Associate Dentist vs. Business Owner: Pros and Cons

[Doctorfish]

Hello everyone,

I just wanted to see what your thoughts are on being an associate dentist vs being an owner of a business. More specifically, what are the differences between an associate dentist, a dentist working in corporate, a dentist in a “group practice” and an owner dentist?

It seems Like being an owner is the most advantageous, but I feel as though I would be better off as an associate.Debt for owning a practice also scares me a lot and do not want to deal with financial burdens.Any estimates of associate salaries vs the owner dentist take home salary in an urban/suburban city in Florida?

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[Mauricio45]

I graduated in 2016. I've done both private office and corporations as an associate. I've never been owner but would like to own someday in future. I currently work part-time in a private office (2 days a week) where 90% of procedures I do is endo because owner doesn't do them. I also work in another office at a corporation as an associate for 3 days a week. Keep in mind, I work in Canada so I think corporation here is different than in States. Also, everyone has a different experience and it may not be the same for everyone. Here are the pros and cons based on my experiences for associateships in both private offices and corporations.




Pros of associateship in corporations

-opportunities to grow as a dentist doing high production procedures which would never happen in private office. Definitely get your reps in doing bread and butter dentistry compared to private offices.

-if multiple doctor office, staff doesn't usually favour one dentist over the other because neither doctor is signing their paycheque. We both get treated equally where I work. No patient poaching. However, sometimes my patient cannot schedule on a day I work, so they're booked with other dentist which can be a crummy feeling. But this happens also with the other dentist's patients when they're booked on my schedule. So, it "evens out".

- I work on the days where no other dentist is around and I'm the only dentist. It's a rewarding feeling when you walk into the office and staff respects you because you are the only doctor for the day.

-Relative autonomy. For the most part, I treatment plan things the way I want to do. No "my way or the highway". No production quota for the corp I work at. However, I do get occasional pressure from higher-up to produce more. But this can happen with private office associateships too. Private office associateships will boot you out the door too if you're under-producing.

-Do not have to deal with financial burdens of running an office. You collect paycheque and then go home.





Cons of associateship at corporation

- lack of control on materials used. Although, with more experience in the practice, you have more leverage and can ask for more.

-sometimes you get the production pressure from higher-ups. I.e. diagnose more crowns

-discourage referring out cases to specialists unless it's a procedure that is beyond a GP's scope. However, we tend to refer within the corporation to avoid losing money. I.e. where I work, I refer out the difficult extraction cases to owner dentist who comes to the practice 1x or 2x a month to do IV sedation cases or difficult extractions.

-lack of control over schedule. I.e. I work Saturdays and I hate working Saturdays. But I have no choice because it's not my office.






Pros of associateship in private office

-do not have to deal with financial burdens of running an office. You collect paycheque and then go home.

-POSSIBLE mentorship from owner. Though this is very rare. I have yet to see this.



Cons of associateship in private office

-lack of respect towards associate from staff since associate is not signing their paycheque. Associate is the bottom of the hierarchy in a dental office. It's a crummy feeling when staff openly puts down the associate and associate cannot do anything about it.

-lack of respect towards associate from owner. Owner will always favor his staff over associate. Owner often treats associate as an annoyance .

-lack of control in regards to materials and staff issues

- seen as a scut or "leftover" dentist. Staff books all the high production cases to owner (even if associate diagnosed it). Associate is stuck with all the breadcrumbs. Staff will never work hard for an associate

-No control over schedule. Although, I think this may vary depending on your relationship with the owner

-lack of growth. Usually cannot grow as a dentist in private office associateships because you're stuck doing "breadcrumbs" while owner does all the high production cases.






I think the only time private office associateships could work out is if the owner is close to retirement and you want to buy the office and you set up an arrangement with owner doc in regards to this. Or if you can do a procedure that owner does not do, it benefits both parties. I work like this currently where I do all the endos in the office because owner doesn't do any endos. It benefits me because I get practice on getting proficient in molar endos and it benefits owner because he doesn't have to refer out endo cases. Otherwise, private office associateships are mainly slavery.

 

[CharlieAF]

I think the debt of buying an existing practice is often manageable as long as the practice is relatively profitable.

I worked for a few years as an associate, and then bought a practice from a retiring dentist (different office). The single-doctor practice was producing just over 1M a year in a rural Midwest area. The debt service was totally doable, and now the practice is entirely paid off, with the exception of 100k left on the building mortgage.

I was blessed to buy a practice with loyal patients and staff, in an area with very little competition. There were times it was stressful, but I don’t regret it at all. I have total autonomy and I sleep like a baby.

That being said, I think the ultimate answer depends on WHERE you want to practice. I’m in an area with no corporate dentistry, and no large practices. People want and expect a “lifetime” dentist. They value that more than cost, in most cases. It’s a typical small town, with three traffic lights.

I hear stories from friends/classmates in areas like LA, NYC, and their environment is drastically different, due to over-saturation and corporate competition. So I think you need to really look at where you want to live/practice and what’s feasible in that area.

I have a lot of friends in Florida. I get the sense that competition in urban/suburban areas is kinda fierce.

 

[charlestweed]

Being a practice owner allows you to do things that you can't do when you work as an associate such as setting your own working hours, lunch hour, patient scheduling, staff hiring/firing, instruments and supplies. Owning a practice, however, doesn't neccessarily guarantee that you will be happier and earn more money. I've seen a lot of older docs who sold their practices and went to work for the corp offices for better income and fewer headaches associated with running a practice. These older docs no longer produce the same income that they once did when they were younger. In order to maintain the same level of success as a business owner, you have to spend a lot of time to manage it. As soon as you let the outsiders (your office manager, associate dentists, consultant etc) manage your office, it will decline quickly. The staff become lazier when you are not present at your office regularly. Patients choose you because of your good reputation. When you are not at the office regularly to take care of them, they will go see another doc.

I've also seen young docs who made poor decisions in purchasing an existing office or spent too much money to build an office from scratch. They were not able to attract enough patients to pay for the high overhead. They gave up and went back to work for the corp or for another practice owner.

I too was scared of taking out additional loan to open my practice when I was a new grad. Like many new grads, I rushed for immediate gratification. I leased nice cars, bought a house......and worked 6 days/wk to pay for these shinny new toys....and life was good. I had worked for the corp for 4 years before I finally had the courage to start my own office from scratch. With close to $1 million in debt ($450k student loan, $380k home loan, 2 leased cars etc), I didn't want to take too much risk. I had $55k in my saving (for rainy days) and I took out a $75k business loan to build a small 1350sf ortho office from scratch. I didn't want to downgrade my lifestyle so I continued to work F/T for the corp and worked at my newly built office, which didn't have a lot of patients at the beginning, on Saturdays and Sundays. As my office got busier, I slowly cut my associate days at the corps and only worked part time for them. Currently, I work at my own office 12 days/month and 11 days/month for the corp. It's the best of both worlds: when my office doesn't produce much during the slow months between Sept-Jan, I still have a fixed steady income from my P/T corp job. Being an owner, I get to decide when I want to work.... 8am-noon onthe weekends and 2-6pm on weekdays. Low overhead is key....when you have fewer bills to pay, running your own office becomes more enjoyable.

 

[deleted954913]

Being a practice owner allows you to do things that you can't do when you work as an associate such as setting your own working hours, lunch hour, patient scheduling, staff hiring/firing, instruments and supplies. Owning a practice, however, doesn't neccessarily guarantee that you will be happier and earn more money. I've seen a lot of older docs who sold their practices and went to work for the corp offices for better income and fewer headaches associated with running a practice. These older docs no longer produce the same income that they once did when they were younger. In order to maintain the same level of success as a business owner, you have to spend a lot of time to manage it. As soon as you let the outsiders (your office manager, associate dentists, consultant etc) manage your office, it will decline quickly. The staff become lazier when you are not present at your office regularly. Patients choose you because of your good reputation. When you are not at the office regularly to take care of them, they will go see another doc.

I've also seen young docs who made poor decisions in purchasing an existing office or spent too much money to build an office from scratch. They were not able to attract enough patients to pay for the high overhead. They gave up and went back to work for the corp or for another practice owner.

I too was scared of taking out additional loan to open my practice when I was a new grad. Like many new grads, I rushed for immediate gratification. I leased nice cars, bought a house......and worked 6 days/wk to pay for these shinny new toys....and life was good. I had worked for the corp for 4 years before I finally had the courage to start my own office from scratch. With close to $1 million in debt ($450k student loan, $380k home loan, 2 leased cars etc), I didn't want to take too much risk. I had $55k in my saving (for rainy days) and I took out a $75k business loan to build a small 1350sf ortho office from scratch. I didn't want to downgrade my lifestyle so I continued to work F/T for the corp and worked at my newly built office, which didn't have a lot of patients at the beginning, on Saturdays and Sundays. As my office got busier, I slowly cut my associate days at the corps and only worked part time for them. Currently, I work at my own office 12 days/month and 11 days/month for the corp. It's the best of both worlds: when my office doesn't produce much during the slow months between Sept-Jan, I still have a fixed steady income from my P/T corp job. Being an owner, I get to decide when I want to work.... 8am-noon onthe weekends and 2-6pm on weekdays. Low overhead is key....when you have fewer bills to pay, running your own office becomes more enjoyable.

Awesome response, Charlestweed. Lovely to have this kind of insight from a veteran in the field. I know many young associates/recent grads mulling over these questions and dilemmas. Quite a stressful situation to be in!

 

[2TH MVR]

Having been a practice owner and now an employee at a Corp. It comes down to one thing.

When business is GOOD (leasing 911 turbos every 3 yrs, vacation homes, boats, etc) then dealing with all the endless issues with owning and managing a private office is fine. When you are making plenty of money .... you are more than compensated for all your headaches. Private practice under these conditions is fun. You don't mind all those extra hours and effort. And it is alot of extra effort.

When it gets to the point that business is plateauing or decreasing (this inevitably happens as you get older) and you are still working as hard ..if not harder ..... then being an employee might not be that bad. Consider that if you maintain the same course (decreasing production) .... your practice will be worth less and less as the years go by. I sold my ortho practices when they were still valuable and I have zero regrets.

Generally speaking. If you are young and full of energy. Find the right location and own your private practice. The rewards will be much higher as compared to being an employee. Many perks to private practice. I expensed alot of stuff through my private practice 🙄 .

There will be outliers (making bank) in both arenas (ownership and associateship/Corp). The employee orthodontist I replaced (he moved to another state) at the Corp I work at .... was working 6 days a week for the last 7-8 yrs. With his daily salary and bonuses .... he was making as much if not more than what I made in private practice. He worked 6 days. I worked 4 days per week.

 

[CharlieAF]

Many perks to private practice. I expensed alot of stuff through my private practice 🙄 .

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