Friday, October 19, 2012

More Questions Than Answers

FRIDAY! Nice, huh? I have big weekend planned; I’m taking my boys to the Gator game on Saturday. Hope things are well with you.

I still really love Shark Tank. I think it is a Friday show, but we watch in on Wednesdays because that is a day we are usually home. This Wednesday, we ate dinner and then everyone piled into the van and went for ice cream. Then we came home and watched Shark Tank as a family. We talked about people's ideas and about how mean the Sharks were being to the people and to each other. We talked about what it takes to make a small business happen. I think it is good for my kids to see something like this. It definitely gets their entrepreneurial juices flowing.

I want to talk to you today about having associate. As you know, I am the sole owner of the practice and my father is now my associate. This has brought about some challenges that I want your advice on. I know I am not the only one going through this. If you are not going through this, make sure you listen because you may go through it in the future. I my case, my father says he wants to work one more year. At first, this seemed like a long time. It isn't.

You might buy out a dentist who is late in their career. It is a great practice and you want him/her to work there for a year or two to not scare off the staff and the patients. Or maybe you plan on bringing in a young associate.

Let’s say a new patient calls. This patient hasn't been referred to your practice. He is a father who just moved into the neighborhood and keeps driving by. He has a wife and three kids. Do I let the associate see them, knowing he is leaving in a year? Would you have a young associate see them? New to the practice, just getting his feet wet, you don't even know if this young dentist is going to work out.

What about the older patient that was referred by a friend to my father? Slam dunk. My dad will see him. The guy is missing a couple teeth and wants to get implants. He needs a bone graft then implants placed. By the time the implants are integrated, there is a good chance my dad is going to be gone, so I might be finishing this case up. But my dad uses a different periodontist than I do. I don't even know what implant he uses.

These are valid issues. We talked this week about him sending his patients to my periodontist. It is not that I don't like his periodontist. I just like mine better. I have a relationship with him, and I know I can just pick up the phone and talk to him. It is the same with my orthodontist.

This is no different than if a middle aged dentist were to bring in a young guy. Does the young associate only get emergencies and their family? Remember, the associate, regardless of age, is working off of production; they want all they can get. But is it right for the patient to get used to a dentist and then have them leave in less than a year? Is it right for the health of the practice?

As I write, this I am thinking about the future. Does the patient come to a practice because of the dentist? I know all of us think they are there because of us. And I agree with you, kind of. How many times do you hear about a patient following a hygienist? How many times do you hear that a patient liked the dentist but left because the front desk was terrible?

I think people come to my office for a lot of reasons. There are friendly faces when they walk in and a warm reception area. We don't make you wait. The hygienists are sweet and gentle. People like the way we handle the checkout. We call the next day to see how you are doing. It is the whole experience.

The dentist is part of it, whether that is me, my dad, or an associate. If my dad meets a new patient and a I slip in after a year, only one of the many good things in our office has changed. I think this is what I am going to go with. My dad still sees new patients, but I try to make sure they see me. I will walk by his operatory, introduce myself, and welcome them. I poke my head in and ask them if everything is okay. I make a joke and then move on.

What do you think? Have you had an associate? Have you been an associate? What were the arrangements?

Have a great weekend.


P.S. Go Gators!

P. P. S. On Monday we are having a team-building experience. I am taking all my staff to a local gun shooting place. They have virtual shooting ranges, with bad guys popping up and stuff. They use real guns that have kick but only shoot lasers. Then we are going to have lunch. I am so looking forward to it. It should be lots of fun.


Dr. Andy said...


There are two ways to avoid many of the problems you are facing.

1) When you buy the practice the previous owner finishes up on Friday and you start on Monday. Come monday he/she is no longer at office. I did this when I bought my practice and I avoided most of the problems/dilemas you mentioned.

2) Pay your associate a salary. Again, this avoids the dilemas of who gets what procedures. Both lives will be simpler and happier.

Good move on poking your head into the operatory. Makes patients feels like they've "seen" you.


Dr. Tom Reed said...


I concur with Andy. The longer the selling doc hangs around, the more difficult it is to really get the transfer to work smoothly. Patients, staff, etc are used to the seller's presence and are generally surprised when the retirement card gets played.

As far as associate arrangements are concerned, my feeling is the owner doc needs to define what they are expecting the associate to fulfill for the practice. Soak up the overcapacity in the current schedule, expand the practice, add in an equity player, etc. Then pay them a salary to start with a move to production based compensation. When structured equitably for both entities, it becomes a win-win. I always like to define a path to equity upfront with an associate candidate, because it sets the tone of commitment and longevity. Most want it deep down inside but are often scared by the numbers.

Associates need to define for themselves: are they looking to "rent or buy the house". With stuedent loan indebtedness reaching epic levels, long term asssociateship may seem like a good conservative play. However, I feel this scenario lends itself ultimately to an economic shortfall for the associate, diminshed motivation, higher frequency of failure.

I think you need to tell your father it is time to go enjoy life outside of dentistry, and then you secure a top tier, younger associate to mentor and ultimately buy in.

Good luck!



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