Yan Kalika, DMD, MS, a San Francisco-based orthodontist and owner of Image Orthodontics, has managed to grow his business to 10 practice locations over the past 15 years. One thing he will tell you, though, is that it hasn’t been easy and it’s not for everyone.

Kalika opened his first practice in San Francisco in 2002, and then a second office in Sacramento in 2005. Now, Image Orthodontics has four San Francisco locations, three in Sacramento, and spots in Glendora, Redwood City, and San Jose.

He cautions people to think through the choice of attempting to grow on a large scale, noting that people should evaluate their personalities and how much they thrive working in a challenging environment. In fact, he says, they should value that more than the potential payoff.

“People feel like multiple locations will be able to bring you more money,” Kalika says. “In reality, it’s much more challenging than that.”

For example, while a successful orthodontist can build up a large base of patients with more than one location, the exit strategy is also far more complex than for doctors who own just one practice.

“When you transition into retirement, most of the buyers don’t want to buy orthodontic businesses,” he says. “The only buyers that will are strategic investors, and you have to be very lucky, in the right place at the right time. People feel like if they get multiple practices, they can get higher appraisal, but that’s not the case. That’s one of [my] warnings.”

So, why does he do it?

A competitive chess player, Kalika works well when he’s juggling a bunch of challenges at once. He thrives on the stimulation.

“Considering my personality, I couldn’t practice in one practice,” he says. “I think that I would not satisfy my curiosity to grow the business and things like that.”

For others who are curious about branching out and growing their business to multiple practices, he says that owners shouldn’t be scared to borrow money from the bank, and not be discouraged by the prospect of failure.

And managing a larger system also brings more opportunities. Most of the growth at the practices Kalika owns came from moving the practice management into centralized locations. He was also able to hire specialized talent, such as someone who used to be a financial analyst and has an MBA degree.

“When you have just one practice, you can’t afford something like that,” he says.

One of the challenges of getting so many practices to run smoothly together was developing a similar management style and experience at each one. That took a lot of work to get doctors to buy into the idea of feeling like owners in developing the practice.

“A lot of challenges are incentivizing the doctor and incentivizing the staff,” Kalika says. “We constantly are changing our incentive structures. We’re now having doctors becoming partners of the group.”

What’s more, those incentives don’t have a “cookie cutter” approach. Instead, they are individualized to fit different people and what they want to get out of their work.

Technology has also helped Kalika to manage the different locations cohesively. From the patient intake process to conversion reports and key performance indicator metrics, his business uses different automated tools to keep everyone on the same page. The 10 locations Kalika owns include those he owns under a partnership model.

But scaling up doesn’t happen with a one-size-fits-all model, of course. And some situations are unique. Doctors who practice in remote areas might have an easier time managing multiple locations than those in large cities or more competitive markets, for example.

“To do it as a model of earning a better living, I think, is a mistake,” Kalika says. “You need to be motivated by growth.” OP

A.J. Zak is a freelance writer for Orthodontic Products. She can be reached at [email protected].