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Your associate doctor: Benefit or bust?

July 1, 2019
Bringing on an associate dentist is a big change for a practice and its owner. It’s important for the owner to be properly prepared for the transition, and also to be prepared for any problems that may arise.

Adding an associate doctor to your practice is part of a natural evolution for an owner-dentist, and like most evolutions, the change creates something new. With an associate on board, you may struggle to be the clinical director and mentor you know you should be, while still maintaining patient goodwill, team engagement, and production numbers. That’s a lot of stress on one person, and the first step toward handling it is to acknowledge it.

A survey of 593 dentists by the American Dental Association (ADA) found that 65% felt their education did not prepare them for leadership and running an effective practice.1 Yet, a 2012 article from the Journal of Dental Education concluded, “When leadership is absent in dental teams, the outcome is often poor productivity, low employee satisfaction, and less-than-satisfactory treatment outcome.”2

Hiring an associate brings leadership expectations, attitudes, and procedures that may very well undermine the relationship from the start. For example, if you honestly believe that, “I am the only person who can do XYZ and do it right,” your associate will become frustrated and you will remain overworked and resentful. Or you might be one of the 23% of dentists who always or sometimes blame themselves for things that are, in reality, out of their control.3 Both attitudes are prime generators of stress.

Here are the top four stressful pitfalls dentists encounter when adding an associate, and ways to avoid them.

Pitfall No. 1: You neglect due diligence

Adding an associate puts several strains on your practice, and the first is financial: breaking even requires that an associate add about three times his or her salary to your bottom line.

Most dentists receive as little financial training as they do leadership training, which can lead to premature or long-delayed financial decisions. In addition, hiring is difficult in any field, but especially when two medical professionals are involved. While insisting on a trial period or a contract with renewable terms may seem demeaning to the profession, it is not.

Overcome these pitfalls

• Evaluate your decision against the three main reasons for hiring an associate: (1) to fill a gap in your practice (for example, endodontics); (2) to prevent business losses due to a consistently packed schedule; and (3) to transition your practice (for example, you plan to retire).

• Ask for help from a professional broker to find an associate, from a CPA to analyze your business, and from a lawyer whose specialty is health-care professionals.

• If you are uncertain of your current need or of your leadership skills, ask for help from a dental practice specialist who can make recommendations at your place of work.

Pitfall No. 2: The associate does not diagnose

Most people start off slow when taking on a new position. For dentists, not diagnosing is often a way of building rapport and likability with their new patients. Because, honestly, what patient likes a doctor who points out what is wrong?

Overcome these pitfalls

• Set your clinical expectations—the standard of diagnosing and care all patients receive regardless of provider.

• Talk with your associate about the normal behavior of holding back because he or she wants to be liked. Let the associate know you will support his or her diagnoses from day one and explain what you will say directly to staff and patients if you hear a concern or complaint.

• Introduce the associate to patients personally and state that you have instructed the associate to be as comprehensive as you would be with patients’ care.

Pitfall no. 3: The associate is not good at case presentation

Associates have rarely mastered case presentation yet. They may lack training, or they may feel that patients should respect them as clinicians enough to take their word about treatment.

This lack of case presentation skills might be something as basic as using language that is too technical for patients (for example, saying “orthodontics” when the patient says “braces”). Poor presentation skills can make patients feel a lack of control when they want to at least be asked about their preferences (for example, someone wants to have multiple cavities filled at once, or during several appointments).

Overcome these pitfalls

• Train your associate on how you present. If you are ready to hire an associate, you probably have skills in case presentation and certainly in your patients’ expectations.

• Have your associate spend his or her first week doing nothing but observing and taking notes on how you present. Consistency is great for the team and patients.

• Hire a personal coach to come into your environment and provide one-on-one training for your associate with actual patients. There is no better learning structure than your own practice.

Pitfall no. 4: Drama arises with staff

You’ve had a loyal staff for years. They’ve worked out the kinks and tensions teams regularly experience while building synergy, and most days everyone is happy to be at work. Now your associate criticizes how the staff works and demands changes, and the staff complains that they can’t work with this new dentist. People are threatening to quit, and you don’t know what to do.

Overcome these pitfalls

• Before your associate starts in the office, hold a two-day team-building retreat. It might seem like a lot of time to spend up front, but it will save you headaches, drama, stress, and money down the road.

• Have your cultural and team expectations publicly displayed in the staff lounge and make sure everyone is adhering to them. These rules dictate staff behavior that supports the business purpose and core values.

Adding an associate will bring your practice to the next level and it doesn’t have to be stressful for anyone—if you perform due diligence, guide the associate in diagnosis and case presentations, and manage staff drama. Accept there are potential pitfalls and have strategic plans laid out ahead of time to help you anticipate and overcome them. Asking for help from other professionals, including a CPA, lawyer, and coach, will help smooth the way and avoid stress and frustration for you and your associate.


1. Taichman LS, Taichman RS, Inglehart MR. Dentists’ leadership-related educational experiences, attitudes, and past and current behavior. J Dent Educ. 2014;78(6):876–885. http://www.jdentaled.org/content/78/6/876.

2. Taichman RS, Parkinson JW. Where is leadership training being taught in US dental schools? J Dent Educ. 2012;76(6):713-720. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616398/.

3. American Dental Association. 2003 Dentist Well-Being Survey. Chicago, IL: American Dental Association; 2005. https://books.google.com/books/about/2003_Dentist_Well_being_Survey.

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