What’s it like working as an private practice associate/DSO associate?

[Doctorfish]

I would like to gain some insights from practicing dentists who are associates. I am more interested in the work/life balance and the working conditions but the more detail, the better (salary, anecdotes, struggles, benefits, etc).

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[nobeldds]

Associateship experience varies significantly from office to office.

On one hand, you may end up with complete autonomy and respect. Setting your hours, deciding what types of cases you do, what materials you use, and what support staff gets hired. You can leave and forget about your work when the clock strikes "X" and may have the freedom to terminate your employment "at will" with no expectation to return to the office. You could be paid a generous base salary regardless of the work you complete.

On the other hand, you may be forced to work set hours, weekends and be available for after-hours emergencies. You may be expected to complete all treatment a patient is willing to pay for that day even if you need to stay working hours after closing. You may be disrespected by support staff, and pressured to use limited materials/labs and failing equipment to save on costs. You may be stuck in a year-long contract, and end up in situations where you work long hours for zero pay.

I have seen both situations, and they exist among both PP's and DSO's. It is hard to find an associateship like the first example where you also end up with a higher than average income.

 

[Doctorfish]

Associateship experience varies significantly from office to office.

On one hand, you may end up with complete autonomy and respect. Setting your hours, deciding what types of cases you do, what materials you use, and what support staff gets hired. You can leave and forget about your work when the clock strikes "X" and may have the freedom to terminate your employment "at will" with no expectation to return to the office. You could be paid a generous base salary regardless of the work you complete.

On the other hand, you may be forced to work set hours, weekends and be available for after-hours emergencies. You may be expected to complete all treatment a patient is willing to pay for that day even if you need to stay working hours after closing. You may be disrespected by support staff, and pressured to use limited materials/labs and failing equipment to save on costs. You may be stuck in a year-long contract, and end up in situations where you work long hours for zero pay.

I have seen both situations, and they exist among both PP's and DSO's. It is hard to find an associateship like the first example where you also end up with a higher than average income.

I appreciate the reply! Would you say that a salary of $130K is fair to expect? Or how much of a salary cut are you talking about

 

[Alpha Centauri]

I appreciate the reply! Would you say that a salary of $130K is fair to expect? Or how much of a salary cut are you talking about

500/day is standard

 

[nobeldds]

I appreciate the reply! Would you say that a salary of $130K is fair to expect? Or how much of a salary cut are you talking about

$130k is not fair, it is below what you should expect if you are working full time, even in saturated areas. In a dentist saturated market like Southern California, you will be offered daily minimums between 500-700/day ($125k-175k). A daily min less than 600 ($150k) for someone with at least one year of experience would be considered a red flag. I would say that an average associate dentist in Southern California makes $800/day, some make a lot more. The hard part is finding one location that could employ you at that rate full time...

 

[PerioDont]

Idk exactly how accurate this is, but I've also heard that 90% of associates leave with in a year.

Sometimes the job sucks, sometimes the owners, sometimes there is not enough pts, sometimes you only get the worst pts, can't choose your materials/schedules/employees. Fundamentally I think people who have been in school for 8 years are not well suited to have a HS grad office manager telling them what to do.

most of us are better suited to work for ourselves in the long run, though its becoming less common with DSOs there are still many, many successful single doc owned private practices. personally, I'd much rather make 120k as my own boss than 150k under someone else as I want my own flexibility. you can definitely make 130k as an associate and can double that with the same amount of dentistry as an owner.

 

[Mauricio45]

There are very few reasons to keep a successful private office associate. There are as follows:

1) owner is close to retirement and associate is looking to buy out.
2) 50/50 partnership and it's pre-arranged in contract
3) owner is not present in the office. I.e. A satellite office that associate works out of.
4) associate can perform high-yield procedures owner cannot do


Other than that, no real reason to keep an associate in private offices. Alot of owners bring them in for selfish reasons, so they can take time off and cherry-pick all the high-production cases away from associate. Staff will never work hard for "just an associate". Keep in mind , it's extremely rewarding for staff to put down an associate doctor who is not their boss and knowing the owner will back them up always (I.e. signing their paychecks). It's harder for owner to hire long-term good-quality support staff; whereas, associates are a dime a dozen and they usually leave anyway.

Despite reputation of corps, at least you develop your speed and reps in. And get to do high productivity cases. Some corps actually allow for autonomy. They do exist. These things are rare for private office gigs.

The best is to own but that comes with its own stress. I think if you can find an associateship job where you have autonomy, make good money and have proper support from staff, that can be better than owning. Alhough it's very rare to find this kind of associateship opportunity. Most of them suck.

 

[frozenicecreamDMD]

most associate positions suck because the previous associates quit for some mentioned reasons above and the new associates join and realize ---well it does suck.

I have a short stint at a private office position whose owner owns 4 offices and have lost associates in all four offices due to extremely poor management. it gets so bad he hires temp dentist 2-3 weeks at a time. I am sure all his offices are bleeding red for a loss every month but with government PPP program he may break even. He constantly ignores my messages, does not communicate, and put all power in his office managers who micromanage and are lazy. Schedules fall apart on a daily basis and instead of figuring out the true cause, they blame it on some external factor (ridiculous? yea, some ex of factors they blame are: it is Monday today, it is Friday today, it is raining outside today)

I quit this after 2 months. The owner even dares to with-hold my last check because I did not give him a 30 day notice (thou my current contract with him already expires and it does not have auto-renew clause aka I can leave when contract expires with no obligation)

the DSO associate I am at is good so far except some mad patients (mostly pedo patients' parents/grandparents who get mad because of their kids' misbehaviors). Hours are set before but pretty okay, 38 hours a week with 5 hour saturday per month. typical 9-5/10-6pm schedule. office manager is trained well not to ever cross my decision and she trains the assistants pretty well to work together. However, the office has complete turn over of assistants and I, a new grad (a year exp), have to work with brand new dental assistants who never work a day assisting in dental field. It's been a huge struggle training them and do dentistry but after 2 months, things change for the better.
Pay is 13k monthly guarantee base with 30% adjusted production monthly whichever is higher. But been here for almost 5 months, I always hit above my guarantee (20% above at least)
The down side/upside (depending on perspective) to work for DSO as a solo doc (in my current situation) is you have to be well versed in a variety of procedures that dental school grads of some schools I recently find out are not capable. Examples are: pulp/ssc, molar endo (straight forward), endo/BU/Crown prep in same appt, quadrant fillings in short time (3 adjacent class 2 in 30 min from A-Z).
contract is 2 year with 90 day termination notice and penalty for liquidated damage (10k) if I leave before 90 day.

I so far enjoy my time at the DSO job. It is a small DSO that has less than 30 offices so almost it is a private practice style?. I learn a lot.

Hope this helps answer your questions.

Remember, dentistry is a skills based jobs. your income is correlated to your skills to do procedures not your skills to diagnose like some specialties in medicine. thus, there is a wide range of income.

 

[Mauricio45]

Having a good quality assistant or hygienist with no "diva" attitude really makes a big difference. Otherwise, it adds unnecessary stress to an already difficult job. That tension spills over on patients and they easily pick up on that conflict. I can't perform my job effectively when there is tension in the office. Not a good situation to be in at all.

Personality >>>>> skills. Skills can always get better but a rotten attitude can't change.

 

[PerioDont]

most associate positions suck because the previous associates quit for some mentioned reasons above and the new associates join and realize ---well it does suck.

I have a short stint at a private office position whose owner owns 4 offices and have lost associates in all four offices due to extremely poor management. it gets so bad he hires temp dentist 2-3 weeks at a time. I am sure all his offices are bleeding red for a loss every month but with government PPP program he may break even. He constantly ignores my messages, does not communicate, and put all power in his office managers who micromanage and are lazy. Schedules fall apart on a daily basis and instead of figuring out the true cause, they blame it on some external factor (ridiculous? yea, some ex of factors they blame are: it is Monday today, it is Friday today, it is raining outside today)

I quit this after 2 months. The owner even dares to with-hold my last check because I did not give him a 30 day notice (thou my current contract with him already expires and it does not have auto-renew clause aka I can leave when contract expires with no obligation)

the DSO associate I am at is good so far except some mad patients (mostly pedo patients' parents/grandparents who get mad because of their kids' misbehaviors). Hours are set before but pretty okay, 38 hours a week with 5 hour saturday per month. typical 9-5/10-6pm schedule. office manager is trained well not to ever cross my decision and she trains the assistants pretty well to work together. However, the office has complete turn over of assistants and I, a new grad (a year exp), have to work with brand new dental assistants who never work a day assisting in dental field. It's been a huge struggle training them and do dentistry but after 2 months, things change for the better.
Pay is 13k monthly guarantee base with 30% adjusted production monthly whichever is higher. But been here for almost 5 months, I always hit above my guarantee (20% above at least)
The down side/upside (depending on perspective) to work for DSO as a solo doc (in my current situation) is you have to be well versed in a variety of procedures that dental school grads of some schools I recently find out are not capable. Examples are: pulp/ssc, molar endo (straight forward), endo/BU/Crown prep in same appt, quadrant fillings in short time (3 adjacent class 2 in 30 min from A-Z).
contract is 2 year with 90 day termination notice and penalty for liquidated damage (10k) if I leave before 90 day.

I so far enjoy my time at the DSO job. It is a small DSO that has less than 30 offices so almost it is a private practice style?. I learn a lot.

Hope this helps answer your questions.

Remember, dentistry is a skills based jobs. your income is correlated to your skills to do procedures not your skills to diagnose like some specialties in medicine. thus, there is a wide range of income.

I'm sorry you had such a rotten first associateship. maybe you could get a small claims court to get him for your last check? might not even be worth the headache.

could you share a little more about your DSO job? How many chairs are you running, how many hyg are there and are you a solo doc? How many doc and how many hyg pts are you seeing per day?

Additionally, do you feel pressured to produce, esp with that time range? I am in my D4 year, and confident in saying I could not do 3 adjacent class 2s in 30 min. I've done a total of 14 Class 2s on real people. sadly, this is one of the highest in my whole class.

from your statement about DAs, I assuming you also do not have EFDAs?

 

[Mauricio45]

I've been out for 5 years and I can't do 3 adjacent class 2s in 30 minutes, lol. And I work for a corp.

The corp I work has 2 docs. The other doc works Monday to Wednesday, and I work Thursday to Saturday.
I work out of 2 chairs (columns) with 2 assistants with 2 hygiene columns. But Saturdays I work out of 1 chair with 1 assistant but still 2 hygiene columns. I would say I see 8-12 pts per day with no official lunch break. However, Saturday is much lighter, often times 3-5 pts. Often times, Saturday is a chill day and pts frequently cancel on Saturday (I don't want to be busy on a Saturday). My schedule is a "dovetail" configuration. For example, numb one patient for a class 2 composite, and then go to next room to do a simple extraction. And then come back to finish class 2 composite. Can be tough but it makes the day go by faster this way. The only time I don't dovetail is during difficult and more challenging procedures or challenging practices (I.e. molar endos). Usually 12-15 hygiene patients per day.

My corp has never given me grief for referring out cases. Owner dentist comes to our office 1-2x a month to do difficult exos that I don't want to do and he also does IV sedation. If I want to refer a screaming, non-cooperative child to pedodontist, they don't give me grief over it.

I also work a 2nd office on Tuesday and sometimes Wednesday at a small private office office doing endos that owner doesn't do.

 

[frozenicecreamDMD]

I'm sorry you had such a rotten first associateship. maybe you could get a small claims court to get him for your last check? might not even be worth the headache.

could you share a little more about your DSO job? How many chairs are you running, how many hyg are there and are you a solo doc? How many doc and how many hyg pts are you seeing per day?

Additionally, do you feel pressured to produce, esp with that time range? I am in my D4 year, and confident in saying I could not do 3 adjacent class 2s in 30 min. I've done a total of 14 Class 2s on real people. sadly, this is one of the highest in my whole class.

from your statement about DAs, I assuming you also do not have EFDAs?

Let me clarify, these adjacents class II are pretty ideal class II not blown out near pulp class II. I mean 30 min is from the time i start drilling to the time I finish restoring in one seating. does not include set up, break down, numbing, socializing, etc. It is possible with direct vision and sharp burs and cooperative patients.

The ex-boss actually paid me but after he gave me grief about patient abandonment and lectured me how I should be professional next time around. Oh, and he deducted lab bill (which was stated on the contract) but never show me the cost of lab bill and the deduction. strangely, I worked out of 2 of his offices then and the % of lab bill is the same. So he must just deduct an arbitrary % of lab bill. Dental world is such a small world so I am sure others know this as well.

I am the solo doc in the office with no hygienists. There is no other doc in the office. I do hygiene as well. The population is pretty healthy so not that much active perio. The office has 4 chairs but mostly 3 chairs are used, rarely 4th chair is used unless for limited/fast delivery. I usually run one treatment column and one or two hygiene column.

For treatment patient, I see probably around 6-7. For recall/hygiene patient, around 10-11. For quick visual exam/limited, probably 3-4.

I actually improve over my time frame as I work. Keep in mind this time frame is for the most optimal situations and the best case scenario. I do not hit it at all time. Probably around 30% of the time. I do feel a little pressure to produce (any job in private practice or corp gives this) but it is mostly me because I want to be more efficient. I guess my average time for a class II is around 20 min. I do not carve out tertiary anatomy on class II like insta god. I make sure it has closed margin, no overhang, good interproximal contact, and good occlusion.
So far, the corp gives me no comment about my production or my treatment plan.

I have done around 40 class II in dental school, but many many BUs, class I, III, IV and V. My total restorations on live teeth are around 200.

Yes I do not have expanded function DA. They are very limited in experience as they mostly suction and can't even hand me instrument I need. I have been training them slowly and it is getting better (fingers crossed).

as you probably know, dentistry is about the procedure quality. you can sit around all day and do 3 crowns cash in 4 hours and get paid more than do 20 fillings with medicaid fee schedule. Restorative (fillings) is not everything you will do or you will burn out really fast. Try to do more difficult procedure and learn from there so your time is more efficiently spent. There are too many medicaid mill who churn out restorative work that I am surprised to see. Like they do not finish the composite. the class II composite look like a square box with over hang.

 

[frozenicecreamDMD]

and my DSO job right now, they fired the ex-associate dentist and brought me on. so my guess was I would not even last long given a new grad and rumors about how DSO run the offices. I had many mixed feelings about this job before and during my first few days there. With complete staff turn over, patient complaint about changing dentist, I feel I survive the hell break loose stage of the transition. I am trying to hold it together so this will not happen again.

But compared to my previous associateship, anything is better so I am like I will just work here for a few months if I get fired I will have some money at least to buy a start up practice in the worst case scenario.

I do agree personalities matter a lot, way way more than skills. The assistants I have now have great personalities so I have been training them slowly. There is no drama or diva attitude.

This may be taken the wrong way but I feel if you pick dentistry, your end goal is to have a comfortable living and good retirement while practicing ethically of course. You have to pay down your student loan debt, your living expense, and future practice debt. There is no shame in wanting a high salary and hustle in the beginning. Just make sure you do things ethically and hard work will pay off.

 

[yappy]

There are very few reasons to keep a successful private office associate. There are as follows:

1) owner is close to retirement and associate is looking to buy out.
2) 50/50 partnership and it's pre-arranged in contract
3) owner is not present in the office. I.e. A satellite office that associate works out of.
4) associate can perform high-yield procedures owner cannot do


Other than that, no real reason to keep an associate in private offices. Alot of owners bring them in for selfish reasons, so they can take time off and cherry-pick all the high-production cases away from associate. Staff will never work hard for "just an associate". Keep in mind , it's extremely rewarding for staff to put down an associate doctor who is not their boss and knowing the owner will back them up always (I.e. signing their paychecks). It's harder for owner to hire long-term good-quality support staff; whereas, associates are a dime a dozen and they usually leave anyway.

Despite reputation of corps, at least you develop your speed and reps in. And get to do high productivity cases. Some corps actually allow for autonomy. They do exist. These things are rare for private office gigs.

The best is to own but that comes with its own stress. I think if you can find an associateship job where you have autonomy, make good money and have proper support from staff, that can be better than owning. Alhough it's very rare to find this kind of associateship opportunity. Most of them suck.

It's sad that people are so terrible.

My job isn't too bad in terms of personnel - people are professional. I usually do 30 min appointments with 2 treatment rooms (1 assistant per room) and 2-3 hygienists (1 hr appointments) depending on the day. Pay is competitive for gp and I get benefits (health, vision, malpractice).
When I'm off I'm off: m-f; 8-5 with the option to work Saturdays if I want.

 

[2TH MVR]

I would like to gain some insights from practicing dentists who are associates. I am more interested in the work/life balance and the working conditions but the more detail, the better (salary, anecdotes, struggles, benefits, etc).

I currently work as a DSO orthodontist. I work out of 3-6 different locations. This is after 25 plus yrs as a multiple private practice owner.

I purposely did not want to associate for a PP. My ego would have gotten in the way. Therefore ...... DSO it was.


1. I have no direct boss looking over my shoulder. No one. You are expected to produce. I knew this from my PP days. DSOs or PP is not school. It's a business that relies on production. Do your job and no one bugs you. I've never been approached during my 3 yrs here to produce more. No one needs to tell me. It's in my dna to want to produce as much as is possible. But producing as an orthodontist is different (simpler with fewer ethical dilemmas) than as a general dentist. Pts can see crooked teeth. They cannot see the difference between a simple prophy and a deep cleaning.

2. I show up a few minutes before the patients and leave when the last patient has been seen. Most of my days are less than 8 hrs. I am paid a daily minimum along with generous bonuses. Some of my paychecks have equalled the largest paychecks I ever paid myself in PP. Seriously.

3. As an associate .... I have no responsibilities towards running the office. NONE. NADA. All patient care. It's a huge benefit for someone my age (58).

4. My malpractice insurance is paid for. A large DSO has their own attorney. I have access to this attorney for any issues that may arise.

5. The DSO provides health or medical/vision/dental insurance at ridiculous cheap premiums. This is a HUGE benefit if you have family. In PP ... my health premiums were ridiculous with large deductibles. Can a PP associateship offer you medical insurance at a decent premium? Probably not.

6. I have "some" control over how much I want to work. How many days per week. Which days.

7. Free CE. Paid for annual meetings (flight, meals and lodging) before Covid hit.

8. I love the interaction with my fellow colleagues: general and specialists.

9. My DSO sees mainly low income patients. Love these patients. They don't complain and appreciate your help. I'll pass on the Beverly Hills patients.

 

[charlestweed]

I have a short stint at a private office position whose owner owns 4 offices and have lost associates in all four offices due to extremely poor management. it gets so bad he hires temp dentist 2-3 weeks at a time. I am sure all his offices are bleeding red for a loss every month but with government PPP program he may break even. He constantly ignores my messages, does not communicate, and put all power in his office managers who micromanage and are lazy. Schedules fall apart on a daily basis and instead of figuring out the true cause, they blame it on some external factor (ridiculous? yea, some ex of factors they blame are: it is Monday today, it is Friday today, it is raining outside today)

This is the problem you often see at an office whose owner no longer wants to practice dentistry and lets the manager and associate dentists handle everything for him. Without the owner’s presence, the manager becomes lazy and wants to go home early by keeping the appointment book empty toward the end of the day. The associate dentists are not treated well by his staff and the owner is not there to fix the issue. As a result, these unhappy associate dentists don’t have any motivation to help the owner. And the people who suffer most in this type of office setting are the patients. In order to maintain the success of a practice, the owner has to be actively involved in running it. And these include sitting down/treating the patients, being physically present at the office, and having regular meetings with his staff and associates. For a practice to be well organized, there has to be a good leader that cares. And the only person who qualifies for this leadership position is the owner himself….not the office manager, not the associate dentist.

When you get older and no longer want to practice dentistry, it’s better to sell your office than to hire associate dentists to run it for you...unless you are in the area that has an unlimited supply of patients. The office will fall apart rapidly when you are not there to manage it. Running a dentistry business is very different from running other types of business. Doctor-patient relationship is very important in dentistry. Without this relationship, many patients will leave you. Nobody wants to see a different dentist every time he/she visits the office

 

[Molar Whisperer]

I've been very fortunate my entire dental career. USAF trained me in molar endo and surgical exos. My 1st DMO (capitation) paid me very well to do full time endo. I also exp a lot of dysfunction such as staff turnover, firings (myself included) and a malpractice lawsuit. I learned dentures at a DSO and exp a Board Complaint. I did PP 1 hr away at a rural area which was poorly managed and very difficult to produce. Now I work on primarily Medicaid with no pressures to produce. My DA followed me and my recently promoted supervisor is a member of my state Dental Board. He and I worked together for 12 yrs, and he knows I do good work.

 

[Mauricio45]

This is the problem you often see at an office whose owner no longer wants to practice dentistry and lets the manager and associate dentists handle everything for him. Without the owner’s presence, the manager becomes lazy and wants to go home early by keeping the appointment book empty toward the end of the day. The associate dentists are not treated well by his staff and the owner is not there to fix the issue. As a result, these unhappy associate dentists don’t have any motivation to help the owner. And the people who suffer most in this type of office setting are the patients. In order to maintain the success of a practice, the owner has to be actively involved in running it. And these include sitting down/treating the patients, being physically present at the office, and having regular meetings with his staff and associates. For a practice to be well organized, there has to be a good leader that cares. And the only person who qualifies for this leadership position is the owner himself….not the office manager, not the associate dentist.

When you get older and no longer want to practice dentistry, it’s better to sell your office than to hire associate dentists to run it for you...unless you are in the area that has an unlimited supply of patients. The office will fall apart rapidly when you are not there to manage it. Running a dentistry business is very different from running other types of business. Doctor-patient relationship is very important in dentistry. Without this relationship, many patients will leave you. Nobody wants to see a different dentist every time he/she visits the office

Hmmm. Interesting. I never really thought of it that way but it makes sense. But you can say the opposite if the owner was present in the office. If owner is around in the office, staff (and owner) will cherry pick all the high production cases away from associate and put in owner's schedule. If associate complains about this, the owner & OM will find an excuse and blame the associate's "poor communication skills".

Not to mention, the staff will fill the owner's schedule first before associate. Associate gets all the "breadcrumbs" that owner doesn't want. These seem to be common complaints amongst associates.

The reality is, 95% of associateships are garbage and just slavery. If you can find a good one then stay there as long as possible because they're few, far and between.

 

[charlestweed]

Hmmm. Interesting. I never really thought of it that way but it makes sense. But you can say the opposite if the owner was present in the office. If owner is around in the office, staff (and owner) will cherry pick all the high production cases away from associate and put in owner's schedule. If associate complains about this, the owner & OM will find an excuse and blame the associate's "poor communication skills".

Not to mention, the staff will fill the owner's schedule first before associate. Associate gets all the "breadcrumbs" that owner doesn't want. These seem to be common complaints amongst associates.

The reality is, 95% of associateships are garbage and just slavery. If you can find a good one then stay there as long as possible because they're few, far and between.

Hmmm. Interesting. I never really thought of it that way but it makes sense. But you can say the opposite if the owner was present in the office. If owner is around in the office, staff (and owner) will cherry pick all the high production cases away from associate and put in owner's schedule. If associate complains about this, the owner & OM will find an excuse and blame the associate's "poor communication skills".

Not to mention, the staff will fill the owner's schedule first before associate. Associate gets all the "breadcrumbs" that owner doesn't want. These seem to be common complaints amongst associates.

The reality is, 95% of associateships are garbage and just slavery. If you can find a good one then stay there as long as possible because they're few, far and between.

Yeah, this is the exact intention of every owner who wants to bring in an associate. And that is to avoid doing things that he hates such as working on the weekends, doing the low pay procedures such as cleanings, fillings, making dentures (so he can have more time to perform the procedures that interest him), and helping him handle the higher volume of patients that he can’t handle by himself. A GP friend of mine used to be an OS resident but he dropped out. At his office, he hires an associate so he can focus his time on doing implants and 3rd molars extractions.

That’s the reward that an owner has for taking the risk to open a business. When he was younger, he had to hustle. Just like many young grads, he had to work under someone else to save $$$ to start his own business. Now that he becomes a successful owner, he wants to work less by bringing in an associate to do things that he hates. There is nothing selfish about this. I am sure when you become an owner, you would want the same thing for yourself. At least at this type of office setting, the office is more organized and the patients are better taken care of. That’s why I’ve always encouraged young dentists to open their own office ASAP. Being an owner, you get to do whatever you want. A practice doesn’t have to cost $3-400k to set up.

 

[frozenicecreamDMD]

This is the problem you often see at an office whose owner no longer wants to practice dentistry and lets the manager and associate dentists handle everything for him. Without the owner’s presence, the manager becomes lazy and wants to go home early by keeping the appointment book empty toward the end of the day. The associate dentists are not treated well by his staff and the owner is not there to fix the issue. As a result, these unhappy associate dentists don’t have any motivation to help the owner. And the people who suffer most in this type of office setting are the patients. In order to maintain the success of a practice, the owner has to be actively involved in running it. And these include sitting down/treating the patients, being physically present at the office, and having regular meetings with his staff and associates. For a practice to be well organized, there has to be a good leader that cares. And the only person who qualifies for this leadership position is the owner himself….not the office manager, not the associate dentist.

When you get older and no longer want to practice dentistry, it’s better to sell your office than to hire associate dentists to run it for you...unless you are in the area that has an unlimited supply of patients. The office will fall apart rapidly when you are not there to manage it. Running a dentistry business is very different from running other types of business. Doctor-patient relationship is very important in dentistry. Without this relationship, many patients will leave you. Nobody wants to see a different dentist every time he/she visits the office

The owner actually is still pretty young, in his 40s. However, yes, he does not seem to want to work and this mentality is transferred to his office manager. The office instruments break down all the time with no fixing (think basic things like handpieces do not work, dull burs with no replacement). it gets so ridiculous he cheaps out on PVS materials and limit to only certain # of catridge per week.

I think exactly like you. I am like I am not paid enough for this. I am not there to change his overbearing manager, work the patient pool, and maintain his office.

I can assure you his practices are all in metroplex area. 2-3 offices he recently bought like in the last 2-3 years. Assistants says before the ownership transitions, chairs are all full but not now anymore. The 2 offices I work out of have like 8 chairs but struggle to make 2k-3k a day.

I had a talk with him before I quit and he shifts all of the issues on the associate dentist. In his new ad for the new associate, he even mentions seeking dentist for thriving/busy practice which I find pretty ironic.

Yeah, this is the exact intention of every owner who wants to bring in an associate. And that is to avoid doing things that he hates such as working on the weekends, doing the low pay procedures such as cleanings, fillings, making dentures (so he can have more time to perform the procedures that interest him), and helping him handle the higher volume of patients that he can’t handle by himself. A GP friend of mine used to be an OS resident but he dropped out. At his office, he hires an associate so he can focus his time on doing implants and 3rd molars extractions.

That’s the reward that an owner has for taking the risk to open a business. When he was younger, he had to hustle. Just like many young grads, he had to work under someone else to save $$$ to start his own business. Now that he becomes a successful owner, he wants to work less by bringing in an associate to do things that he hates. There is nothing selfish about this. I am sure when you become an owner, you would want the same thing for yourself. At least at this type of office setting, the office is more organized and the patients are better taken care of. That’s why I’ve always encouraged young dentists to open their own office ASAP. Being an owner, you get to do whatever you want. A practice doesn’t have to cost $3-400k to set up.

Opening up an office is good after you get some experience for like 3-4 years. I actually wanted to buy a inexpensive office (300k price that gross in 500k) but this new DSO job shows me how much of business in dentistry I don't know.

I guess open up an office when you get sick of working for another dentist or in DSO. But the pay I am getting now I do not think ownership will even match that (at least in the first 5 years when I have to pay back business loan).

 

[2TH MVR]

One advantage to being an Associate in a PP practice. You get to see 1st hand how a dental practice operates. Not sure you pick up any real ownership knowledge at a DSO.

 

[I_Love_Huskies]

I think this answer on Quora does an excellent job explaining why most associateships fail. Why do a lot of dental associateships fail to work out? - Quora

I'm going to copy and paste the answer from the link below:

My guess:

• The inherent personality of some dentists set this relationship up for failure: ego, self-centredness, greed, controlling, even insecurity, on top of emerging practice management skills. Some dentists are shady characters. This is not the face that patients ever see.
• On the flip side, some associate dentists may be too aggressive, some inexperienced and don’t treatment plan to the same level, they just don’t work well with the staff who dislikes that associate, or they just aren’t there yet with the communication skills with patients, and the principal dentist doesn’t mentor or communicate productively with the associate.
• Lack of autonomy for the associate dentist. You can expect conflict if the principal dentist is more controlling in nature (and very rightfully, they worked hard to build up the patient base and in cut-throat times like today, you can’t afgo to lose s single patient). Let’s face it, different dentists treatment plan differently depending on their experience, skills, training, and philosophy. Unless the principal and associate have inherently similar approaches, it may be a difficult fit.
• The practices of some offices (the shady ones) make you question what your ethical obligations are to patients and the profession. I’ll just leave that one at that.
• The intent of the principal dentist is such that they need a dentist to extend their hours of operation to compete, without actually having the patient base to keep the associate busy enough. It’s a plus for the principal dentist and rather selfish because the associate gets paid on collections (not production) and if there’s no work, you don’t have to pay a dime to the associate for babysitting the office for those just in case emergencies. Some receptionists are ordered by the principal to book one patient in the morning then one at the end of the day just so to make sure the associate is there for the whole day. See how long anyone would stay.
• Sad thing is, there are so many dentists and so many new dentists that especially the inexperienced ones are desperate enough for a job that involves babysitting an office. However, that burns out because you eventually can’t pay your bills and your debt, but got some experience on your resume so you can hence move on.
• Ineffective dental staff and bad management by the principal can be a pain to tolerate for the associate. Great staff makes a winning team and the associate is booked and more productive. Staff who know how to act in front of the principal dentist then acts differently with the associate is very frustrating and counterproductive. A common policy is to always fully book the principal dentist first, then start filling the associate dentist’s column. The result: the associate is hardly booked and you do this long enough, the associate leaves because they don’t want to waste their time. The insult on top of that is the receptionist may need to lie to the associate to justify what they’re doing by saying things like, “oh, they don’t want to book with you, or they prefer the other doctor, or that time doesn’t work with the patient, it’s been really quite”. These are self-preservation lip service so the associate doesn’t get pissed off and blame the staff. If the staff doesn’t quite get along with the associate, they will play these games. Other times it may be pressure on the staff by the principal dentist to full book them first (you know, book the person who pays your salary). It is inherently never really a fair deal for an associate to do contract work.
• Contracts, particularly with unfair terms. Unfair with respect to the associate. I had one contract where the dentist was trying to enforce a 20km (12.4 mile) radius restrictive covenant where I was only working 2 days a week. The restriction means I can’t work anywhere within that radius for 2 years after I leave that job. The purpose is to protect the principal dentist from the associate dentist whom they fear may poach patients from their office to a new location. Most are less, with a 5km (3.1 mike) restriction, but if you only work there for 1 maybe 2 days, you can’t find another job elsewhere unless it is farther or in different cities or in suburbs. Most dental associates need full time work from combined days by working in 2, 3 or even 4 offices. There are also other contract terms unreasonable for an associate which I won’t discuss.
• Corporate dentistry. Are you treatment planning to the patient’s needs? Or are you being told/ordered by the office manager (a non-dentist) that you must treatment plan a certain way in order to meet production goals. It’s not always like that, but these offices, which aren’t very transparent as corporately owned, may push the boundaries in your obligations to the Hippocratic oath. Those who aren’t comfortable with that leave.
• Some offices just have low quality, difficult patients. If you value your own mental health, who’d want to work long term with patients like that and possibly risk your license. Like attracts like, you probably have a principal dentist who’s also a bit off.
• Associates want to have their own autonomy and own their own office one day. They were never going to stay long term anyways.

I admit that I had more bad associate experiences than good ones. Some dentists were liars, shady and questionable, or had unresolved issues with their insecurities (they subconsciously don’t like it if the associate is better liked). I’ve had bad office manager who was a liar, not upfront with information and had potty mouth (which is inappropriate in a dental office). Some principal dentists tend to blame/ scapegoat the associate for things that isn’t under their control. I’ve had to turn a blind eye to some shady practices by the principal and just put my head down and do my own thing. I’ve had a dentist, nice person, who was trying to groom me on techniques to upselling treatment - I left and never really told that dentist the real reason why I didn’t return after maternity leave.

The principal-associate relationships that do work out are the ones with fairness, mutual respect, mentoring, and willingness to compromise, on top of a good office culture.

 

[Mauricio45]

Word of advice: never work in an office where the owner's spouse works in the office. Especially if the spouse is the office manager or working the front desk. Staff frowns upon it. Every marriage has issues and they always spill over onto the practice. It's like having 2 sets of hyper-critical eyes and 2 people absolutely unshakable in their desire to screw you over as the associate, and that's not even counting the DAs and staff!

Better to work at a corp than be with this arrangement. RUN!

 

[beannaithe]

Most associates leave a practice within a year if the job is bad. And usually when the job is bad, the next associate realizes it and moves on. Most associate positions end up being a revolving door until the owner realizes he doesn't need an associate or makes the changes to make an associate successful. If an associate finds a good job, they don't tend to leave unless they move, find a better one (rare) or buy an office (likely).

I've been associating with the same practice for almost a decade. I work two days a week and have a great work/life balance. I have two little kids and have been staying home with them more due to COVID. I am lucky to work with an experienced staff and get paid extremely well. Pre-COVID, the benefits of a longer term associate job is seeing a lot of the "big cases" I planned years ago finally coming to fruition. I would see patients who I planned for larger plans finally ready to do them after a few years. Patients also say yes more readily now because I have been seeing them for a very long time. Trust is a huge thing with patients and when I find started, I would see patients balk at being told they needed a crown. Now that they trust me, patients are more likely to agree to treatment plans. They are also more likely to ask about Invisalign, veneers, implants, overdentures, etc.

And I also second the advice to avoid a practice with a spouse in the office. I've never heard of it working out well.

 

[HelicaseInitiator]

Private practice: No paid time off for vacation and sick days. You aren't there you aren't producing = 0. DSO or Public Health contracts had paid time off for sick leave and 2-3 week of paid vacation.