Working as an employee in a practice is probably not the number one choice among dentists who are starting their careers, but it can be a smart move. It’s unfortunate that the majority of these relationships fail. I have seen some very successful practices with positive associate relationships, but they are in the minority.
Unless you are a second or third generation dentist, you probably don’t have a lot of practice management experience. Working as an associate gives you the opportunity to learn the business side of dentistry. You can gain “real-life” experience with managing the practice and staff while paying down student loans and gaining clinical experience with no financial risk. If you plan on buying in the practice, an associateship gives you an opportunity to “try before you buy.” Dentistry can be a lonely profession. An associate position can provide you with a sounding board; a partnership that can include mentoring, which is extremely valuable to a new dentist. It can provide you with a lot less “I wish I’d known that” moments down the road.
Most associateships fail because of what didn’t occur before the relationship officially began. The owner doctor and perspective associate failed to properly analyze the practice to see if an associate was needed in the first place. Another reason is that they never shared their goals. They were mismatched and had unfulfilled expectations, either on the part of the owner or associate. They were heading in different directions, a common denominator for most break-ups in life. This could have been avoided with better planning and better communication. I’m sharing some key points in this article that will enhance the associate interview and working relationship.
Establish Personal Goals
Before considering any position, you need to establish your personal goals. Unless you know what you are looking for, you may never find it. What is your purpose for seeking an associate relationship? Better planning will help prevent disappointments, stress and loss of time in the future.
Factors to Consider:
- I want to work as an associate temporarily and do a start up in a few years
- I am interested in a partnership or buyout
- Office location (consider that if you start your own practice in the future, you may have a non-compete clause to honor)
- I prefer working on children or adults
- The procedures I enjoy most
- The procedures I enjoy least
- CE Goals
- Expected length of employment
- Required salary range
- What are my priorities? What type of practice do you envision?
- Practice philosophy
- Facility requirements
- Short term and long term personal goals?
- Short term and long term professional goals?
Once you have established where you are going and you know exactly the type of practice you want to work in, you are ready to start your search. Consider utilizing a listing all of your goals, benefits and negatives of a particular practice, to see how each practice you interview measures up.
Can the practice support another dentist?
Many times the idea of hiring an associate appears to be a solution when a practice is struggling with keeping one dentist busy. I’m not sure how this myth got started, but it just doesn’t work, even if they are considering a marketing campaign. This is definitely not a solution. An associate should be considered when the owner dentist can no longer handle the number of patients in the practice or wants to cut down the amount of days worked. Many times a son or daughter graduates and joins a practice that doesn’t have enough patients to keep them busy. My advice is to resist the temptation if the practice was not in the market for an associate.
You will need to verify that the practice can support two doctors. You can easily do this by learning the number of active patients from the computer software. I’ve seen practices try to determine this number by counting the number of physical patient charts, but this is not the correct way to do it. A computer generated report will show you how many individual patients have been in the practice over a certain period of time. I use an 18 month period. You will need to ask the owner doctor to supply the report and look it over with you. You should also ask to see a computer generated report showing the number of new patients by the month, over a 12 month period. In my opinion the minimal requirements to support a second doctor is 2000 active patients and 30 or more new patients each month.
You should be considering a salary range and be aware of what you will need to produce to meet your compensation goal. If you are going to be paid the standard 30 to 33 percent of collections, you will need to produce at least $300,000 to get in the neighborhood of $100,000 gross. You will never reach this if the patient flow is not there for you.
How do I learn about Associate Opportunities?
The best way to find an associate opportunity is through a recruiter. It will save a lot of time and from my experience, practices utilizing a recruiter to find an associate have better success with the entire process. Typically, the recruiter has experience with interviewing potential associates and is excellent with matching specific short and long term goals.
Interview with Owner Doctor
The interview process goes two ways. You are being interviewed, but you are also interviewing the owner dentist. Preparing your interview questions in advance will help you identify exactly what he/she is looking for, ensuring better compatibility. This will help you better predict compatibility.
Questions for the Owner Dentist
- What types of procedures do you expect the associate to perform?
- Will the associate have management responsibilities
- Do you feel the current scheduling system could be maximized?
- What days and times do you anticipate an associate working?
- Have you thought about how you plan on paying an associate?
- Will the associate be responsible for paying any practice expenses such as lab costs, supplies?
- How are new patients brought in to the practice?
- How do you feel about marketing?
- How many weeks of vacation do you take?
- How much outstanding treatment does the practice have
- What is the percentage of production collected?
- What percentage of the schedule is filled each day?
- Do you have regular staff meetings?
- How many staff, and how long have they worked in the practice?
- How do you feel about continuing education
- Are you a member of any dental associations
- Are you a member of any charitable organizations
- What do your consider the strengths of the practice
- What do you consider the weaknesses of the practice?
- What are your goals for hiring an associate?
You are going to learn a lot about the practice and the doctor from this conversation. Pay special attention to the part about the staff and length of employment. If the doctor has a turnover problem, or is critical of his team, that may be a clue about how an associate would be treated. A good employer may be one that has trained and groomed others like yourself having them move on to fame and fortune after working under them. Learning your goals and preparing questions for the doctor owner will also prepare you for the interview.
Questions you can expect to be asked in the interview:
- Are you interested in buying into a practice?
- What are your plans for the future?
- What compensation and benefits do you expect?
- Is there anything that could change your plans?
- Tell me about a time you had a disagreement in the office.
- How would you handle an employee that started arriving late?
- How do you feel we should handle patients that continue to break appointments?
- What can you bring to the practice?
- What is your management style?
- What are you most interested in learning?
- What procedures do you enjoy most? Which ones do you enjoy the least?
- What do you consider your most difficult procedure?
- Describe the ideal new patient visit.
- How do you feel about dental insurance, PPO’s?
- You will most likely be asked about your experience with specific technical procedures.
After the interview process and things are looking favorable, plan to spend at least a couple of days in the practice observing and listening. You’ll be able to get a first hand feel for the practice tone and style. Plan some time away from the practice with the owner dentist to attend social events such as golf and/or dinner with the spouses. This will be beneficial in making your final decision about joining the practice. Before you make your decision, you must verify that the practice is ethical and safe. Check with the state board about past complaints and ask around the dental community to learn more about the practice.
I’m often asked for a good associate contract, one that will guarantee a successful relationship. While a well written contract is important, there is so much more to the relationship. It is important that you do your due diligence to avoid a mistake that could cost you years that can never be replaced. A lot of the contracts I have seen look like they were borrowed and shared by many different dentists, who got it from another dentist and so on. Hire an experienced attorney.
One thing I want to make clear is that for an associateship to be successful you must have affinity for the practice owner and you have to agree on the practice model.
I hope the advice shared in this article will increase your chances of having a positive experience. Dentistry is a great profession. Open up your eyes, ears and hands so that the owner doctor can share years of experience and wisdom. Best of luck to you.