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What you should know before you become an associate

April 1, 2013
I've been a dentist since 1985. After four years in the U.S. Navy, I entered private practice as an associate. I've worked as an associate dentist for at least five different employers and have learned some lessons the hard way.

By Douglas Wright, DDS

I've been a dentist since 1985. After four years in the U.S. Navy, I entered private practice as an associate. I've worked as an associate dentist for at least five different employers and have learned some lessons the hard way.

Here are five suggestions I recommend that any prospective associate dentist consider:

Get a contract! No, do not scribble something down on a table cover or napkin. Get a lawyer who knows something about professional contracts and has time to listen to you. Do not be afraid to interview more than one attorney. If your prospective employer provides a contract, get it reviewed by an attorney who has your best interests at heart. Do not start seeing patients until the contract is completed and signed.

Do a little research. Speak to your local and state dental association representatives. See if there have been any legal rulings regarding issues such as noncompete zones in your state recently. Also, see if your dental association can recommend any lawyers.

Whatever you do, get a well-constructed, well-negotiated contract with your employer. Look over items such as noncompete clauses and the hours you'll be expected to work. Consider who will cover weekend and holiday emergencies. How long is the workweek? What about vacations, continuing education, and malpractice insurance? What input will you have in regard to choosing your dental assistant?

Also, review what insurance policies are accepted in the practice. Will you be the only HMO provider in the practice? Is the employing dentist using you to cover the least profitable portion of the practice? A good attorney will help you with these items.

There is an added benefit to negotiating a contract before you become an associate. It will provide you with an opportunity to learn how your potential employer reacts under a bit of pressure. The process of contract negotiation, by its very nature, creates a gentle form of conflict between you and your future boss. It will be good to see how your potential employer handles this before you work in the practice.

Spouse in the practice: I do not mean having the spouse serve as a bookkeeper who visits the office once a week. I mean having the spouse work in the office on a daily basis, handling patients or working as an office manager. I've seen a number of practices in which a spouse has worked as an office manager or a second dentist.

In some cases, these practices work well. However, mixing a spousal relationship into the working relationships of everyone else in the practice can create turmoil. Now, add in another dentist. A husband-wife partnership will always trump your relationship as an associate. While this may mean your boss has a successful marriage, it does not bode well for your business relationship. If you have a falling out with either party, you will have fallen out with both.

There are exceptions to this rule. For example, one instance might be if you are working as an associate in a husband and wife office for a defined (in the contract) period of time before the owner retires and leaves the practice to you. If this is the case, I suggest you have a signed sales agreement before you work as an associate. You are an associate for only a short time while the selling dentist introduces you to the patients.

Because you are younger, some patients in the practice may be drawn to you. On one occasion early in my career while working as an associate, I did a nice anterior bridge for one of the patients in the practice. I worked hard on the case. I did a diagnostic wax-up and worked with the best porcelain technician I could find. The esthetics were exceptional.

My patient was extremely pleased and went out of his way to tell the office manager that I was the best dentist he had ever met. The office manager was the wife of the owner-dentist. She felt threatened because her husband was older and did not routinely do anterior crown and bridge dentistry. I had to leave this practice.

There are exceptions to every rule. But if you consider working in an office with a husband and wife team, make sure you understand the interpersonal issues and consider the difficulties you may encounter.

Fraternization: I served in the U.S. Navy for four years on active duty, and for another 17 years in the reserves. Most people recognize fraternization as a military term for having an unauthorized relationship with a subordinate member of the staff. Let's face it, most dental offices are run by a small staff. If the owner dentist has a physically and/or emotionally inappropriate relationship with a team member, it spells disaster. Some dentists go from disaster to disaster in their professional lives. They experience multiple divorces, embezzlement, drug addiction, bankruptcies, and other seismic upheavals. It is amazing to me that these practices survive, but I've seen some continue through crisis after crisis. Unless you have a burning desire to work as a psychological counselor, stay away from practices like this. Fraternization is a symptom of an unhealthy practice. It's a sign that the owner is unprofessional and does not take relationships with the staff seriously. When a dentist practices fraternization, he or she places a higher value on the relationship with some staff over others. It also signals that the owner will probably not worry too much about his or her relationship with you.

Talk to previous associates: I cannot emphasize this enough. You will gain valuable information from anyone who has worked in the practice previously. Ask your potential employer if you can have the names and locations of previous associate dentists. Remember, in the earliest phase of your relationship with the employer-dentist, you want to see how he or she handles stressors and conflict.

If the owner balks at this, chances are there is something he or she does not want you to know. Call the former associates. As a dentist completing dental school or your residency, I assume you're at least 26 or 27. You're an adult. You're probably becoming a good judge of other people.

When you talk to the former associates, ask them for their story. Were they pleased with the experience? Were there problems in the practice? Does their story seem to verify the owner's story and your observations? Were they just a poor match for the practice or does their story and your observations indicate potential problems in this new office?

In one associateship, the practice owners asked me to cosign for a $250,000 loan with them for new equipment. They were building a new office and were overextended on their credit line. After I declined, the owners offered me a "new" contract that cut my income. Life became pretty miserable for me and I resigned.

Later, I bought a practice from another dentist who had once worked for my previous employers. He asked me what caused me to leave this office. I told him the owners wanted me to cosign a loan, and that I had refused. "Funny," he said, "I made the mistake of loaning them money; then they cut MY contract!" A few weeks later, another associate dentist still working in this practice called me to complain that the owners had cut her contract and asked her to purchase equipment for the practice.

The old adage is, "People change … but not much." Make it a point to talk to as many former employees as you can. Separation from the practice may be the fault of the associate. But then again, it may indicate some flaws in the practice you're considering joining.

Go where you are needed: There are areas in the United States that are underserved by the dental profession. Forbes and other business magazines often have articles about burgeoning technological enclaves in rural areas. The Internet and other technology make it possible for highly skilled people to work in areas that were once thought remote. Unfortunately, the dental community has not been quick to follow.

Most dentists start their practices in their late 20s and early 30s, and they want to be in an urban or suburban setting. I can tell you from interviews with dentists from across the United States that rural areas are underserved and misunderstood.

When you consider working in a new practice, ask how many new patients the practice gets in a month. Check the records for the office. Is the new patient flow consistent over a long period of time or has the owner recently pumped money into an advertising campaign to boost new patient flow?

Check out other area practices. Are there any that do not accept new patients? If there are a number of practices in the area that no longer take new patients, it is a sure sign that the community could support another dentist.

Dentistry is an amazing profession and you are entering it at an amazing time. If you're considering joining a practice as an associate, my hope is that my hard lessons can serve as good guidelines for you.

Douglas Wright, DDS, is a graduate of the University of Maryland. He has worked in health care since 1975. He has had articles published in the Journal of Navy Medicine, Proceedings of the Naval Institute, and Journal of the Academy of General Dentistry. He practices general dentistry in Harrisonburg, Va., and may be reached at [email protected].

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