Take it from someone who has toughed it out in Los Angeles since 2010: It takes work to survive in an expensive, crowded city. Here’s what I’ve learned—and how it might help you.


I HAVE NEVER questioned my decision to start a practice in Los Angeles. That doesn’t mean I’ve never thought about leaving. California has more dental schools than any other state, and dental offices are almost as common as gas stations. True, it’s sunny year-round, but housing prices are astronomical and taxes strain our finances. My business partner, Dr. Taline Kotchounian, and I spent nearly three years scouting locations and jumped through more hoops than a Cirque du Soleil acrobat to appease the city’s stringent zoning. It wasn’t easy, and luck played a part, but here’s what I’ve learned.

Find a place that’s worth your commitment.
Nestled at the edge of the San Fernando Valley, Studio City is known for its artistically inclined residents. The lush rolling hills are scattered with multimillion-dollar mansions, but also plenty of apartments and modest homes. It adds up to an eclectic mix of people ranging from the Hollywood elite to wannabe actors to young families. Dr. Taline and I both revel in the fact that we’re outliers too. We don’t take ourselves very seriously, and we’ve somehow found a sense of belonging as doctors in an artsy community.

Don’t be afraid of slow growth (at first). Rather than doing actual dentistry, our early days were mostly filled with learning how to run a business and brainstorming creative ways to advertise. In the meantime, we honed a strategy for delivering on our clear promise: Impress by producing an office environment that appeals to the creative side of patients and their social circles. It worked, ultimately establishing an internal referral-based marketing system.

Go into business with the right partner. Splitting startup costs can get you into business faster, and you won’t have to go it alone. I consider myself extremely lucky to work with someone as talented and supportive as Dr. Taline. I wouldn’t be where I am today without her.

Build from scratch. Dr. Taline and I acquired an existing office in another part of L.A. about two years ago. We loved the challenge, but if we had to do it over, we’d definitely start from scratch like we did in Studio City. Though financially straining at first, with the right mindset and tools, it’s much easier—in L.A., at least—than converting someone’s existing patients to a new dentist.

Understand that there’s no shortcut to standing out. A big mistake in a saturated market is attempting to appeal to the masses with a washed-out product. We focused on one or two aspects we loved about dentistry and business, and worked hard to be the best at them. With this approach, you’ll draw the attention of a niche demographic. Suddenly, you’re the dentist everyone wants to see specifically for those one or two things.

Know what makes your team feel appreciated. Everybody should offer simple things like periodic free lunches and one-on-one meetings. From there, customize for your team’s specific desires and challenges. We always incorporate a few weekdays off per month so our staff has time to focus on errands and self-care. We also create growth opportunities so they have a choice about the direction in which to take their careers. Above all, we never stop praising a job well-done, whether verbally or through monetary compensation.

Above all, we never stop praising a job well-done, whether verbally or through monetary compensation.

The harsh reality? You need to produce enough income to sustain your lifestyle. That’s simply harder in big cities. But, if you truly love where you live, and are lucky enough to find an ideal business partner who’ll share your ups and downs, you’ll have the motivation to find your way. It worked for us, it can work for you.

SAKO KARAKOZIAN was born and raised in California’s San Fernando Valley. He majored in physiology and neuroscience at UC San Diego and graduated from New York University College of Dentistry. His first name rhymes with taco, he’s a passionate volunteer and is co-owner of Dental Design Studio City and Esthetic Dentistry Los Angeles.