Very Dental: The Dentist's Dilemma: Doctor or Entrepreneur? with Dr. Mark Costes

Aug 8, 2025

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Is the entrepreneurial drive something you're born with, or can it be learned? Alan had the chance to sit down with his friend and colleague, Dr. Mark Costes, at the recent Voices of Dentistry Pop Up for a deep dive into the mindset of a business owner. Drawing from his own family history, Dr. Costes argues that an entrepreneurial spirit is often an innate trait (nature), but that the skills to succeed can absolutely be cultivated (nurture). They explore the massive shift in the dental profession from the "golden era"—when clinical skill alone could guarantee a great living—to today's reality, where staggering student debt loads make business acumen a non-negotiable key to survival and success. The conversation also contrasts the cottage industry of dentistry with the consolidated world of medicine, weighing the pros and cons of being a W2 employee versus taking on the risks and rewards of practice ownership.

Key Takeaways

Entrepreneurs: Nature or Nurture? Mark believes that while an entrepreneurial spirit might be an innate personality trait, the systems and knowledge required for business success can be learned and mastered by anyone. His father, a corporate man, had the spirit but chose security; Mark was able to live out that entrepreneurial drive.
The "Golden Era" of Dentistry is Over: Dentists from previous generations could often succeed despite lacking business knowledge because the revenue from clinical dentistry was high enough to hide inefficiencies.
The Stakes Are Higher Now: With average student debt approaching $300,000, new dentists cannot afford to be sloppy with the business side of their practice. Every penny must be accounted for, making business education more critical than ever.
The W2 Path is a Viable Option: For dentists who are not interested in the risks and stress of ownership, being a W2 employee can still lead to a successful career and financial freedom. However, it requires a different kind of discipline focused on personal finance, smart investing, and tax strategy to build wealth without the final asset of a practice sale.
If You Own, Do It Right: For those who do take the leap into practice ownership, it is crucial to commit to learning the business. Otherwise, you are taking on all the risk, liability, and stress for potentially no significant reward.
The Problem with Medicine (and a Blessing for Dentistry): While medicine offers high-income W2 opportunities, it is a highly consolidated system that often leaves physicians with little control and massive tax burdens. Dentistry remains a "cottage industry" with immense entrepreneurial opportunity, despite its own challenges with insurance and patient payment discussions.
Information vs. Willpower: Whether discussing personal health or business success, simply having the information is not enough. The key challenge is developing the discipline and willpower to act on that knowledge, a hurdle that many people struggle to overcome.

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