The following advice was gathered from multiple interviews conducted by CDA staff with CDA member dentists who were associates or recently had been associates when interviewed. The members selected for the interviews represent a variety of associateship experiences and backgrounds – general dentists, specialists, dentists who worked in multiple practices, dentists who chose one solo practice and dentists who worked in large group practices. Although the backgrounds varied between those interviewed, the advice given was relatively consistent across the board. Here’s what your peers had to say…
The last year of dental school can be overwhelming to say the least – but, as busy as it may seem, it is important to begin networking and getting your name out in the community at least six to nine months before you expect to start working as an associate. Even if you’re not sure where you will eventually land after graduation, you should start attending alumni and local dental society events while in school to meet practicing dentists. You never know – a dentist who practices in Los Angeles may have a good friend who practices in San Francisco who’s looking for an associate. Get your name out there early – at the very least, it will help you refine your networking skills for when you graduate and move to the location in which you wish to practice.
It is important to adopt a proactive attitude and approach when it comes to looking for associateships. This may require that you approach practice owners who haven’t even yet posted a job opening. This may mean placing calls or personally visiting practices to “put a face with the name” and show you are a serious candidate. One dentist interviewed commented that she mailed her CV and cover letter to all practices owned by more seasoned dentists within a five-mile radius of her home, regardless of whether an associate position was being advertised. This effort proved to be effective as she generated six interviews and was hired to work as an associate in the practice she now owns.
You may be graduating at the top of your class, which should give you the confidence to successfully begin your career. But don’t confuse confidence with arrogance; recognize that you still have a lot to learn. Accept mentorship and seek as many opportunities as possible to continue learning. It takes compromise from both the practice owner and associate, and often when the relationship fails it is because one or both parties were not willing to learn or share.
The reasons for hiring an associate vary among practice owners. Some owners hire associates to transition into retirement, some to boost production while maintaining the fixed costs of the practice and others to delegate certain procedures and patients with the goal to focus on new techniques or areas of expertise. In the interview process, find out the reason why you are being hired to make sure your professional goals align with those of the practice owner. Knowing this information will help you to position yourself as a valuable asset to the practice.
Before signing on the dotted line, be sure to ask questions that help you assess whether the practice and owner are ready for an associate. Ask to look at some patient charts to see how treatment planning is handled (the practice owner should de-identify all charts shared to abide by HIPAA laws), evaluate the number of new patients coming in each month, ask about hygiene recall and patient retention and know the collection/production ratio to make sure the practice’s cash flow is managed well. These are just a few of the questions you will want to have answered to ensure the practice can support the additional provider.
One of the most common reasons why associateships fail is because the relationship is not defined and documented from the beginning. It may seem awkward to request a written agreement to be created, especially if the practice owner seems trustworthy and willing to settle with a handshake, but a written agreement is pertinent to starting the owner-associate relationship off on the right foot. A well-written agreement should address all of the terms of the relationship, including employment status, length of the associateship, compensation structure, definition of services the associate is expected to perform and details of the buy-in/buy-out if applicable, to name just a few.
A surefire sign of your experience, or lack thereof, is letting patients dictate their own treatment and question your recommendations. When a crown is necessary, don’t let a patient talk you into a large filling - be confident in your treatment recommendations and practice positively explaining to patients the reasons for your recommendations when questioned.
This advice holds true too if the practice owner or another practitioner pressures you to diagnose or perform treatment that you believe is not clinically sound or necessary. Also, be honest with the practice owner as far as the extent of your clinical abilities and comfort level with certain procedures. It is a lose-lose situation if you promise to do procedures in which you lack confidence and/or experience. If you are being placed in compromising situations, seriously consider your exit strategy from the associateship.
As a new associate, there is a lot to learn. You will learn many positive and helpful lessons, and you will likely also learn from mistakes made by you and by other practitioners around you. Take it all in – the good, the bad and the ugly. You have time to decide which lessons to take with you and which lessons to leave behind. Keep a journal of all that you learn so you have documentation to reference down the road should you become a practice owner (make sure the journal is separate from patient records as you wouldn’t want your personal notes to be potentially discoverable in litigation). When you have downtime in the practice, observe the practice owner and other practitioners if applicable. Observe how the more seasoned doctors talk to patients, overcome difficult treatment discussions and interact with the staff. Again, the purpose isn’t to become a “copycat” but to begin to collect data so you can eventually develop your own style.
One of the most challenging aspects of becoming an associate is adapting to the dynamics of the dental team. Whether you plan to purchase this practice or not, it is important to establish yourself as a leader amongst the team. Be professional in your interactions and conversations with the staff. Don’t try to be their new best friend, but show your appreciation for their hard work – a simple “thank you” goes a long way when you are getting to know the team and learning to work with a new assistant. Ask them lots of questions to learn about the practice systems, and be cautious when providing constructive criticism – there is a time and a place to suggest improvements and often the “new guy” can be easily alienated if this is done too soon.
It takes time to build trust with patients, especially established patients who have been used to seeing the practice owner for some time. Patients accept treatment based on trust. Accepting treatment is an emotional decision and it surprisingly has little to do with clinical ability and skill. Trust is built when the patient perceives he is heard and believes he has been provided with the utmost respect and care. Practice active listening and paraphrasing what you hear back to your patients.
Use the patient’s name whenever you paraphrase, make eye contact, dress professionally and smile. Patients need to like you before they accept your treatment recommendations – be personable and ask questions to get to know them. Be sure to take notes so you remember the details the next time you see that patient. There is nothing more powerful than walking into the operatory with a smile and handshake and saying, “It’s great to see you Mrs. Jones. How was your trip to the Grand Canyon? I’ll bet you had a blast rafting with the kids.”
The owner/associate relationship only works if the associate can live by and support the owner’s practice and treatment philosophy. If these are askew, the relationship will inevitably turn sour. Ask lots of questions, learn from the owner and if you find you truly do not share the same (or similar) philosophies, keep your options open. Remember, this isn’t your practice, so either you get with the already established program or you find another one you can support.
Patients, knowing you are new to the practice, may see an opportunity to take advantage of policies that are otherwise enforced by other dental team members. Find out how case presentation, treatment consent and financial presentation is handled in the practice. If a staff person talks finances with patients, find out the process of “passing the baton” to that staff member. Patients may try to negotiate treatment cost with you, so make sure you are comfortable with the practice’s billing and collections process. Be sure to talk to the staff about the patients you are seeing each day so you have any necessary background information for each one. This should ideally happen each day in a “morning huddle” with the dental team.
It is obvious that supplies and materials vary from practice to practice. However, a common pitfall for new associates is not asking to see the materials that the practice owner uses in advance of seeing patients for the first time. If there are materials you are most comfortable using, have a conversation with the practice owner to see if your materials/supplies can be added to the practice’s inventory. If that is not an option, be sure to practice with the new materials prior to your first day treating patients.
Be humble and try to learn as much as you can about the practice and the owner before trying things “your way.” This is not to say that you shouldn’t give feedback and suggest ways to improve and be more efficient, but approach the conversation respectfully while acknowledging that the person who hired you has likely spent thousands of hours creating the systems and techniques in which the practice currently operates. When the time is right to offer a suggestion, find something to first compliment before providing the critique.
It is no secret that many recent graduates are faced with student loan debt and managing that debt after graduation can be daunting. The advice across all the interviews was “live on a student’s budget” for at least five years after graduation. Getting that first paycheck after dental school is exciting, but living frugally and trying not to accumulate more debt will put you in a financially stable situation for when and if you do want to purchase a practice.
You’ve worked hard to get where you are – enjoy it! One dentist interviewed provided these parting words: “Enjoy where you work and work somewhere that allows you to sleep at night.” If you find you are not working in a place that makes you happy, recognize that this will not be the last practice you work in and take small steps to make a change. The reality is you may have to take a job to start paying the bills – but you should never feel trapped and should make it your goal to find something that better suits you.