Navigating growth: Employment challenges for expanding dental practices

Expanding your dental practice brings exciting opportunities, but it also introduces complex employment challenges that can expose your business to significant liability. As you add team members, open new locations, or restructure operations, understanding the evolving landscape of employment regulations becomes critical to protecting your business and avoiding costly mistakes.

Employee count triggers legal obligations

One of the most important things for growing practice owners to understand is how employment laws change as your team grows. Many federal and state laws kick in, or expand their requirements, once you hit certain employee thresholds. Here are a few examples:

• Title VII of the Civil Rights Act applies to employers with 15 or more employees, meaning protections against discrimination (based on race, religion, sex, etc.) become a legal requirement at that point.

• The Americans with Disabilities Act (ADA) also becomes applicable at 15 employees, obligating employers to provide reasonable accommodations to qualified individuals with disabilities.

• The Family and Medical Leave Act (FMLA) mandates that employers with 50 or more employees must provide eligible employees up to 12 weeks of unpaid, job-protected leave for qualifying family and medical reasons.

These examples only scratch the surface of how employee thresholds add new layers of compliance complexity. State and local laws are growing in quantity, and nearly every law will have a qualifying employee threshold, which can range from one into the hundreds.

Multistate growth brings multilayered compliance

For growth that involves multiple state locations, it's imperative to know that state, city, and county laws can vary widely and dramatically affect how you operate.

Minimum wage laws differ by state and/or city, requiring multistate employers to keep track of-and comply with-each location's requirements. Paid sick leave mandates, family leave laws, and meal/rest break regulations also vary widely. Some states require final paychecks to be issued immediately; others don't. The enforceability of noncompete agreements, background check limitations, and drug testing rules also differs.

Each state or city may also have unique employment poster requirements and recordkeeping rules, adding more administrative work to your operations.

What works for your team in Boise, Idaho, may be illegal or insufficient in Portland, Oregon. Without a firm understanding of geographic variances, well-meaning employers can quickly find themselves out of compliance.

Beware of joint employer risks

Joint employment has become one of the most significant risks for growing dental practices, yet many owners remain unaware of this. Joint employment occurs when two or more entities share control over workers, creating shared liability for wages, benefits, and working conditions. For dental practices, common scenarios include partnerships with staffing agencies, dental service organizations (DSOs), or shared arrangements between practice locations.

This is particularly important considering the employee threshold rules above. One location may only have eight employees and the other location only nine-individually they are below a threshold but would be over if combined. Creating separate tax IDs or corporations does not eliminate joint employment requirements.

Culture and communication challenges multiply

Beyond legal and compliance concerns, operational issues also intensify with growth:

• Inconsistent procedures: Informal policies can lead to unequal treatment across teams, creating morale problems-or worse, legal claims.

• Weakened culture: When leadership becomes less visible and communication less frequent, your core values may not carry across locations.

• Burnout and turnover: Rapid growth without adequate support or staffing often leads to employee dissatisfaction and high turnover rates.

Maintaining a cohesive and engaged workforce during growth requires a conscious effort to communicate expectations, train supervisors, and reinforce your company culture from the top down.

Best practices for smooth growth

Successful growth requires investing in HR infrastructure before problems arise. This means developing comprehensive employee handbooks that address multilocation policies (if applicable), creating standardized onboarding processes, and implementing time-tracking systems that capture all work performed, just to name a few.

Regular employment training for managers becomes essential as your practice grows. Supervisors must understand their role in preventing discrimination, harassment, and retaliation claims. They need clear guidance on documentation requirements, disciplinary procedures, and managing employees to minimize risk.

Owners should consider regular audits of policies, practices, and documentation to identify potential issues before they become expensive lawsuits. The cost of preventive legal guidance is minimal compared to defending employment claims or paying regulatory penalties.

Growth is exciting, but it isn't without challenges. Dental practice owners who plan for the employment challenges that come with expansion can protect their businesses, improve team engagement, and create a strong foundation for long-term success.

Editor's note: This article appeared in the September 2025 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.