Succession Planning Isn't About Selling. It's About Not Going Out in a Wheelchair

A practice that would fetch roughly $1.08 million at 62 is worth closer to $297,000 at 69, and the seven extra years of owner income in between don't close the gap. That's not a market timing problem. That's what happens when a business that depends entirely on one person's hands slowly stops being a business and becomes a job with a lease attached.

Here's the claim an informed owner can argue with, so argue with it: the average retirement age for American dentists climbing to 68.7 is not evidence of a healthier, longer-serving profession. It's evidence that thousands of practices each year are being wound down rather than sold, and that the owners running them made no decision at all. ADA Health Policy Institute data puts that average retirement age at 68.7 in 2024, up from 64.7 in 2001, with average career span stretching to 41.3 years from 37.8. Four extra years at the end of a career sounds like vitality. Read it alongside the transition data and it looks more like drift.

68.7 Is Not a Victory Lap

There are two ways to arrive at 68.7. One is the owner who planned it: sold the majority stake at 61, stayed on clinically three days a week, kept the part of the job they actually like and handed off the payroll, the compressor, and the credentialing. The other is the owner who kept meaning to get to it, deferred the CBCT purchase in 2019 because why buy now, dropped Fridays in 2021 because the body said so, lost the hygienist who'd been there eleven years and never fully replaced her, and now runs a practice collecting 25 percent less than it did at peak with overhead that never shrank to match.

Both dentists retire at 68.7. Only one of them gets paid for it.

Blue & Co. puts the average dentist's retirement age at 69 as of 2023, up from 62 in 2000, and identifies age 62 as the point of maximum value recognition on a practice sale. That same analysis notes nearly 35 percent of practicing U.S. dentists were 55 or older as of 2025. Against 205,088 professionally active dentists, that's roughly 71,800 people who need an exit inside the next decade and change.

Now look at the other side of the transaction. BLS projects about 4,800 dentist job openings per year and 6 percent employment growth from 2025 to 2035, with a median annual wage of $176,110 as of May 2025. Openings aren't buyers, but the direction is the point: the cohort that needs to sell is large, concentrated, and running out of runway at the same time.

The Buyer Standing Across the Table Doesn't Want to Own Anything

The generation that would historically have bought your practice has largely opted out of ownership. HPI found that fewer than 1 in 10 dentists under 30 were practice owners as of 2021, and among dentists aged 30 to 34, ownership fell from more than half in 2005 to just one third in 2021. Ownership rates have declined across every age group since 2005. That's not a blip tied to student debt or a soft year. It's a structural preference shift.

The modality numbers say the same thing from the other direction: 13 percent of U.S. dentists were DSO-affiliated in 2022, up from 8.8 percent in 2017, and only 17 percent of dentists within ten years of graduation are solo owners compared with 50 percent of those more than 25 years out.

Translate that into your specific situation. The associate you've been half-hoping would buy you out probably isn't going to. Not because they don't like you, but because they've watched their classmates take $180,000 guarantees with no personal guarantee on a $900,000 note, and they've done that math faster than you think. Which leaves you with a corporate buyer, a neighboring owner rolling up a second location, or a wind-down. All three are legitimate. Only two of them pay.

And every one of them prices the same three things: collections trend, doctor dependence, and how recently you spent money on the place.

What Most Owners Get Wrong: They Treat Succession as a Transaction Instead of a Deadline

The specific mistake, and it's overwhelmingly made by owners between 56 and 63 who are still producing well and still enjoying most of their days: they think succession planning starts when they decide to sell. So they don't start. They keep the plan in their head as a vague intention, "probably four or five more years," and they re-roll that intention every January.

The consequence isn't that they sell late. It's that they make a decade of operating decisions with no exit date to discipline them. No date means no reason to replace the 2011 chairs. No reason to build a second producer who could carry the schedule if you're out for six weeks. No reason to fire the PPO contract paying 41 percent below your fee, because the pain of the transition outlasts your remaining horizon. No reason to document the hygiene protocol living in one person's memory. Every one of those deferrals is rational in isolation and catastrophic in aggregate, because each one is a direct subtraction from the multiple.

Our view: succession planning has almost nothing to do with finding a buyer and almost everything to do with committing to a date early enough that the date changes how you run the place. The buyer search is the last 8 percent of the work.

The second mistake, smaller but more expensive per instance: owners who have no written answer to what happens if they're out for 90 days starting tomorrow. Not retirement. A shoulder. A cardiac event. A spouse's diagnosis. If your practice generates $1.2 million and you personally produce 70 percent of it, a 90-day absence with no covering doctor and no disability structure is a six-figure hole plus a staff exodus plus a patient list that quietly relocates. That's the wheelchair scenario, and it doesn't wait for 68.

Selling at 62 and Staying On Beats Grinding to 69 by $293,000

Take a general practice collecting $1,200,000 with market-rate associate compensation backed out, leaving adjusted EBITDA of $240,000. The owner is 62, personally produces $700,000 of the total, and feels fine.

Path A: sell at 62, keep working. At a 4.5x multiple, the practice transacts for $1,080,000.

They stay on as an employed provider at 32 percent of personal production, which on $700,000 is $224,000 a year. Assume production tapers as they drop days, averaging $200,000 a year in compensation across the next seven years. That's $1,400,000 of post-sale earnings.

Total cash position by age 69: $2,480,000, with zero payroll risk, zero lease exposure, and zero capital calls for seven years.

Path B: hold it. Collections drift down 4 percent a year as days come off the schedule and hygiene openings go unfilled. Seven years of that on $1,200,000 lands at roughly $902,000.

Owner earnings compress faster than collections because rent, software, insurance, and the front desk don't scale down. Say take-home falls from $360,000 to $180,000 over the seven years, averaging $270,000, for $1,890,000 in total owner income. That's real money, and it's the honest case for staying.

Then the sale. A $902,000 practice with deferred capex, one aging producer, and a declining trend line doesn't earn 4.5x. Adjusted EBITDA runs closer to 11 percent of collections, about $99,000, at a 3.0 multiple.

Total position by 69: $2,187,000, after seven additional years of carrying the entire operational risk yourself.

The gap is $293,000 in favor of transitioning at 62 and continuing to produce.

Change the assumptions and the number moves. Hold collections flat instead of letting them slide 4 percent and Path B closes most of the gap. That's exactly the point. Path B only works if you keep investing in a business you're about to stop owning, which almost nobody does. We wouldn't take Path B on the hope that you'll be the exception.

What Actually Sits in a Succession File

Not a binder. Six items, most of which fit on two pages:

• A date, in writing, with a year attached. Not "mid-sixties." A year. Share it with your accountant and your spouse so it costs something to move.
• A named covering doctor and a signed locum arrangement. Who is in your operatory on 72 hours' notice, and what do they get paid.
• Disability coverage stress-tested against actual overhead, not against your personal income. The practice has fixed costs that continue without you.
• A capital schedule that runs through your exit date, not up to three years short of it. Buyers discount hard for a chair count they'll have to replace in year one.
• A second producer carrying at least 30 percent of collections by 24 months before the date. This is the single largest multiple driver you control.
• A current valuation, refreshed every 18 months. You cannot manage toward a number you've never seen.

The dentists who go out in a wheelchair didn't plan to. They planned to decide later, and later decided for them.

Three Moves Before Friday

Write down a target exit year and text it to one person who will hold you to it, because an undated intention is not a plan. Then call your disability carrier and ask what your policy actually pays if you're out 90 days, and compare that number to your monthly fixed overhead, not your paycheck. Finally, pull your last three years of collections and adjusted EBITDA side by side and look at the slope, because that slope is the only thing a buyer is really purchasing. If it's flat or falling, your date just got earlier.

We're watching two things that could change this call. First, whether DSO affiliation rates keep climbing past 13 percent, because a deeper corporate buyer pool props up multiples for practices under $1.5 million and makes waiting less punishing than it is today. Second, whether ownership rates among dentists aged 30 to 34 stabilize off that one-third floor. If a real cohort of young owners comes back, the private-sale market reopens and the age-62 peak shifts later. Until we see either, we'd treat 62 to 64 as the window and plan backward from it.

If you want to know where your own practice sits against that $1.08 million versus $297,000 spread, the variables are your adjusted EBITDA, your collections trend, and your doctor dependence. Put your actual numbers into our practice valuation calculator and run your own numbers before you pick a date, because the date should follow the valuation, not the other way around.