Ep. 59: All About Associate Doctors, Part 2
This week we wrap up our series on associate doctors. Sabri Blumberg returns to discuss how to structure the associate relationship, finding the right doctor, and get them integrated into the practice.
Topics:
1:27 – What type of associate role do you want? And what works financially?
20:00 – Finding the right associate doctor
33:55 – Hiring and putting agreements in place
44:56 – Onboarding an associate doctor smoothly
Links:
Have a question for Sabri? – SabriB@mgeonline.com
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Questions From This Episode
What are the different ways a practice can actually use an associate doctor?
There are four basic models. The traditional model brings someone in to pick up work the owner doesn't want to do, like single unit crowns or molar endo. The production doctor model has the owner sell all the treatment and hand it off to the associate to perform. A satellite office model puts an associate in a second location entirely. And a specialty model brings someone in to do work the owner physically can't do themselves, like implant placement, using money that would otherwise go to an outside referral.
How should pay change depending on which model you're using?
For the traditional model, associates typically run 30 to 35 percent, assuming the owner is still producing at a high level. For the production doctor model, that number drops to 20 to 25 percent, since the associate isn't building their own schedule, they're simply executing the owner's production. Specialist arrangements, where the owner can't do the work at all, can justify 40 to 50 percent, but only on cases that were genuinely being referred out before, never on new volume generated specifically to feed that associate.
What four qualities are true deal breakers when vetting an associate candidate?
They have to be personable, since a cold personality doesn't work well on a patient chair regardless of gender or clinical skill. They need a clinical philosophy that generally matches the owner's, which can be tested by handing them a set of x-rays or models without the existing treatment plan and asking them to diagnose it independently. They need to meet the practice's standard of care, checkable by asking how many redos they typically run into. And they need reasonable speed for the procedure, not necessarily as fast as an owner with twenty years of experience, but not so slow it frustrates patients or eats into profitability. Missing even one of these four is enough to make someone the wrong fit, regardless of how good a dentist they otherwise are.
What's the biggest mistake to avoid when first building an associate's schedule?
Don't have a brand new associate see all the new patients or all the hygiene checks in an attempt to have them sell their own dentistry and build their own schedule. If an associate could reliably sell treatment, they'd likely be running their own practice instead of working as an associate. Handing them that responsibility too early just means a lot of diagnosed treatment goes unclosed, which makes the hire far more expensive than it needs to be. Keep sales with the owner until the associate has proven they can convert cases.
Episode Transcript
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eff: This episode is part two of a two part series on how to find, hire, and onboard great associates, we're calling it All About Associates. I'm joined again this week, as I was last week, by Sabri Blumberg, our Deputy Chief Operating Officer. How are you doing, Sabri, are you all set up over there?
Sabri: I'm all ready to go.
Jeff: Perfect. Let's jump right into this since we have a lot to cover. If you missed last week's episode, I'd definitely recommend going back and listening first, but if you're like me and don't always follow instructions, that's fine too. In last week's episode we got into the fact that there are six issues Sabri and I look at whenever a client asks whether they should add an associate doctor, six questions we walk them through to make sure it's the right move and that the relationship actually succeeds. We covered the first two last week: one, do you actually need one, and how to figure that out, and two, if you got one, could you continuously support them, because if the plan is for you to sit in your office while the associate does the production you used to do, that doesn't tend to work out.
Sabri: No, exactly.
Jeff: So let's move to point three. How are you going to use this associate? How often do you see people not actually figure this out ahead of time?
Sabri: Honestly, I don't see it happen too often with our existing clients, since we're pretty controlling about getting that figured out before they bring someone on, because it can be a huge mistake otherwise. But with new clients, or clients who already have an associate in place, I see it constantly. I actually saw it just yesterday, someone brought on an associate without ever fully working this out, and now the profit the practice is making is getting eaten up by the associate, to the point where the owner doctor isn't really getting paid.
Jeff: So that's a utilization problem.
Sabri: Right. Let's lay out what we normally look at. There are really four basic ways a practice ends up using an associate. One is the traditional model, bringing in a doctor to pick up the work you don't want to do, single unit crowns, some molar endo, maybe on-call coverage or emergencies. Then there's the production doctor model, which we've covered in a couple other episodes, where you sell all the treatment yourself and hand the actual production to the associate. Third, you might be opening a satellite office, which is its own can of worms. And fourth, which we used to see almost exclusively with specialists, is bringing someone in to do work you genuinely can't do yourself, maybe you don't place implants, so you bring in an associate who can.
Jeff: So figuring out how you'll use them is really about figuring out what you, the owner, actually want to spend your time doing.
Sabri: Exactly. If your main goal as the owner is to focus on larger cases, full mouth reconstructions or similar, then you're bringing in an associate to absorb the work you don't want.
Jeff: And pay structures for all of this could be a whole episode on their own, and actually, I did one. If you want the full math broken down on how to pay an associate under each of these models, traditional, production doctor, and satellite, look for the episode on paying your associate doctor, we also have a video version on the MGE YouTube channel that walks through the numbers visually.
Sabri: For the traditional model, you could bring in a new grad, someone looking for a mentorship situation, and I'm completely fine with that. There are real advantages, you get to mentor them and shape them exactly to fit your practice. But what people overlook is that new grads genuinely need your time. You can't just turn them loose on your patients.
Jeff: So if you don't have time to actually mentor someone, don't bring in a new grad.
Sabri: Right, bring in someone who's been out two years instead. And in a mentorship situation, obviously we're not dentists so we won't get into the clinical specifics, but there's a real limit to how much correction is reasonable. If it starts to detract from your profitability, either by making production take too long or by lowering your production because the new associate isn't really contributing yet, that's a problem. It's fine if your production stays steady while you're mentoring someone, but you have to adjust their pay accordingly so it doesn't eat into you. Most people bringing on an associate need an associate, if you want to run a charitable mentorship program, that's your call, but don't let it damage the business side. It shouldn't require constantly reeducating them on basics they haven't done repetitively.
Sabri: Associates vary enormously in competency straight out of dental school. Some new grads are incredible, confident, detail-oriented, sometimes even placing implants depending on their program or residency. Others genuinely struggle, someone who takes three hours for a two surface filling is a real problem, and most practices aren't set up to accommodate that. So ordinarily I steer clients away from new grads unless the doctor has a genuine desire to mentor, or the new grad shows real aptitude.
Jeff: For the traditional model, whether it's a new grad or someone more experienced picking work off your schedule, and again I'd recommend listening to the pay episode for the full numbers, generally you don't want to pay more than 30 to 35 percent.
Sabri: Assuming you're still producing well yourself. That's the deal breaker. If it becomes more of a teaching job than someone facilitating you, that math stops working. Same if you're stepping back significantly or reducing your hours specifically to bring on the associate, but you're still paying them 35 percent, that's your whole profit gone.
Jeff: Right, but in the traditional model we're assuming you're sticking with the heavier, higher end work yourself, so the base pay conversation is what we cover in the pay episode. Then there's the production doctor concept, which is newer in dentistry, we had clients start doing this around 2005 or 2006.
Sabri: Essentially you're selling all the treatment yourself, and we've had a lot of clients work their way out of the chair this way. In a nutshell, you first need volume, a good amount of hygiene coming in and enough new patients to keep the owner doctor busy doing case presentations and exams all day. Then you're presenting treatment and handing it to the associate to perform. Some owner doctors keep a specific procedure they enjoy, like implant placement, and have the associate restore what they place. But the pay rate for a production doctor, since you're essentially handing them your production, lands in the 20 to 25 percent range, considerably lower, since they're not expected to build their own schedule while you're doing that work for them.
Jeff: And it can't go higher than that or you'll go broke.
Sabri: We actually had a few clients in Canada run into trouble with this early on, the going rate for associates up there started around 40, sometimes 50 percent depending on the region, and that's been changing because it just doesn't work at that level.
Jeff: I understand the basic logic when it's like bringing in a specialist, you stop referring out complex extractions, so now you're making 50 percent of something instead of 100 percent of nothing. That part makes sense. But it's different when the associate is doing work you could do yourself, on a production doctor or even traditional model, it's just work that would otherwise happen later on your own schedule.
Sabri: Exactly, which is why for the production doctor model specifically, you want a strong volume of new patients and hygiene, probably a bit higher volume than you'd need to justify a traditional associate. And one thing people trip over: they'll say, okay, I'll be the sales doctor and have one production doctor. But think about it, how long does it take to sell a $15,000 case, half an hour, maybe an hour? How long does it take to actually produce it? Hours and hours. So one sales doctor can usually keep two or three production doctors busy, we've seen that work when the owner is doing nothing but hygiene checks and new patients, no production of their own at all.
Jeff: Then there's the satellite office model, which would take us completely into the weeds, so we'll set that aside. But you wanted to bring up the specialist model, since you've seen this play out a couple of times, bringing in someone who can do work you genuinely can't do.
Sabri: Right, and we're not necessarily talking about an endodontist here, since endo doesn't require much in materials or equipment, if you bring an endodontist in-house for cases you'd normally refer out, big curved roots and so on, paying them 50 percent isn't a big deal. But say you bring someone in to place implants, and you don't place implants yourself, you just restore them, and then you start marketing aggressively to bring in more implant cases specifically to feed that associate at 40 or 50 percent, you'll go broke.
Jeff: So if I'm the owner and I bring in an associate to do work I can't do myself, I need to keep producing what I was already producing, and the associate's work is essentially gravy, money I would have referred out entirely, now I get to keep half of it instead of none of it.
Sabri: Exactly. Any cases that come up for that specialty, refer them in-house instead of out. But what you can't do is pour marketing dollars specifically into generating new volume for work you personally can't do and are paying 50 percent on, because your numbers will look great on paper and you'll have no actual money left.
Jeff: So walking through it: if I have a regular bread and butter practice and I bring in someone who can place implants because I can't, ideally I'm bringing them in to absorb the implant cases I was already referring out, not launching a marketing campaign to generate a flood of new implant cases specifically to feed a 40 or 50 percent associate.
Sabri: Exactly right. The one exception is orthodontics, since ortho is continuing care, if anything happens to your orthodontist, you're left responsible for finishing cases you've already collected money on and can't easily hand off. I wouldn't recommend bringing in an orthodontist unless you know how to do ortho yourself. We've seen situations where the orthodontist leaves or something happens to them, and the practice has to bring in a second orthodontist who then has to finish out cases the practice already paid the first one for. Or the two orthodontists just don't get along, and one of them ends up seeing the other's leftover patients every week for two years. Not a great scene.
Sabri: I was actually asked something interesting just yesterday. I was sitting with a longtime client who asked whether they should bring in a specialist, and they had the space for it. My instinct was yes, I generally like bringing in specialists, and I assumed they were referring out quite a bit. So I asked whether they'd calculated how much they're currently referring out, to see if it would actually be worth it. They said, no, I'm not referring out anything, I do it myself. So why would you bring in a specialist at all? The only time a 50 percent specialist arrangement works is if that's revenue you're currently losing because you genuinely can't do the work. Otherwise it doesn't pencil out.
Jeff: And ideally this applies to a higher volume practice too, referring out ten, twelve, sixteen endo cases a week, not one or two.
Sabri: Right, and that's actually part of what corporate dentistry targets, bigger offices, because they can bring a bunch of specialties under one roof and negotiate deals with the oral surgeon or periodontist so they're not paying 40 or 50 percent. It works at that scale. It doesn't work if you're only referring out two root canals a week and decide to bring in an endodontist.
Jeff: So bottom line, if you've listened to the last episode, which you really should before this one, you've confirmed you actually need an associate and that your business can support one. Point three is doing your homework on how you're actually going to utilize them before you bring someone on.
Sabri: And we're happy to help with that, email us if you have questions, I'll put both addresses on the episode webpage. But run the financials on whatever plan you land on to make sure it works in the real world before you commit to it.
Jeff: Which brings us to point four: how are you going to pay them? It's closely related to point three. We covered pay in detail in that earlier episode, but the general idea is you need to work out what you're paying, what production you're expecting in return, what that leaves you producing, and how all of that affects your overhead, additional supplies, a new lab bill, and the associate's salary itself, since obviously you need to know the number before you start interviewing anyone.
Sabri: Once you know what you're paying and how you plan to use the associate, you also know who you're targeting. A production doctor associate, for example, is probably someone with five to seven years of experience, especially since they'll be taking on your existing production, their clinical skill essentially has to be at your level.
Jeff: Which brings us to point five: where do you actually find this person? It seems like it's gotten easier since the pandemic, since a lot more people are relocating.
Sabri: It really has. There's a locality piece to this too, some areas make it harder to find associates locally, so we can talk through what to do there as well. It really depends on where you're located. In a market like Miami, which is one of the most competitive dental markets in the country, you can genuinely just place an ad.
Jeff: Where would you place it?
Sabri: Honestly, pretty broadly, whatever general job site you'd normally use, Indeed, ZipRecruiter, even Craigslist still works for associates in certain areas, believe it or not, that one weirds me out a bit, but we've had clients tell us they found a great associate through Craigslist. Beyond the general sites, there are dental specific ones too, though those tend to skew more toward hygienists and assistants, sites like iHireDental, DentalWorkers.com, DentalPost.net. We'll put links to a few of these on the episode webpage, though to be clear, we're not endorsing or partnered with any of them, this is just what's been working for clients.
Jeff: Say I've tried all that and I'm still not finding an associate.
Sabri: Then you notch it up. We've had a client, and you know who I'm talking about, who couldn't find an associate and pulled out the actual Yellow Pages, this was a while back, and called every dentist in town saying he was looking for an associate. He found one by the time he got to the letter C, it took about three hours of phone calls, and that associate stayed with him for years. Think about it, if you're a dentist, you know other dentists, you went to school with them, you see them at association meetings. Even if the person you're calling isn't available, there's a good chance they know someone who is.
Jeff: So you have to actually talk to people.
Sabri: Right, and if you're in a really remote area, headhunters do work, they'll find you an associate for a fee, but you have to plan for it. Since you're licensed statewide if you're licensed in that state at all, we've had clients here in the Tampa Bay area, where it was difficult for a while to find associates, advertise in Orlando or Miami instead, where it's much easier. We had another client advertise in Manhattan and successfully recruit someone to move up to rural upstate New York. If you're in a more rural area where you won't get many applicants, or any, advertise in the largest city in your state instead. You have to get creative. Headhunters are always an option too, but if you want an associate by June and you're in a rural area, you may need to start advertising back in January.
Sabri: As a bit of a last resort, and email has made this easier, I've had clients who struggled send letters directly to every dentist within an increasingly larger radius, or contact the dental society and advertise in their publications. You can also mail dentists in states with easy license reciprocity, where all they'd need is a jurisprudence exam. Most states are like that, Florida and Delaware being the tougher exceptions. But if you get enough communication out into the world, you'll eventually find somebody. We had a client in rural Tennessee who advertised in Los Angeles and ended up bringing someone across the country.
Jeff: How hard is it to transfer a license from California to Tennessee?
Sabri: Honestly, I never asked, it didn't seem to be a problem. He started advertising about six months before he actually needed someone, and the person relocated from LA because they wanted that quieter, more rural lifestyle.
Jeff: I think since the pandemic especially, if you were an associate stuck in a small apartment in Manhattan on lockdown with your only outlet being the roof of your building, the idea of moving somewhere with space and a backyard has real appeal.
Sabri: It absolutely does. So let's say you've advertised and now you have real prospects, people you can actually talk to about becoming your associate. There are four things I go over with clients, and I call them deal breakers, meaning it's not that a candidate needs most of these four, they need all four. If even one is missing, they can't be your associate, full stop.
Sabri: The first is that they have to be personable. In any interview, the candidate is going to put their best foot forward, if it looks bad on interview day, that's a real red flag. Usually with someone genuinely personable, communication feels easy and you can feel warmth coming from them. That matters especially because it's a doctor, you don't want a cold fish as your associate. Clients sometimes ask me whether they should look for a male or female associate, assuming gender affects patient response, and honestly I've never seen that hold up, it has nothing to do with gender and everything to do with personality.
Sabri: The second is that they need to share your clinical philosophy, at least broadly. I've seen this go wrong in a production doctor situation specifically, an owner doctor diagnoses and sells a treatment plan, the patient comes back, and the associate goes in and says, actually you don't need X, Y, and Z. That's a disaster. Clients used to ask me how to test for this, some suggested having candidates bring in models or case photos, but what I recommend instead is handing them a set of x-rays, or models if you have them, and some charting, without the existing treatment plan, and asking them to diagnose the case cold. That tells you whether they generally land where you'd land. There's real subjectivity in dentistry, depending on how aggressive a diagnostician someone is, the same tooth might get anything from watchful waiting to a crown recommendation, and there's no absolute right or wrong there, just the doctor's viewpoint, within standard of care.
Sabri: Which is the third qualification: standard of care. You've set a certain acceptable standard, and the candidate has to live up to it. Most dentists keep photos of past cases, ask to see them. Nobody's going to say they do bad dentistry in an interview, but you can also ask how many redos they typically run into, that gives you a rough sense, unless someone's leaving everything with open margins, in which case there wouldn't be any redos, which we've also seen.
Sabri: The fourth is speed. Clients sometimes push back, saying they don't want the practice to feel production driven, but speed matters for two reasons. First, there's basic viability, if procedures take an unreasonable amount of time, that's not sustainable for the business. Second, and more importantly, your patients are used to a certain timeframe from you specifically.
Jeff: And to be clear, that's not the same as saying speed matters more than quality. If an associate could somehow do a beautiful, fully up-to-standard procedure in half the normal time with no corners cut, that would obviously be great, less time in the chair is good as long as the work holds up. But if someone takes three hours for a two surface composite, that's going to frustrate the patient, and financially, what the patient paid for that procedure doesn't come close to covering what you're paying the associate for that much chair time.
Sabri: We had a client, and you know who I'm thinking of, who had real trouble getting patients to come back for their permanent crown because the temporary was so beautifully crafted, hours spent shaping and staining an acrylic temp, on a molar, not even something visible like a veneer, that patients assumed they were already done and never came back until the temp eventually cracked under a walnut or something. So the associate needs speed that's reasonable and average for the procedure, not necessarily as fast as an owner who's been practicing for twenty or thirty years, nobody can compete with that, just reasonable. You can gauge this simply by asking how much time they'd need for a given procedure.
Jeff: I think the best real world example of this is a dentist we know who, right out of dental school, looked at how long it took her to do an amalgam and realized there was no way she'd be able to succeed at that pace working for someone else. So she joined the military instead, not because her work was bad, but because it let her do good work without pressure to hit a certain production number while she built up speed. It worked out, she eventually owned her own practice and did great.
Sabri: Assuming a candidate clears all four of those qualifications, and if even one is missing, you're going to run into problems with them sooner or later, it just means they're not a fit for your specific office, not that they're a bad dentist or won't succeed somewhere else. The next thing to check is that they meet the same basic employment expectations you'd have for any staff member. You're hiring an employee. Everyone in the practice, including our own in-house attorney here at MGE, has both a general staff member role and a specialized job on top of that. What sometimes happens is owners bring in a doctor and think, well, they're a doctor, so they skip training them on the basics, how to request supplies, how to actually ask for time off properly. Then the doctor does something that annoys the rest of the staff, like writing themselves onto the schedule as unavailable instead of requesting the day off the way everyone else does. Whatever you'd expect from any normal employee, attending certain meetings, following the same request procedures, all of that should apply equally to the associate doctor.
Jeff: Agreed. The next thing is obviously making sure you have a contract in place. Before we get there though, one thing worth asking during the interview itself is what the candidate's actual plan is. If someone tells you, even indirectly, that they're planning to work for you for two years and then open up four doors down, that's useful information, even if nobody states it quite that bluntly. Or if they mention they're only in town for six months until their spouse finishes a specialty program, that's probably not the associate you want long term. But you also want to get a read on what they're actually looking for, maybe they've spent seven years in corporate and are looking to transition into private practice, either to eventually go out on their own or to find a partnership opportunity, in which case this could be a potential future partner, or someone who could spearhead a second location.
Sabri: Which is exactly why the associate agreement needs a couple of specific things in it: the terms of the associate arrangement itself, and separately, a buy-in and buyout agreement, laid out in advance, even if it isn't triggered automatically.
Jeff: It should all be spelled out ahead of time, because otherwise you end up in a room six months in with someone saying, hey, I think this is going really well, we should talk partnership, and you're thinking, well, I was picturing more like a year from now. That happens more often than you'd think.
Sabri: So the contract should be extremely specific about when partnership will actually be offered, at what rate of buy-in, and what benchmarks have to be hit first. What percentage do they acquire, and on what schedule, five percent every six months, for example? Some owners never want to sell more than 30 percent of the practice total. Can they buy in all at once, or does it have to happen incrementally? And critically, how is the value of the practice going to be calculated at the time of sale, based on the practice's value at the time the contract is signed, or its value at the time the buy-in actually happens? There are two schools of thought on that.
Jeff: Let's actually walk through the numbers, since it makes the disagreement clearer. Say we sign a contract on January 10th, and we agree that after a year we'll consider partnership. Say I'm the owner, you're the associate, and you're going to buy in at 50 percent. My practice did $2 million last year, so using the conventional valuation method, roughly 70 percent of collections, that's a $1.4 million valuation, meaning 50 percent would run you $700,000.
Sabri: One school of thought says that valuation should be locked in as of the contract date, January 10th, since the associate hasn't picked up a handpiece yet, and I'm not paying for their future sweat equity. The other school says it should be calculated a year later, based on the practice's value at the time of the actual buy-in, since there's no sweat equity to account for, the associate already got paid for their production during that year.
Jeff: So walking the numbers forward: say in that first year together we go from $2 million to $3 million in production. At 70 percent, the practice value goes from $1.4 million to $2.1 million. So does the associate pay the original $700,000, since they already got paid a salary for the extra million they helped produce, or does the buy-in price move up to reflect the new $2.1 million valuation, meaning they'd owe $1.05 million for that same 50 percent?
Sabri: My view is they should pay based on the value at the time of sale, not the contract date. It's not just that they already got compensated for their production during that year, it's that for that entire year, all of the risk and responsibility of business ownership sat with me, the owner. The associate didn't carry any of that exposure, so it wouldn't be right for them to get the benefit of the increased value without ever having carried the risk.
Jeff: The counterargument is that locking in the price at contract signing could tempt an owner to intentionally suppress productivity that year to avoid inflating the buy-in price, similar to how people sometimes downplay income during a divorce.
Sabri: Sure, but you can build in benchmarks the associate has to hit to even qualify for partnership in the first place, so that concern cuts both ways. To me, the value of the practice isn't just about who got paid for what, it's about who carried the risk during that period, and that was the owner, start to finish, so I wouldn't agree to just hand over that increased value for free.
Jeff: What I've suggested to clients who are genuinely torn on this is splitting the difference. If production went from $2 million to $3 million, value the practice at $2.5 million instead of picking one extreme or the other, it becomes a reasonable middle ground. But this is a great real world demonstration of exactly why this has to be nailed down in the contract before anyone starts, because otherwise these disagreements start eating into what could have been a genuinely great long-term relationship for both people, and it gets ugly fast, and it's just not fun for anyone.
Sabri: One more thing worth mentioning, since I've drafted a lot of these agreements: most contracts spend plenty of time spelling out what happens if everything goes well, how the buy-in gets executed, and so on, but very little time on what happens if it doesn't work out. You see the same gap in business operating agreements generally, partners get along fine until they don't, and if that scenario was never spelled out, it turns into people trying to maneuver against each other on the way out. Make the agreement just as specific about what happens if it doesn't work as you are about what happens if it does.
Jeff: Good advice. Alright, so we've got the right associate identified and under contract, now we need to actually onboard them.
Sabri: We can move through this part fairly quickly since we're already well past our usual half hour. There are a few things worth doing. Obviously you're going to put them to work, and if your existing team is willing, having the associate work on your staff first is genuinely useful, since your team is the one who'll actually be scheduling and selling this associate to patients going forward. It's easy for a front desk team member to say, oh, Dr. Associate is my doctor too, you'll love them, or, Dr. Associate treats my whole family. If we've ever had a client dismiss that idea outright, and we've had this happen twice, it does not go over well. One person made the mistake of telling Greg Winteregg once that he'd never let an associate work on him personally, and Greg spent a good half hour explaining exactly why that was the wrong instinct. Working on your own staff, and having your staff genuinely vouch for the associate, is important.
Sabri: The most important thing overall, though, is that the associate's clinical skill has to be solid, because that's the one thing you can't fix quickly. A sales problem you can fix in a day. A marketing problem you can fix in a couple weeks. A clinical problem takes months to fix, at minimum six months, and that's only counting the patients you actually see again, plenty of others will just quietly stop coming back, which damages your reputation in the area, since that's the whole reason patients choose a practice in the first place.
Sabri: One thing we've done a lot with clients is have the new associate assist the owner for a few procedures first, and vice versa, so you can each get a feel for how the other works clinically. Then, when you're presenting a case to a patient that's going to land on the associate's schedule, you walk the patient through it as usual and then say, actually, my associate handles cases like this, and they're excellent, want to meet them quickly? About 95 percent of patients are perfectly fine with that. You'll always have the occasional patient who insists on sticking with the doctor they've seen for years, that's fine, keep those, you'll probably retain around 5 percent that way regardless.
Sabri: For a newer associate you haven't seen much clinical work from yet, I'd make a point of checking their work at the end of the appointment, in a way that doesn't put them on the spot. You come in, take a look, and either genuinely compliment the work if it's good, or, if something's off, quietly flag it to the associate directly rather than to the patient, so it gets corrected without making a scene. You're not trying to embarrass the associate, you just need it fixed. I've had people ask in seminars whether the associate will be upset about being checked on, and honestly, that doesn't matter, you just handle it in a way that doesn't make them look bad in front of anyone. You'd never correct any staff member in front of a patient, and that applies to an associate exactly the same way it applies to an assistant.
Jeff: What kind of assistant would you pair with a new associate?
Sabri: Always your most seasoned assistant. Practically, this means the new associate might spend their first couple of days assisting the owner instead, essentially for free, just until you're both comfortable and on the same page clinically and diagnostically. Then you might assist the associate for a bit and watch how they work. This doesn't need to take weeks, we're talking days, sometimes even just hours if things click quickly, just until you're confident letting them work on your patients unsupervised. Even after that, I'd still check their work periodically, quietly, for a while. You can move into a rhythm where you drill and they fill and you check, and eventually just hand off the work you're fully comfortable with. Pairing them with your best assistant matters because that assistant knows exactly what you want and how you want it done, since you can't be everywhere at once, and it becomes much easier for that assistant to spot the difference between your standard and someone else's. That consistency of clinical care is genuinely the hardest part to maintain, and if you're not paying attention to it, you'll end up with unhappy patients and an unhappy staff.
Jeff: That makes sense. I think that pretty much covers it assuming things are going well, from there you're just executing whatever's in the contract, a partnership agreement a year later or whatever the terms specify, and if you've found someone genuinely great, you'll want to keep them in your professional life long term. Before we wrap, I do have one honorable mention I want to squeeze in.
Sabri: Go ahead.
Jeff: What I've seen go wrong is doctors building an associate's schedule by having them see all the new patients, or all the hygiene checks, specifically so the associate can sell their own dentistry and build their own schedule. That's a mistake. If an associate could reliably sell treatment, they probably wouldn't be working as an associate, they'd be running their own practice. What actually happens is a lot of diagnosed work never gets closed, which makes the associate hire a very expensive way to bring someone on, because of all the lost opportunity. Keep sales with yourself until the associate has built up to a point where they're comfortable taking some of that on, and keep a close eye on their conversion rate as they do.
Sabri: That's a great point, and honestly more of an onboarding principle than a seventh numbered issue, but it's extremely applicable.
Jeff: There's genuinely enough here for another hour, but I think this is a good place to wrap up. Bringing on an associate can be a real turning point for a practice, for better or worse, depending on how it's handled. I hope this was helpful, Sabri, it was great having you on again, we'll definitely have you back plenty in the future. Folks, that's all we have for this week. If you have questions about anything we covered, I'll put the relevant links on the episode webpage. You can reach Sabri directly at sabrib@mgeonline.com, and you can email me at jeffb@mgeonline.com. You can also learn more about us at mgeonline.com or by calling (800) 640-1140. Have a great week, and we'll see you at the next episode.