text: With 12 operatories, two labs and nearly 10,000 square feet, Dr. Geoffrey R. Gamache created one of the largest practices in New York’s capital region—and one of the busiest. Here, he looks back on his journey, shares what he learned and talks about weathering the shutdown.
  DO I SHRINK, or do I decide to grow?
  I joined this practice in 2003 as an associate, became a partner in 2007 and bought it out in 2015. We had outgrown our present practice space, about 2,800 square feet, which was outdated and not reflective of the vision I had for the practice. After analyzing our current practice and trends in our community, it was clear we needed a new space. Considering our steady growth over several years, I decided it was time to go big or go home. So I designed a practice that would allow for growth and provide the state-of-the-art service and facility our patients deserve.
  Do you know your practice truthfully?
  I find a lot of colleagues rely on end-of-the-year numbers to assess their practices. They’re important, but in these bizarre times, you need a monthly assessment to see trends and set parameters. This allows protocols to be made and baselines set. This is also where a good advisor who knows the dental world can help. What do those numbers mean? How did you get there? What are appropriate expenses and what is deviating from industry standards? Unless you dig down and do a full assessment, and examine the why as much as the what, it’s hard to know where your practice is and where it’s going.
  I had several years’ worth of good data to work with when I was deciding whether to expand.
  I could see where the practice stood but needed help to develop a vision of where it was going. That’s where my advisor at Cain Watters & Associates, Hunter Satterfield, took charge to help make sense of it, and together we were able to see the trends and forecast our growth rate. That’s the data that told me, OK, now here’s how much I can afford to spend. When I built, I was confident, so I built to grow.
  Considering our steady growth over several years, I decided it was time to go big or go home.”
  The pandemic, the shutdown, they were genuinely scary.
  Actually, scary isn’t the right word at all. It was a feeling of hopelessness, fear, uncertainty, panic and anxiety. Our profession was halted in its tracks and I felt the weight of my staff, my family and my patients on my shoulders, as I think most of us did. We were asked to navigate waters we had never been in before. Managing layoffs, total loss of revenue, conflicting information, confusing government aid and lack of proper PPE. My practice just came off its first full year in the new facility with a 25 percent increase in revenue from the past few years. My plan was working, this large investment was paying off, so the shutdown was like a punch in the gut. Now I had this enormous debt and mountain of uncertainty. What would dentistry be like in the Covid world? Would I have to invest more just to practice? How long was this going to last? The banks had deferred payments on the notes, but that wasn’t going to last forever. When we started up again, could I continue to be profitable enough to manage my debt overhead? If I were on my own, without financial advisors and the aid of my Benco rep helping me manage acquisition of PPE supplies and new standards in infection control, I would have lost my mind. Having people to turn to who knew my practice made it manageable.
  We’re still digging out.
  But I’m more comfortable than I was even a few months ago.
  March 17 to June 4—those dates are burned in my memory. That’s the period last year that we were closed. That money is never coming back, but it’s not something worth dwelling on for any of us. There’s a lot to look forward to at this point, so it’s much better to focus on that.
  Financial advisors are key.
  The pandemic really drove that home. Cain Watters were rock stars in that regard. They seemed to be ahead of the curve on interpretation of government responses and relief from the pandemic. They were also always there for personal phone calls. They provided partnership with a human-resources consultancy to manage staff layoffs and rehiring. Their info was way ahead of everyone else. They didn’t just parrot what others were saying; they actually read the regs and laws and did their own analysis. That’s what happens when you have a firm with intimate knowledge of your practice working tirelessly on its clients’ behalf. My advisor, Hunter, was
  truly my Covid consigliere.
  Dr. Geoffrey R. Gamache is a member of the Incisal Edge 40 Under 40, class of 2012. For a deeper look inside his practice, see our Winter 2020 issue or visit IncisalEdgeMagazine.com.