A Story About Opening an Aesthetic Dental Clinic, Part 1

There are quite a lot of young dentists who visit our clinic before opening their own practices. They are curious about many things: what the clinic looks like, how it operates, how we maintain the quality of care, how patients find us, and what kind of care they receive before leaving. Now that I am entering my third year since opening a resin-focused aesthetic dental clinic, I would like to organize my thoughts on how this clinic is run, based on two years of operating records.

1. It is different from the usual formula for opening a dental clinic.

There are the usual factors to consider when opening a dental clinic: whether to open at a busy intersection near a subway station, in a large space with many employed dentists; whether to establish a small- or medium-sized clinic in a residential-centered commercial area supported by a sufficient number of households and stable underlying demand; and whether the number of competing clinics nearby, their clinical skills, service orientation, and implant fees are important. However, I have become more convinced that the considerations involved in opening an aesthetic dental clinic are fundamentally different.

Most opening strategies are based on recall checkups supported by the surrounding demand—that is, a model in which the clinic runs on its own once enough existing patients have accumulated. That is why the business becomes structured so that it will not fail as long as it survives for a few years. This is even why some dental clinics do not accept new patients. As long as they do not force themselves to expand their size, they can operate long-term with a relatively low-cost structure.

However, aesthetic dental clinics have a structure in which it is difficult to accumulate existing patients. As a result, they are always faced with the threat of survival. In other words, a steady supply of new patients is directly tied to survival. This means that no matter how much time passes, the clinic cannot survive on existing patients alone. You might therefore think that an enormous advertising budget is necessary. However, it is also impossible to rely on advertising for the supply of new patients. No matter how much you spend on advertising, you can never beat large dental clinics that way. That is why the referral rate is far more important.

In other words, the outcome of treatment is the most important thing in an aesthetic dental clinic. Therefore, we have to work hard to maintain treatment quality even if it means sacrificing chair time. This makes it difficult to overlap appointments, and a strategy of seeing a large number of patients per day is impossible. When appointments overlap and the number of patients increases, chair time naturally decreases, and when chair time decreases, quality control becomes impossible. Even a machine cannot do that. Steps in the process have to be removed. The steps that are removed will likely be the parts that contribute the least to profitability. Basically, aesthetic dental clinics are sought out by discerning people who are not satisfied with ordinary dental treatment. If 90% of patients are satisfied with a quality level of around 70 points, 5% want around 85 points, and the remaining 5% want 90 points, ordinary dental clinics have no choice but to make business decisions that result in losing the most demanding 5–10% of patients. That is because they may have to devote 80% of their resources to that 5–10%. An aesthetic dental clinic, however, is fundamentally different in that it primarily targets those top 10% of patients.

These days, the healthcare business world is fixated on “structure.” And it is not limited to hospitals. Because various AI systems such as GPT and Gemini overuse the word “structure” in their answers, there is hardly a title or catchphrase these days that does not include the word. I have therefore been tired of the word “structure” for some time now. “The consultation structure.” “The dental clinic management structure.” “The director’s problem is not the fees, but the structure.” “The problem is not marketing, but the structure.” “The problem is the structure.” It is irritating enough to make me angry.

Systems are certainly necessary, but I think the question of how far they need to support the operation is a separate matter. Of course, even an aesthetic dental clinic can be systematized to a limited extent. A workplace with absolutely no systems cannot exist. I remember visiting a large dental clinic and being genuinely impressed by its systems. However, there were also aspects that were clearly impossible to apply to an aesthetic dental clinic. That is because it is impossible even to simplify the treatment protocol. In aesthetic dentistry, there are no steps in the treatment process that can be removed or simplified. Having a system means that members of the organization follow predetermined rules automatically, without the dentist having to make decisions. But because the nature of aesthetic dentistry requires the dentist to be involved in every step, advancing that “system” is fundamentally at odds with aesthetic dentistry from the outset.

Therefore, deciding how much of the clinic to systematize and which parts to personalize will be a very important criterion for judgment. I think this is not limited to aesthetic dental clinics; it is something that everyone running a small dental clinic with a single dentist has to consider continuously.

In a typical dental clinic, increasing the number of chairs and staff and creating standardized protocols can clearly improve treatment efficiency and increase revenue. That is why the saying “Hiring an employed dentist increases revenue” is actually true. While the owner-dentist is struggling alone, the treatment room can reach full capacity and become a bottleneck that prevents the clinic from operating smoothly. An employed dentist can break through that bottleneck. It also becomes possible to absorb losses caused by no-shows and to retain patients who might otherwise be lost because their treatment had to be postponed.

In a typical dental clinic, capacity is defined as “how many patients can be seen in a day.” Therefore, adding chairs, increasing staff, and hiring employed dentists increases capacity. In an aesthetic dental clinic, however, the most important capacity is the range within which the dentist’s judgment and concentration can be maintained. The artistry of aesthetic treatment does not double just because another chair is added. Rather, once the daily treatment volume exceeds a certain level, the first things to decline are manual skills and judgment. And because these are ultimately what patients are paying for in an aesthetic dental clinic, patient satisfaction inevitably falls. Therefore, increasing capacity in an aesthetic dental clinic is not so much about seeing more patients as it is about gradually expanding the range in which a high level of judgment can be maintained.

Managing chair time and patient satisfaction is important for every dental clinic, but it can certainly differ which of the two becomes the greater constraint on the dentist. In a general dental clinic, the bottleneck is the dentist’s chair time. In an aesthetic dental clinic, the bottleneck is often created by patient satisfaction. That is why there are bottlenecks that cannot be resolved no matter how well the staff are trained.