Successfully Bringing in An Associate Dentist to Your Practice
Improve Your Life and Grow Your Practice By Successfully Bringing in An Associate Dentist
(Or a Co-Owner Dentist!)
“I have hired three separate associates in my practice in the past. All of them failed to work out. Hiring associates doesn’t work!” Thus declared a prominent dentist recently.
Upon inquiry, he never used any kind of written agreement. He gave them a chair to use in the office and the most unqualified and inexperienced assistant on the team. Very little training or interaction was given each associate. They were told, “There is your chair, find some patients, good luck!” This happens way too often when bringing in an associate into a dental practice.
In this scenario each associate dentist was doomed to failure from the onset. The associate quickly realizes there are not enough patients for him/her to make it work. Once the associate starts, generally he has one foot in this office trying to make it work, but the other foot is searching elsewhere for a better opportunity. Commitment on the part of the host dentist or the associate doesn’t exist.
If you have never brought an associate into your dental practice you need to learn how to do it and do it well.
It is an investment. Requiring investments in thought, time, money, and energy.
The rewards can be great if done correctly!
Let’s talk about three (3) potential rewards:
REWARD #1 – FINANCIAL BENEFITS
The numbers for your bottom line are fairly simple when bringing on an associate. For each dollar you pay an associate to work in your practice, you make about the same dollar for you, the practice owner, to take home as a profit. Thus, if you compensate an associate $5000 in a month ($60,000 annually) based upon his collections, you should be generating about the same for you. The associate can do this working the equivalent of 1.5 to 2 days per week.
At this pace the associate will contribute about $140,000 additional collections annually to the practice overhead making the practice more successful and allowing the owner the choice of slowing down without lowering income.
Also, as the associate maintains this collections pace for a full year, the value of your practice can increase by approximately $150,000.
So you see, an extra $60,000 a year in profits and an increase in practice value of $150,000. That adds up to $210,000 benefit to you the practice owner in the first year, if done correctly. Thus, the financial rewards are a very big reason to invest time, money, and energy in mastering the skills of bringing in an associate.
If an associate can collect about $2000 per day…
Associate Projected Potential Increase In Days/Week Collections/Mthly Profits/Mthly Practice Value
1.5 $12,900 +$3870 +$116,100
2.0 $17,200 +$5160 +$154,800
2.5 $21,500 +$6450 +$193,500
3.0 $25,800 +$7740 +$232,200
4.0 $34,400 +$10320 +$309,600
5.0 $43,000 +$12900 +$387,000
Ask yourself, “Would you as the practice owner appreciate an extra $5000 per month income that doesn’t require your time or your hands?
Question: How does it make sense that if an associate is paid $1.00, that the owner makes an equal amount ($1) as profit? If you pay the associate $5000 per month, how does that create about $5000 in income for you, the owner?
Too often it is offered by well-meaning, but poorly informed individuals, that if you have a practice and you are on a PPO that discounts your fees by 35%, you may only bring in 5% from an associate because you have a 40% net in your practice. This is really very “bad math”.
As an example, a patient visits your practice and spends a total of $1000 collections over a year for dental care services. Let’s determine your hygiene department generates $300. That leaves $700 in restorative completed by your associate. You compensate your associate 30% of the $700 in the amount of $210.
The $210 represents 21% of the $1000 collected from the patient. As you are netting 40% in an average practice, you received as a contribution to profits – 19%. Thus, for about each dollar paid to the associate, you net about the same.
The really cool thing is that if you have an associate work two days a week, you can take one day off and maintain the same income for yourself. Provided the associate is producing at your level or above.
Remember to calculate the added value of your practice from increases in cash flow/collections. Generally, at least 75% of collections can be added to practice value.
NOTE: As a dental practice owner, you are a capitalist. You operate a business that brings in revenue to first pay the bills (overhead), and then what is leftover is for your personal income (profits). Now that the majority of the overhead is paid, you have the ability to grow the income of the practice. The income generated in addition to the overhead plus doctor income is profitable at a much higher level because the overhead costs have been met. An associate helps build this additional income stream.
REWARD # 2 – QUALITY OF LIFE BENEFITS
As the dentist/owner of a practice you benefit in multiple ways by having a productive associate in your practice. Among the chief benefits is an improvement in your quality of life choices.
TRUE STORY: Recently, a very successful dentist with a thriving practice announced that he was extremely stressed over the shortage of cash flow occurring in his practice. Upon inquiring about the cause, it was determined that he had closed the office recently allowing himself a one-week extended vacation with family. Closing the office for that period of time was having a profound affect on the cash flow of the office after his return.
He shared that while he was on vacation he was adding up in his head the costs of being closed each day. The numbers stressed him as he stood in line at Disneyland. His wife sensed the stress and admonished him to stop thinking about work and be there with family. This made things worse…
The solution is of course is to have another dentist in the office and not close when on vacation or when leaving the office for various reasons. Imagine how this affects the bottom line on an annual basis.
Many times a dentist will grow a practice to the point wherein the number of patients exceeds the capacity of the dentist to treat them all. He works diligently to meet the needs of each patient. But exhaustion or burnout will occur if the situation is not adjusted. Or worse, patients exit your practice in search of dental care services elsewhere. (Refer to article, “Prosperity and Success as a Dentist Can Be Killing You”)
Patients stop referring in this situation, sensing that the office is too busy to see them let alone someone they may refer to the practice. The patient is rushed through the experience in the office because the office is “so busy”. Treatments are not scheduled or accepted because the treatment plan was not understood, leading to the lack of trust to have the work done.
Staff becomes anxious and frustrated.
The dentist/owner becomes so overwhelmed that he neglects or totally delegates the business operations of the practice. Leadership fails.
In this scenario, the dentist is encouraged to take some time off. Gives himself and the team a well-deserved break. Thus creating more stress as cash flow diminishes.
The solution to this begins by knowing a specific number in your practice.
NOTE: The active patient count is the most important number in a dental practice.
From this number it can be determined how many dentist days per week are needed to service the needs of the patients.
A simple guideline to follow is that it takes about 300 active patients to keep a dentist full one day a week for a year. Thus:
Active Patients Dentist Days/Week
Obviously, it is impossible to work 8 days a week!
If you want to work 4 days a week, but the patient count is much higher than 1200, you tend to still try to see all those patients that call with a need. You skip lunchtime, you come in early, and you stay late. You overbook too many patients. You get behind on the schedule. Team members burnout often because of the long days and the inconsistent or demanding hours.
This scenario does not create quality of life for you or your team. Ultimately, your patients are hurt the most.
Why do you do this? You have struggled for years to build a strong patient base. You decide that each patient can only see you. You are the best dentist for them. They own you now! You are afraid to let go. You are unable to allow someone else to provide care for them. Thus you become a slave to the demands of the business and the patients.
You consistently operate on a scarcity mentality versus a prosperity mentality.
Often, in such a practice, the team members don’t recognize the problem either. This encourages them to maintain this situation as status quo. They abhor change. A new associate in the practice will definitely create multiple changes. It is easier for them to keep the schedule full if there exists an excess abundance of patients to be seen. This environment is not the best quality of life for the dentist/owner.
NOTE: Quality of Life improves when you successfully bring on an associate that allows the dentist/owner to back away from being the producer and to more fully step into the role as business owner.
As a major focus of your dental career, you must learn how to successfully engage associates in your practice. You must become a Master Associate Developer. Build the lives and careers of other dentists.
The associate can help expand hours in your office by adding those days or hours you are not open. He can add an evening or two for patients who can’t come in during normal hours. Having an associate in your office on Saturdays can be an immense benefit to the practice. But most importantly it can improve the dentist/owner’s quality of life.
Many times the associate can improve on services available for your patient base. The associate may have strong skills in doing implants. Or they love doing endo procedures that you are referring out. Some associates can be specialists in your practice such as an Orthodontist or Pediatric Dentist.
Thus by adding an associate, you share with your patients that your practice is now expanding days/hours and treatment services to better serve their needs.
And you have the ability to back away from being the solo producer in your practice. Turn your attention to being a better business owner. Focus on family more. Enjoy life as you have always expected. Balance priorities. Determine “quality of life” values and pursue them.
It has been rewarding to see dentists cut back a day or two a week and focus on more rewarding aspects of life. Working fewer days allow them to be on top of business demands rationally. They see practice income generated without using their own two hands. Often the practice can develop into a 3 day a week presence for the dentist/owner, but the business hours are six days a week and some evenings. The owners are then able to get more exercise or recreation. They make better efforts concerning their overall health. Family relationships become stronger and more rewarding. They become more actively involved in community activities. Some open doors to other business ventures in their newly acquired free time. But when they are in the office seeing patients, they are much more productive. Balance in life brings its own rewards.
REWARD #3 – PRACTICE BUILDING AND EXIT STRATEGIES
Well, the record so far is the dentist with one operatory doing $620K per year! But then again, consider the two dentists with three operatories doing $1.3M per year! It is amazing what can be done when you put your focus on growing and doing better.
When the patient count gets too much, you must bring in an associate. Remember the number 300? It takes 300 patients to keep a dentist busy one day a week for a year. Thus you can work every Monday for a year and expect to be busy. If you want to work four (4) days a week, you need 1200 patients. If you desire to work five (5) days per week, you must have 1500 patients.
If on the other hand you decide you only want to work four days a week but you have 1800 patients, you must bring in an associate two days a week.
It is best to bring in an associate to work on a part time basis. You rarely have enough patients to bring them on full time, four-five days a week.
With adding a part time associate you maintain your schedule and personal income. Gradually you grow the practice, adding more days for the associate. You may choose to slow down as the associate proves the capacity to treat the patients.
As the practice grows, your income increases. That can be good. Or it creates other problems. The tax benefits you generate from owning a dental business diminish as you grow. Your benefits begin to outstretch your growth. Tax consequences continue to penalize you for growing successfully.
The associate is proving to be a keeper. This is someone you want to see stay with the practice and help bring in success.
You need to evaluate presenting an offer to bring your associate into ownership.
There are several variables in structuring this step. What is your age? How is your health? What is your financial status? Where do you stand as to debt? What would be your tax consequences? What are your needs with family? What is the patient count? How is the facility when it comes to capacity? Is there an agreement already in place with the associate about becoming an owner? ETC.
The answers to these questions determine how to move ahead.
Having two dentists owning the same practice is an ideal situation. The benefits abound. Quality of life improves. The business operates more efficient creating better incomes. Responsibilities in the practice are divided and shared. Stress is reduced. Options and choices increase.
The biggest benefit is to allow Exit Strategies to develop in a calm and straightforward manner.
At this stage an Operating Agreement is part of the co-ownership situation. This spells out how you operate the practice together and how each dentist is compensated. It addresses many aspects of eventually redeeming the value of your business interests. If a dentist is disabled or unfortunately passes away, the operating agreement specifies what is to be done.
Practices should be owned 50/50. There are but few exceptions to this rule. An equal co-ownership denotes trust. An adversarial set up doomed to failure does not exist.
Decisions are made in the best interests of the practice to build positive cash flow and increase business equity value.
Owning a practice on a 50/50 split allows some major tax advantages.
When there are two owners you have also an option for healthy and gradual growth and eventual options for fading away from being a practicing dentist as financial security allows.
DETERMINING WHEN BEST TO BRING ON AN ASSOCIATE
The most important determining factor on when to bring in an associate to your practice is the “active patient count”.
Active patient count is known by either using your computer or counting charts to find out how many patients have been in your office in the last two years. Determine a good estimate of the number of active patients in your practice.
It is valuable to determine how many have been in in the last 12 months. Then compare that number to how many in two years. You are able to see how many patients didn’t come in from one year to the next. Are you losing patients because they are not being put on the schedule?
This information allows you to determine if an associate is needed.
For every 300 active patients a dentist works one day a week to see those patients during the year. It goes to say then that if you want to work 4 days, you will need 1200 active patients.
If you have more patients than you could possible see, you need an associate.
It will also help you determine if more hygiene days are required.
If you are tired, facing a health problem, or simply burning out, you may need to slow down by bringing in an associate even if not based upon the patient count.
If you need to bring in an associate to develop a future exit strategy for yourself, you should have a proper game plan to make this work successfully.
If your market has a high demand for patients to be seen on days, evenings, or Saturdays when you presently don’t have the office open, you may need an associate.
FINDING AND ONBOARDING ASSOCIATES
Finding an associate to bring into your practice is far different than bringing in another team member on the staff. Plan accordingly.
Where can you find a quality associate with great clinical skills and excellent people skills? Someone who will help build your practice?
There are many sources to generate inquiries and contacts. Just like trying to find the right staff member, it takes time and effort to locate the right associate.
You must know that the perfect associate does not exist! Build upon their strengths; improve upon their weaknesses over time. Be patient. Be engaged.
Don’t look for a best friend to share weekend activities together. These are good on occasion, but you have a business relationship priority.
Write down some of the qualities you may desire in an associate. Dependable, intelligent, pleasant, calm, determined, positive, confident, diligent, and fun are just some thoughts. A person with all those qualities doesn’t exist. Just try to come close to matching those qualities.
You must determine if clinical skills are at your level of expectation. Mistakes will happen in using those skills on patients. Many times it is not the clinical aspects that cause problems. Interactions with patients are people skills and bedside manners. Remember to tell the associate you expect problems, but it is how they are handled that count. Talk with the associate about possible situations. Train them to your expectations.
A simple place to encounter associate dentists is at dental schools. New graduates are anxious to go to work after school and get a strong foothold on becoming a successful dentist. Many established dentists are uneasy about bringing in a new dentist. They take more supervision and handholding. Especially for the first six months they are very much in an adjusting/learning mode. They generally are slow in clinical procedures. Communications with patients and team members are not always ideal. Expectations of the new dentist are sometimes misplaced. But after six months they tend to really take off in all areas. Confidence replaces problems. If improvement continues, they become ideal associates.
It must be said here that dentists coming out of school are not all equal. You cannot say you would “never” hire a new dentist right out of school. About a third of the dentists right out of school are great candidates to be an associate in your practice. Evaluate each candidate independent of how long they have been practicing, or not practicing.
Many associates are found because you knew them before. Either they were a patient before going to dental school, or even a family member. You know them well enough to have confidence in bringing them on board. Ask those who work with you if they might know anyone.
Dental practice transition specialists are an excellent resource to find and qualify potential associates. Your lab people or dental supply reps are aware of associates looking to make a change to a different opportunity. These are excellent sources to develop interviews with prospective candidates.
Another source is simply to run an ad. Whether in the statewide association site or many other publications or online sites with classified ads, you can open the door to applicants. Sometimes it is best to run an ad out-of-state in a classified site or a nationwide site. Many times dentists are thinking about relocating into your area and see your ads.
Cast a wide net. Evaluate candidates. If you come across someone you really feel is the right one, tell them. Invite them to meet with you more. Talk about them and their history, dreams, family, and personal interests. Make friends by getting to know them.
You must create a positive win/win relationship when you find someone you are interested in bringing aboard.
Bringing an associate into your practice needs to be well planned and completed correctly to have success. This is called onboarding.
First and foremost, an associate cannot do any procedures or see any patients unless the provider agreement is signed and in place. Period.
This must be a hard and fast rule. No exceptions.
Not doing this proves to be the biggest downfall in bringing on an associate.
A working interview should not be part of the experience. Observations in the practice are fine, but do not ask for a working interview.
A sample Provider Agreement is available through our services (DBA 801-210-2522). Please contact us and ask for a copy to be sent to you for review. It would be a template to develop your own agreement. It is written in layman language to be understood easily by all parties to the agreement. Read it! Ask questions to clarify the why and how. Be familiar with all aspects.
It is valuable to introduce the new associate to your team. Do it in a positive manner. First impressions for the staff can make or break the associates future success. Bringing in a treat or flowers, something nice for each team member is a nice touch. Have the associate tell about himself, more on a personal level, not on a clinical level so much. That comes later. Introduce him as “Doctor…”. If he is going to buy in soon or even if deferred, let the team know that the process is in place for the new dentist to become an owner. This helps team members to consider the new dentist as possibly their employer in the future.
Schedule to have the new dentist do an exam on the dentist who owns the practice right away. In the first month, schedule staff members to have exams by the new dentist. It is great for the team to share with patients that the new dentist is the owner dentist’s dentist! This works really well in getting patients to see the new dentist in the practice.
Make announcement letters or emails or both to go out to the patients announcing the addition of the new dentist. Point out the benefits to the patients of having this additional dentist come into the practice. There will be more hours to meet the needs of patients. Services in the office may be increased. Another friendly face will be there for patients to meet on their next visit. State that the “existing dentist” plans on being in the office for many years to come (this to alleviate fears that senior dentist may be leaving or retiring). Have copies of these announcements in the front desk area to share with patients as they come through the office.
Best if these announcements were from the owner dentist making this announcement and endorsing the new dentist. A second page with a photo of the associate dentist and his/her family is a very nice addition. On that second page, the new dentist should write a brief introduction focusing on family and interests. Avoid going overboard describing clinical skills, if any. Patients are interested in you as a person. You are licensed, so the clinical skills are mastered in the patient’s mind. In sharing your hobbies or interests you open the door to bond with various patients. You appear to be a nice person, more like your patients.
The new dentist will make mistakes in your practice. Either it will be a clinical problem or a communication misstep. Talk in advance with the associate and team members that this will happen and how resolutions will be satisfied. This is a challenge that becomes a very good training experience. A successful associate in your practice is more valuable than any given patient or team member. Learn from mistakes and build a stronger relationship because of them.
Scheduling is something you work together on to come to the best solution. Try a schedule for a while, and then make adjustments as needed.
It is encouraged that you add evenings, Fridays, and/or Saturdays to your schedule to accommodate the new dentist. These are high demand times for patients. They are much easier to fill. Make sure the scheduler offers those new times to patients.
TRUE STORY: One client dentist brought in an experienced dentist who owned a practice about 40 minutes away… This new dentist was in his forties and needed to create a little more income as he allowed his own practice to grow. He started working the end of April one year. His s