When Dentists Fire Dentists: What Associate Terminations Reveal About Practice Leadership

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Categories: Practice Transitions;
Posted: July 14, 2026
By Howard Farran, DDS, MBA

When Dentists Fire Dentists: What Associate Terminations Reveal About Practice Leadership

When a dentist fires another dentist, the story usually arrives with a villain already assigned.

The associate describes betrayal, inadequate mentorship, or a toxic office. The owner describes poor performance, patient risk, or a failure to meet expectations. Both accounts may contain truth, but neither usually captures the whole system that failed.

Most associate terminations are not caused by one bad crown, one missed canal, or one difficult conversation. They emerge from an accumulation of smaller problems involving clinical judgment, speed, documentation, patient communication, staff relationships, treatment planning, production, coachability, and trust.

That matters because owners often focus on the final incident instead of the pattern that made the final incident decisive.

A practice may remember the open margin that triggered the termination, but the deeper problem may have started months earlier. Expectations were vague. Feedback was delayed. The associate did not know whether the owner valued speed, conservative diagnosis, case acceptance, documentation, or all four. Staff concerns reached the owner indirectly. Frustration grew faster than clarity.

By the time the employment relationship ended, both sides had usually formed protective narratives. The associate believed the office never intended to mentor. The owner believed the associate could not improve. Staff believed they had been carrying the consequences. Each group noticed evidence supporting its conclusion and discounted evidence pointing elsewhere.

The firing itself is rarely the most important failure. The hiring process often is.

Many practice owners evaluate technical skill, personality, and availability, then assume the rest can be worked out later. Associates often focus on compensation, schedule, and procedure mix without asking what mentorship actually looks like.

Who reviews radiographs?

Who evaluates crown margins?

How are treatment planning differences resolved?

What happens when the associate is too slow, too aggressive, too conservative, or clinically uncertain?

How long is the learning period?

What specific performance would trigger intervention?

When those answers are missing, everyone fills the vacuum with assumptions.

Private practice also demands more than technical competence. A dentist may produce excellent dentistry and still struggle with patient confidence, case presentation, chairside leadership, time management, documentation, or team communication. Another dentist may produce quickly but create remakes, complaints, or overtreatment concerns.

Production alone is not the standard. Neither is perfection.

The owner needs evidence.

Useful signals include chart audits, remake rates, patient complaints, emergency follow ups, case acceptance, documentation quality, production trends, clinical photographs, radiographs, and observed improvement. A pattern matters more than a single case.

Feedback also needs to be specific enough to change behavior.

Telling an associate, “Your margins need work,” is not mentorship.

Showing representative cases, identifying the defect, explaining the clinical standard, observing the next procedures, and reviewing progress is mentorship.

The same principle applies to diagnosis and treatment planning. Dentists vary in restorative thresholds, risk tolerance, clinical philosophy, and case selection. Differences do not automatically indicate incompetence or dishonesty. The practice needs a structured way to separate legitimate clinical variation from unsafe or economically driven decision making.

Owners also need to recognize the power of first impressions. Once an associate is labeled weak, slow, difficult, or overly conservative, later improvement may receive less attention than new mistakes. The reverse is also true. An associate who starts strong may receive more patience when problems emerge.

That bias is human, but unmanaged bias becomes a personnel system.

Associates carry responsibilities as well. Mentorship cannot work without humility, follow through, and a willingness to examine uncomfortable evidence. A dentist who responds defensively to every chart review may become impossible to coach. At the same time, an owner who treats every question as insubordination will eventually create silence rather than improvement.

The best practices define success before the first patient is seated. They use structured onboarding, scheduled reviews, written expectations, objective case evaluation, and clear remediation plans. They separate clinical coaching from emotional frustration. They document what was discussed, what must improve, and when progress will be reassessed.

Termination may still become necessary. Patient safety, repeated clinical failures, dishonesty, poor judgment, or an irreparable breakdown in trust can make continued employment unreasonable.

But a firing should not be a surprise built from months of unspoken resentment.

For the owner, the final question is larger than whether the associate deserved to stay. It is whether the practice created a fair system for hiring, evaluating, teaching, documenting, and protecting patients.

A dentist firing another dentist is not merely a personnel event. It is a stress test of the entire practice.

Did the associate fail, or did the practice wait too long to discover that the relationship was never designed to succeed?

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Professional Ethics

American Dental Association. Principles of Ethics and Code of Professional Conduct. Section 2. Nonmaleficence.
https://www.ada.org/about/principles/code-of-ethics/nonmaleficence

Patient Dismissal and Continuity of Care

American Dental Association. Managing Patient Dismissal.
https://www.ada.org/resources/practice/practice-management/managing-patients-dismissal

Michigan Dental Association. Terminating the Dentist Patient Relationship and Avoiding Abandonment.
https://www.michigandental.org/legal-article/terminating-the-dentist-patient-relationship-and-avoiding-abandonment/

Texas Administrative Code § 108.5. Patient Abandonment. Legal Information Institute, Cornell Law School.
https://www.law.cornell.edu/regulations/texas/22-Tex-Admin-Code-SS-108-5

Practice Leadership and Performance Management

Society for Human Resource Management. Performance Management.
https://www.shrm.org/topics-tools/topics/performance-management

Institute for Healthcare Improvement. Quality Improvement Essentials Toolkit.
https://www.ihi.org/resources/tools/quality-improvement-essentials-toolkit

Organizational Psychology

Kahneman D. Thinking, Fast and Slow. Farrar, Straus and Giroux. 2011.
https://us.macmillan.com/books/9780374533557/thinkingfastandslow

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