The advice below was gathered from multiple interviews conducted by CDA staff with CDA member-dentists who are or recently were associates. The members selected for the interviews represent a variety of associateship experiences and backgrounds.
Network and get your name out in the community at least six to nine months before you expect to start work. To meet practicing dentists, attend alumni and local dental society events while in school. 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 where you wish to practice.
Adopt a proactive attitude. Approach practice owners who haven’t posted a job opening. Personally visit practices to “put a face with the name” and show you are serious. One dentist mailed her CV and cover letter to all practices owned by dentists within a five-mile radius of her home, regardless of whether they advertised for an associate position. This effort generated six interviews and she was hired to work in the practice she now owns.
You may be graduating at the top of your class, but you must recognize that you still have a lot to learn. Accept mentorships 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.
Practice owners hire an associate for a variety of reasons such as transitioning into retirement, boosting production while maintaining the fixed costs of the practice and delegating certain procedures and patients to focus on new techniques or areas of expertise. Learn why you are being hired in the interview process to make sure your professional goals align with those of the practice owner. This information helps position you as a valuable asset.
Before you sign on the dotted line, ask questions to help assess whether the practice and owner are ready for an associate. Ask to look at patient charts to see how treatment planning is handled (the practice owner should deidentify all charts shared to abide by HIPAA laws), evaluate the number of new patients each month, ask about hygiene recall and patient retention and know the collection/production ratio to make sure the cash flow is managed well.
A common reason associateships fail is because the relationship is not defined and documented from the beginning. It may seem awkward to request a written agreement, especially if the practice owner seems trustworthy and willing to settle with a handshake, but a written agreement starts the relationship off on the right foot and addresses terms of the relationship, such as employment status, length of the associateship, compensation, expected services to perform and details of the buy-in/buy-out if applicable.
Check out our Sample Associate Agreement.
Never let patients dictate treatment and question recommendations. Be confident in your recommendations and practice ways to explain recommendations when questioned. This advice holds true if the practice owner or another practitioner pressures you to diagnose or perform treatment you believe is not clinically sound or necessary. Also, be honest with the practice owner about the extent of your clinical abilities and comfort level with certain procedures. If placed in a compromising situation, seriously consider your exit strategy from the associateship.
As a new associate you will learn many positive and helpful lessons. Take it all in – the good, the bad and the ugly. You have time to decide which lessons to take with you and which to leave behind. Keep a journal of all that you learn so you have documentation to reference down the road. If 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. Observe the practice owner and other practitioners. Take note of how more seasoned doctors talk to patients, overcome difficult treatment discussions and interact with staff. Again, the purpose isn’t to become a copycat, but to collect data to develop your own style.
You don’t have to be an expert but gaining basic knowledge on how dental insurance works for the office as well as the patients could save you some costly mistakes down the road. Familiarizing yourself with common terms, billing requirements and frequency limitations might be just the thing to instill a patient’s confidence in you and your treatment plan. Understand your legal obligations as the treating provider with a dental insurance company. A dental insurance claim form is a legally binding document between the doctor (treating entity) and the insurance plan. Make sure the codes on the claim form match the treatment that was rendered, not only what the insurance plan covers. Also be sure you are listed on the claim form as the treating dentist – this is a common mistake made when billing is done on behalf of an associate. Set aside time to meet with the practice’s insurance coordinator and have some general questions ready. Make sure the insurance coordinator is listing you as the treating provider, as insurance plans periodically conduct audits and incorrect insurance claim billing can negatively impact you and the practice owner.
A patient’s chart and record are legally binding documents and, if needed, can be subpoenaed by a judge or court. Thorough charting of a patient’s conditions, diagnosis and treatment plan is imperative. Charting should be chronological, factual and objective and should provide anyone who reviews the patient record a clear insight of the patient’s dental health. Charting should never be defamatory, negative or emotional. If a patient requests a copy of their patient record, all documentation in the patient record, including communication logs between you and the dental team in the patient’s record, will be included. Assume the patient will read the record one day when you are writing in the chart.
Whether you plan to purchase the practice or not, it’s important to establish yourself as a team leader. Be professional in your interactions and conversations with staff. Don’t try to be the new best friend but show your appreciation for their hard work – a simple “thank you” goes a long way. Learn the practice systems and be cautious when providing constructive criticism – there is a time and place to suggest improvements and often the “new guy” can be easily alienated if suggestions are made too soon.
It takes time to build trust with patients, especially in an established practice. For most, accepting treatment is an emotional decision based on trust, with little to do with clinical ability and skill. Trust is built when a patient is treated with the utmost respect and care. Practice active listening and paraphrasing back what you hear from your patients. Use the patient’s name whenever you paraphrase, make eye contact, dress professionally and smile. Be personable. Patients need to like you before they accept your treatment recommendations. Ask questions. Get to know them. Be sure to take notes so you remember the details the next time you see them.
The owner/associate relationship only works if you can support the owner’s practice and treatment philosophy. Ask a lot of questions, learn from the owner, and if you find you do not share 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.
Since you are new to the practice, patients may try to take advantage of policies enforced by other dental team members. Learn how case presentation, treatment consent and financial presentation is handled in the practice. If staff talks finances with patients, find out the process of passing the baton. If patients try to negotiate treatment costs with you, make sure you’re comfortable with the practice’s billing and collections process. Get background information on the patients you see each day in the dental team morning huddle.
A common pitfall for new associates is not seeing materials the practice owner uses in advance of seeing patients. Talk to the practice owner to see if materials/supplies you are comfortable with can be added to the practice inventory. If this is not an option, practice with the new materials prior to treating patients.
Be humble and learn as much as you can before trying things your way. It’s not that you shouldn’t give feedback, but approach the conversation respectfully 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 compliment first before the critique.
Many recent graduates are faced with student loan debt and managing that debt can be daunting. Live on a student’s budget for at least five years after graduation. Getting that first paycheck after dental school is exciting, but you should live frugally and try to avoid accumulating more debt. That way you’ll be financially stable when you purchase a practice.
If you find you are working in a place that does not make you happy, recognize that this is likely not the last practice you’ll work in. The reality is you may have to take a job to start paying the bills – but you should never feel trapped and unhappy with your long-term work situation. Eventually make a goal to find a new position that offers the right combination of job satisfaction, positive challenges and new opportunities – one that suits your personality and meshes with your goals for the future.
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