Session 3 – Best City in the USA – Podcast

Session 3 – Best City in the USA

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Best City, U.S.A.

By Scott McDonald


You may be a student about to graduate or an experienced dentist who wants a change. So, where is “The Best Place to Practice?”


Sorry. That is a question that no one can answer.  They cannot answer it because the question is too broad.  The better question would be:


“Where EXACTLY is the best place to practice FOR YOU?”


The variables of what makes the right place to practice are many. Some are excited about the prospects for practice growth and are trying to figure out how to take advantage of all the great fee-for-service patients they are receiving as they scout for a second and third office site.  Others weep bitter tears that their once fertile garden of patients has grown barren. The most interesting thing is, many of them are looking at the same neighborhood.


What makes a practice location good or bad does not depend upon an entirely objective set of criteria but upon the specific definition of “best place” in the mind of the dentist.


There is a company, OnBoard, Inc., that compiles ways of looking at cities primarily from the standpoint of relocating one’s home.  They have about 1,300 cities in their database that rank cities in many ways.  They recently published their list of the Best Cities in Which to Live.  Here they are, in their order of rank (the City that follows is the Metropolitan Statistical Area with which the community is associated):


1 Moorestown, NJ 20,700 Philadelphia

2 Bainbridge Island, WA 21,600 Seattle

3 Naperville, IL 163,900 Chicago

4 Vienna, VA 61,700 Washington, DC

5 Louisville, CO 32,400 Boulder

6 Barrington, RI 16,800 Providence

7 Middleton, WI 21,400 Madison

8 Peachtree City, GA 35,800 Atlanta

9 Chatham, NJ 17,600 New York City

10 Mill Valley, CA 29,200 San Francisco

11 Larchmont, NY 18,200 New York City

12 Greenwich, CT 62,000 Stamford

13 Westwood, MA 14,500 Boston

14 Blue Bell, PA 19,700 Philadelphia

15 Princeton, NJ 48,700 Trenton

16 Chanhassen, MN 22,100 Minneapolis

17 Gaithersburg, MD 132,500 Washington, DC

18 Powell, OH 30,300 Columbus

19 Mequon-Thiensville, WI 23,400 Milwaukee

20 Ellicott City, MD 72,000 Baltimore

21 Yorba Linda, CA 64,400 Los Angeles

22 Delmar, NY 16,300 Albany

23 Papillion, NE 27,400 Omaha

24 Fishers, IN 48,900 Indianapolis

25 Coronado, CA 23,800 San Diego


It is interesting to note that only 4 are found on the West Coast. Four of the fastest growing states are entirely left off (Nevada, Arizona, Georgia, and Texas.)  We have done very few demographic reports for those locations.  And yet, OnBoard recommends these as the top 25 cities in which to live.  But will they work as good places to practice? Not necessarily.


In another survey, they found the top ten fastest markets in job growth are:


  1. Castle Rock, CO 244.43%
  2. Parker, CO 244.43%
  3. Boerne, TX 157.91%
  4. Cumming, GA 157.70%
  5. Ashburn, VA 132.66%
  6. Leesburg, VA 132.66%
  7. Sterling, VA 132.66%
  8. Mcdoungh, GA 130.12%
  9. Henderson, NV 107.82%
  10. Las Vegas, NV 107.82%


So, what is going on?


Dentists are told by classmates, professors, equipment salespersons, friends, and family information about where to practice. “This area is doing GREAT!” they will say enthusiastically, And darned if the Chamber of Commerce doesn’t agree!!!  But the sobering reality is that a single set of statistics, however, true, may have noting to do with how well YOU will do in practice at any given location.


There is also a signficant disconnect between what makes a location a great place in which to live and a great place in which to practice according to this company’s priority list.


There are some more “universal” sets of statistics that makes sense to consider the practicality of practice, rather than reflecting personal preference. These include:


  1. Competition Rates
  2. Growth Rate
  3. Property Values
  4. Quality of Life


It is worth noting that none of these four statistics are static. All change over time.


Competition ratios (the number of dentists practicing per resident or per household in a given market geography) must be considered within some boundaries. What is “acceptable” is a function of population density, transportation accessibility, and employment.  The desirability of a specific projected rate of growth is usually a function of the number of households or residents (baseline), population density, and household size.  


Property Values are often an indicator of dental fees because they strongly influence the cost-of-living in a community. While we cannot predict the direct relationship between UCR fees as defined by the dental insurance industry and the cost-of-living, anecdotal research shows that property values are a strong predictor of the reimbursement rate.


The Quality of Life is a more subjective group of statistics that will have a significant impact upon practice. These issues involve Crime (against individuals and against property), Education (school scores and services), Arts (museums, theater, etc.), and Misc. (night clubs, churches, universities, and other institutions that affect different lifestyle groups in different ways.)  If an individual is single and looking for other singles, or a practicing Buddhist with a family, happiness in practice cannot be tied 100% to life in the office.


We tend to look at the “best places” to practice as those that have an increase in population, good property values, and a decent “quality-of-life” as interpreted by the lifestyle preferences of the doctor and family.


Competition and Growth Rates that affect a practice usually are considered on a very small geographic scale. The other issues, however, are often expressed on a larger stage. We want to thank our friends at the National Association of Realtors for this information. Nationally, Median Home Prices gained 7.7 percent in the third quarter versus the same period in 2003, according to a National Association of Realtors (NAR) report.

The median price was $188,500, which means that half the homes tracked cost more and half cost less. Of the 127 markets tracked, 45 areas had growth of more than 10 percent. The NAR is projecting that existing-home prices will increase 5.3 percent in 2005.  In short, if there is a single cluster of statistics we think are worthy of special attention, it is the Real Estate market.

Over the past 12 months, Las Vegas home values showed the biggest gains. The median price of an existing single-family home in and around Clark County shot up 53.7 percent. In Bradenton, Fla. prices were up 40.7 percent, and in Riverside and San Bernardino counties near Los Angeles prices were up 36.2 percent.

Not all markets have seen these kinds of gains. In nearly 40 metro areas, prices inched up less than 3 percent. In 11 metros, prices declined.

The Bottom Line

No single set of statistics should be relied upon in order to find the best place to practice. And even a location that seems not to do very well may have simply changed in its demographic character.  People are, after all, a moving target. So as a practice ages and local populations shift, grow, decrease, or increase, so the doctor must learn to use demographic information to target the NEW target market that has just moved in.