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Job 101: What They Didn’t Teach You in Dental School by Thomas D. Kohn, Esq.

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Congratulations on your graduation! To get this far, you have worked hard and learned many new and exciting things. You have invested countless hours, hard work and tuition dollars to be the best dentist you can be. At some point in your dental education, you knew all of the cranial nerves and, unless you went into endodontics, you also once knew how to spell gutta percha.

A large percentage of this graduating class will be moving on to work at a private practice in some fashion. In my experience, many dental schools fail to teach their students the basics needed to intelligently enter into their first employment agreement. In all fairness to the dental schools, however, even if they conducted courses for this purpose, you most probably (1) would not have paid attention or (2) probably did not pay attention or forgot. So, class, welcome to the nuts and bolts of your first job in private practice.

In a nutshell, the purpose of an employment agreement is to establish the terms and conditions of employment for an associate, set out the terms of compensation and benefits, and provide for the termination of the relationship and restrictions on competition in the event the relationship is terminated. In certain cases, the employment agreement can be used to set out the terms upon which you may become a future partner.

As you read this, please keep in mind that all private practices are not created equally. Even within a single specialty, some practices are large, others are small; some practices have affluent patient bases, others not so much; some practices are dependent on insurance, others are wholly fee for service; some practices are looking to enter into long-term relationships and others have a history of retaining associates for only a year or so and then moving on to the next. Also know what you, the associate, want from your first job. Are you looking to settle down in the area or are you planning to move on in a few years? Do you want to own a practice eventually or will you be content working for someone? Are you seeking a long-term growth opportunity or a short-term “big time” salary? While it sounds trite, the best employment relationship is a “win-win,” where the expectations are clear, consistent and understood. If you can identify and understand what both the employer and employee are looking for, you will be in a good position to be successful.

Employee vs. Independent Contractor
The first question in this discussion is: Are you an “employee” or an “independent contractor?” For most purposes, the real difference between the two terms is not terribly significant for the associate. Without going into the formal test, an employee is typically defined as a full-time worker for the practice with the practice having control over when, where and how the associate will provide professional services. In contrast, an independent contractor is more likely to be a part-time or multi-job worker who will come and go on a schedule that is mutually agreed upon from time to time between the associate and the practice.

Tax-wise, an employee is subject to withholding from each paycheck, receives a Form W-2 at the end of the year and the employer must contribute to FICA and social security on behalf of the employee. An independent contractor is paid without prior withholding and must plan to withhold and pay taxes, social security and FICA on his or her own. At the end of each tax year, the independent contractor will receive a 1099 form showing all compensation from the practice. Finally, practices, in many cases, are only required to offer participation in health, pension and other benefit plans to full-time employees. If you are an independent contractor, these costs must be part of your calculation.

Decoding Employee Agreements
Within the Employment Agreement, there are a number of specific terms and conditions which may seem innocuous but are highly relevant in ensuring your first job is both properly enriching and, ultimately, a fair and reasonable first step towards a successful career. This article does not attempt to fully discuss all of the different issues and nuances. If you are going to negotiate an Employment Agreement, plan and budget to retain an attorney and an accountant to help you. I will, nonetheless, try to highlight a number of specific issues and questions that you need to raise and discuss when applying for a job with a private practice.

Term: What is the duration of your agreement to work for the practice? Most employment relationships are “at will” unless the written agreement states otherwise. This may sound trivial, but imagine a situation where an associate is “at will” and terminated with two weeks’ notice. The odds will not be in your favor if you are trying to find a new job in such a short time period. Negotiating a longer termination period or a severance package are important alternatives to preventing this result.

Work Duties and Schedule: How many days a week are you expected to work? Are there nighttime hours? What is the schedule for “on call” and other emergencies? Will you be responsible for any specific type of procedures? These questions allow you to understand what the time requirements will be and what expectations the practice will have for you.

Compensation:. Why do we work? To get paid, of course. What compensation will you be paid in exchange for your services? There are many options, but the two most popular options are: (1) a base salary, or (2) payment based on a percentage of the fees generated by your work – either production or collections. While there is sometimes a bit of confusion with regard to these terms, don't despair. Production means the total amount of fees you have produced for the practice, without reduction for uncollectible fees or insurance write-offs. Note that some practices include the write-offs in the production calculation, so make sure this is clear. Collections means the total amount of fees the practice actually collects from the patients for whom you performed services and their insurance companies. If the patient does not pay, you do not get paid.

Benefits: What are the benefits and expense reimbursements available? Will your employer pay for malpractice insurance? What about health insurance? Continuing Education? The annual “seminar” held at the St. Johns Diving Academy (probably not)? Are you qualified to participate in a retirement plan? Will you be reimbursed for tools of your business such as the use of your car, smartphone and data plans? Finally, what about business entertainment expenses. In many cases, the practice encourages you to help “build” the practice and find new referral sources. If this is the case, what type of reimbursement will you receive?

Termination and Restrictions: As important as the terms and conditions of your employment, the terms of the termination of your employment may be just as important. What if things “just don’t work out” or you are told to move on? What if your Dr. Jekyll has turned into Mr. Hyde? Severing the relationship in a time and manner that gives you the time and opportunity to find new employment is crucial.

Another very important component of most agreements is the restrictive provisions that go into effect upon termination of employment. The practice should also be aware that, if you leave, you could take patients and damage the practice. Smart doctors are always careful about protecting the practice. Two types of restrictions are most prevalent – non-solicitation and non-competition. Non-solicitation means the associate agrees not to solicit or induce any patient of the practice for treatment or consultation by the associate. While, in theory, this makes sense, in practice, it is difficult to enforce. In a world of the Internet, social media and other forms of mass advertising and communication, it is nearly impossible to prove that the associate “solicited” the patient. Moreover, many states have refused to enforce this type of a contract provision if it means the patient will not be able to use the practitioner of his or her choice.

Non-competition provisions, however, are much more effective. Typically, these provisions will bar the associate from, directly or indirectly, practicing within a fixed mile radius of any office of the practice in which the associate rendered services. While the area of the restriction may vary from rural to urban areas and in relation to population density, the general concept is sound – most patients like the convenience of a local practitioner and will not travel long distances to follow the associate. For an associate who has spent a number of years building contacts and creating a network of patients and referral sources, this restriction can be a real game changer. Be sure to pay attention to the restricted area. Take the time to call it up on Google maps (or even a paper map if you can find one) and look at the area. Can you carve out certain population centers or limit the restrictions to areas that are not truly competitive with the practice?

Future Events: Beware of the promise of future partnership! I know it would be really nice to believe, on your first day, that the practice “loves you, wants you, needs you” to be a future partner. Unless the practice is owned by your mom or dad, any such promises are simply smoke and for very good reason. How can either the practice or the associate know that they are a good fit until they have worked together? Why would the practice make this commitment without being sure you are the “one”?

As an alternative, attempt to set up the boundaries and criteria required to become a partner in the practice. For example, what are the production hours needed or number of new patients you need to bring into the practice? Can you set some sort of time limitation for conversations and negotiations regarding potential partnership, which will allow you to determine whether the practice is serious about you becoming a partner? Some practices will give indications of interest but can’t pull the trigger. If the time passes and nothing is happening, you may be wasting valuable time that could be spent elsewhere.

In conclusion, if you remember anything from this article, remember that, after getting through countless years of classes, having to work with cadavers and, in all likelihood, running up a significant student loan debt, the first job can either be the start of a successful career or a dead-end that can set you back many years and dollars. Don’t let a lack of knowledge and experience hold you back or put you in a bad position. With a little planning and assistance, you can make a fair deal with long-term satisfaction.

Author's Bio
Thomas Kohn is a member in the firm of Adelberg, Rudow, Dorf and Hendler, LLC, in Baltimore, Maryland, and is part of the firm’s Healthcare Professionals Practice Group. Kohn was previously a partner with Lenrow, Kohn & Oliver, a law firm he co-founded in 1995. He has consistently been selected as a Maryland “Super Lawyer” in the area of Business and Corporate law, an honor afforded to only five percent of Maryland attorneys each year.

Kohn devotes a significant portion of his practice to working with private health care providers, specifically dentists and orthodontists, to develop fair and efficient strategies for the profitable creation, operation, management and, ultimately, sale of professional practices. Kohn assists clients with practice formation, partner relations, hiring of associates, practice growth and management, purchase and sale of existing practices and startups of new or expanding practices.

He is married to Dr. Shari C. Kohn, a Pediatric Dentist in private practice in Hunt Valley, Maryland. Together, they are raising their two children, Rachel and A.J., and Penny, their Golden Retriever.
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October 2025
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