Transitions Roundtable

June 25, 2015
We ask two experts the same question on a complex issue.

We ask two experts the same question on a complex issue.


I want to hire an associate, but I'm not sure if I'm busy enough. Do I base this decision on how long my patients have to wait for an appointment, total number of patients, or some other metric?

Tom Snyder, DMD, MBA

The most important metric is the number of active patients. Active patients are defined as patients who visit your practice at least once every 18 months for a recare appointment. We typically find that the number of active patients for a general practitioner to be at full capacity is between 1,300 and 1,500 active patients. This number varies based on types of services that you provide. Not all doctors have enough patients to support a full-time associate, so for every 200 to 250 active patients, that should be enough to support one associate day per week. However, if you are fortunate to have in excess of 2,500 active patients, then a full-time associate is right for you.

The next most common metric that we use is appointment wait time. If you are booked at least 80% of the time six to eight weeks in advance, you are reaching your maximum capacity. We also find that a busy practice has a fully prebooked hygiene schedule usually six to nine months in advance. So another metric is the number of available reserved appointment slots for a new patient hygiene appointment. In a saturated practice, the demand for recare patient appointments is so great that new patient hygiene appointment slots are often sacrificed by demanding patients, thus putting the doctor in a bind to find an appointment time to treat a new patient for hygiene services.

The final metric to use is number of patient-of-record emergencies. If this is a substantial number, it tells you that past-due recare patients are calling about issues that should have been detected during regularly scheduled recare visits. So having a "saturated" practice is fertile ground to hire a part-time or full-time associate.

Gary Schaub

When to hire an associate, if ever, is a complicated question to answer.

The first aspect of the decision should be based on the "busyness" of your practice. For example, if new patients need to wait more than a week for an appointment, your schedule may be too full. Getting new patients scheduled into the practice quickly should be a number one priority. If this is not the case, then examine your reasoning for wanting to hire an associate. Maybe new patients can be quickly worked into your schedule because you are not busy enough. You may then think, "Why not hire an associate now, since the associate can bring in his or her friends and help fill up the schedule?" Wrong. Most associates are looking for employment, not to slowly build up their own practice. This is probably the number one reason why associateships fail-the lack of "busyness."

It may be necessary for you to cut back on your schedule in order to give the new associate a full appointment book when he or she starts. So, if you are starting to scale back your time in the practice, then hiring an associate could be a smart move.

Are you hiring an associate to eventually become a partner or to take over your practice? In that case, I would suggest looking deeper than a recent dental school graduate. Why? A recent graduate's real-world experience is usually nil, and it may be based on academia's perception of private practice. The associate's right path might not be apparent until the associate can set long-term goals, bridge the financial chasm of school debt, and gain business and clinical skills. As one of my clients told me, "Gary, you need to go through three associates before you find the right one."

Concentrate on hiring the right associate the first time.

Tom Snyder, DMD, MBA, is the director of transition services for Henry Schein Professional Practice Transitions. He can be reached at (800) 988-5674 or [email protected]

Gary Schaub is the founder of HELP Appraisals & Sales Inc., a dental and medical appraisal and brokerage firm in Portland, Oregon. He is a member of ADS Transitions and can be reached at (503) 223-4357 or (855) 463-0101.

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