Practice Integration Advisor Brian Roemke
Hiring an associate dentist is one of the biggest decisions a single-doctor practice owner can make. It’s not just about adding staff; it’s a strategic shift in the practice that impacts the culture, patient experience, cash flow, and the long-term value of the practice. Done correctly, bringing on an associate can fuel growth, reduce doctor burnout, and create a path toward partial or full transition. Done poorly, it can strain cash flow, disrupt staff morale, and lead to an expensive revolving door of short-term hires and potential loss of patients.
Why Hiring an Associate Is Such a Big Deal
For many solo dentists, the idea of hiring an associate is driven by a very real pain point: long days, full schedules, and the feeling that the practice can’t grow any further without help. That instinct is often correct, but the timing and structure matter tremendously.
An associate doesn’t simply “add production.” In the early months, they often reduce profitability as overhead increases faster than revenue. They also introduce new dynamics such as shared patients, staff, operatories, and decision-making. This is why associate hires fail so often—not because of clinical skill, but because the business and leadership foundations weren’t prepared.
Assessing Whether Your Practice Is Ready
Before focusing on who to hire, ask whether hiring makes sense right now. A practice is
generally ready for an associate when:
• The owner’s schedule is consistently booked several weeks out
• Hygiene is strong, productive, profitable, and well-managed
• New patient flow is steady and sufficient for more than one doctor
• Cash flow can absorb higher overhead for at least six to 12 months
If your practice still has significant unused capacity—empty chairs, inconsistent hygiene schedules, or weak recall systems, those issues should be addressed first. An associate will not fix foundational problems, instead they can amplify them.
Clarifying Your Motivation and Goals
One of the most overlooked steps is truly understanding why you want an associate. Different goals require very different associate models.
The expectations for adding another doctor can be problematic when parties are misaligned. For example, hiring an associate to “slow down” while also expecting rapid growth often leads to frustration on both sides. Being honest with yourself about your priorities allows you to design a role that actually supports the associate.
Understanding the Financial Implications
From a financial standpoint, hiring an associate is an investment and not a quick win. Key costs to consider include:
• Associate compensation (commonly a percentage of production or collections)
• Additional staff costs
• Increased lab fees and clinical supplies
• Credentialing, malpractice insurance, and continuing education
• Marketing costs to maintain or increase patient flow
Adding an associate with the proper production goals is critical. While there are multiple avenues to determine a production goal for the new associate, one common approach is to strive for the associate to produce roughly three times their total cost to the practice over the course of their first year. While this is not a hard and fast rule and will vary from practice to practice, it is a potential goal setting benchmark when modeling scenarios conservatively.
The practice owner should anticipate a ramp-up period once the associate is brought into the practice. Profitability may dip before it improves.
Patient Flow, Scheduling, and Case Distribution
Operational logistics can also be a pain point leading to failure in associate relationships.
Consider how:
• Patients will be assigned between doctors
• Whether the associate will see mostly new patients, existing patients, or both
• Hygiene exams will be divided
• Larger or more complex procedures will be allocated
If the owner retains all high-value procedures, the associate may struggle to produce and feel they are not getting the opportunity to learn and grow. If the owner gives too much production away, resentment can build. Transparent scheduling policies and intentional case distribution will help prevent these issues.
Leadership, Culture, and Team Readiness
When you hire an associate, you become a mentor and leader to your new doctor. Before you take this big step, ask yourself:
• Are systems and protocols documented, or do they live in your head?
• Are you comfortable giving feedback and setting expectations?
• Is your team ready to support another doctor?
The buy-in from your staff is critical. Assistants, hygienists, and front desk staff all feel the impact of an associate hire, and their attitudes will strongly influence whether the transition feels smooth or chaotic. Talk with your staff about the decision and create an open environment where they can bring both positive and negative feedback to you as the practice owner.
Clinical Philosophy and Compatibility
Clinical alignment matters more than many owners expect. Differences in treatment planning, clinical speed, or communication style can create tension with patients and staff. Before hiring, discuss:
• Treatment planning approach
• Expectations around speed versus thoroughness
• Use of technology and materials
• Philosophy on ethics and patient communication
You don’t need identical clinical styles, but you do need mutual respect and philosophical compatibility to protect the reputation of the practice and create harmony among staff and patients.
Contracts, Legal Structure, and Risk Management
A clear, well-written contract protects both parties and sets the tone for a professional relationship. Important elements include:
• Compensation structure and payment timing
• Termination clauses and notice periods
• Non-compete and non-solicitation provisions
• Malpractice coverage details
• Any discussion of future buy-in or ownership
Working with a dental-specific attorney can be essential. Generic employment contracts often miss nuances unique to dental practices and can cause a lot of stress, time, and money to unwind.
Planning for the End—Even at the Beginning
It may feel pessimistic, but planning for how the relationship could end can actually increase the odds of long-term success. Clear exit pathways help to reduce anxiety and prevent conflict later. It’s important to ask yourself:
• What happens if the associate isn’t a good fit?
• How patients and staff transitions would be handled?
• What does the path look like if the associate wants more responsibility—or less?
Final Thoughts
Hiring an associate dentist is potentially a defining moment in the life of a single-doctor practice. It can unlock growth, flexibility, and long-term value but only when approached with intention, clarity, and preparation. Rather than asking, “Can I hire an associate?” a better question is, “Have I designed a practice where an associate can succeed?” When the answer to that question is yes, the decision can become far less risky and far more rewarding.
The information provided is educational and general in nature and is not intended to be, nor should it be construed as, specific investment, tax, or legal advice. This reflects the opinions of Focus Partners or its representatives, and presents information that may change. This is prepared using third party sources considered to be reliable; however, accuracy or completeness cannot be guaranteed. Services and investment advice are only provided pursuant to an advisory agreement with the client. Services are offered through Focus Partners Advisor Solutions, LLC and Focus Partners Wealth, LLC (collectively referred to in this document as “Focus Partners”), SEC registered investment advisers. Registration with the SEC does not imply a certain level of skill or training and does not imply that the SEC has endorsed or approved the qualifications of the RIAs or their representatives. Prior to January 2025, Focus Partners Advisor Solutions was named Buckingham Strategic Partners, LLC, and Focus Partners Wealth was named The Colony Group, LLC. ©2026 Focus Partners Wealth, LLC and Focus Partners Advisor Solutions, LLC. All rights reserved. RO-26-5216218
About the author: Brian is a member of the Practice Integrated Wealth Management team, providing comprehensive financial planning services to help Focus Partners Wealth clients understand and achieve their financial goals. He is enthusiastic about working collaboratively to develop, implement, and monitor a plan that helps clients achieve their distinct objectives.