intangible factors align. The practices that disappoint are often those where the numbers looked good but the intangible factors were problematic.
Before closing an acquisition, ensure that both the numbers and the intangible factors support your decision. Be honest about culture alignment, team potential, patient loyalty, and market conditions. Don’t rationalize away intangible concerns because the financials look good.
The best acquisitions happen when you’ve thoroughly assessed both dimensions and determined that the practice is not just financially viable, but genuinely aligned with how you want to practice and live.
Work with JoAnne for comprehensive acquisition guidance that goes beyond financials. With 30+ years of experience and expertise in assessing the intangible factors that determine success, JoAnne helps dentists evaluate the complete picture and make acquisitions they’re genuinely satisfied with for decades to come.