Tom Bodin, a Practice Integration Advisor with Buckingham Strategic Wealth, works with dentists to help them achieve financial freedom through a comprehensive approach to wealth management.
Associates can be a great addition to a practice and beneficial to your career. They can provide the office with greater production capabilities, introduce specialty services for patients, and increase the profitability of your practice. However, not all associates are a good fit for every practice.
In this article, I will explore some angles to consider if you are contemplating replacing your associate. For instance, replacing an associate dentist is a disruptive process. It will likely involve retraining your staff and patients during and after the transition. You will likely face a decrease in production and profitability while you seek a replacement.
So, when considering replacing an associate dentist, you should think of the decision in terms of “fits”:
Financial Fit: An associate dentist should be able both to make a good living and provide a profit margin to the practice owner in the range of 5%-15%. Sometimes the profit margin can be higher, but it should not be lower. For an owner dentist, your hygiene department and associates should represent profit centers. If an associate is a financial burden for greater than one year, it is likely he or she will continue to be a financial burden into the future.
Cultural Fit: Your practice’s culture is its look and feel. Are patients welcomed warmly at the door? Does staff do everything possible to create an inviting atmosphere? Have you, as the CEO of your dental practice, taken the time to identify, communicate and foster the right culture for your staff and patients? If an associate dentist does not buy into or understand the cultural environment you want staff and patients to experience, this can be a red flag. Chairside manner is important to patient retention and production growth. Similarly, how staff is treated is important to workplace culture and ultimately the patient experience.
Clinician Fit: Not all practices take the same approach to their clinical work. But, in very broad terms, practice profitability will depend on a balance of clinical skill and speed. A practice in a geographic region marked by PPO providers with low reimbursement schedules may need to bring greater speed to its clinical work to drive production and collections. Perhaps a fee-for-service practice in an affluent region will grow its patient base by differentiating on exceptional clinical care, sometimes at the sacrifice of speed. If you, for example, need to differentiate your practice on the quality of clinical care and your associate is not able to diagnose and treat patients to this level, he or she may not be a good fit. Alternatively, if your practice’s profitability is contingent on a balance of speed and clinical care, and your associate is unable to perform competent dentistry at an appropriate pace, it may signal a poor fit.
Patient Fit: Associates should be tasked with building a patient base of their own. Compensation packages should align with production growth and goals. Is your associate helping to realize the practice you set out to create? Consider a dentist I know whose pediatric practice was defined by a high level of clinical care focused around developing a patient base from a select group of area employers. His associate was less interested in building a targeted patient base than in building the easiest patient base. The associate started accepting Medicaid patients and expanded his patient age range. The business became bifurcated; one side was a clinical-focused, high-end, strictly pediatric practice marked by high profit margins while the other was turning into a volume-focused, low-profit-margins practice. The patient base was getting out of control, and it was difficult to market the practice based on the owner’s vision.
Career Fit: Here I am talking about your own career path and goals. Do you want an associate to be a permanent fixture? That is, are you looking at the associate role as a permanent position? Do you want a business partner? That is, are you looking at the associate role as one that will start sharing management responsibilities? Do you want a transition strategy? That is, are you looking at the associate role as an opportunity to transfer ownership and transition to a more clinical focus prior to retiring from dentistry? Misalignment between the associate’s career goals and your career objectives will lead to poor results and frustration.
As you think about a current associate and the preceding points, including the likelihood that replacing an associate will represent a cost to a practice owner, you must also look internally. Perhaps the first step, then, is to offer actionable feedback on how an associate can improve. Most individuals want to do a good job. If associates are not given the information they need to perform to their potential and do not have an understanding of how their professional performance will be evaluated, they are less likely to succeed.
If you have provided clear goals and communicated expectations to an associate and he or she is still underperforming, it may be time to replace your associate. If your career goals and objectives for the associate position do not align with a current associate’s desires, it may also be time to amicably part ways. Do not take this decision lightly, but do not delay it if the decision is necessary. Postponing the inevitable will only lead to greater frustration, loss of revenue, and unhappy patients and staff.