Ep. 125: Should Your Associate Present Treatment Plans?
We receive this question fairly often: how involved should my associate doctor be in presenting treatment? Jeff’s answer is a bit unconventional compared to the traditional associate model, and you’ll understand why as you listen.
Links:
The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc
Treatment Coordinator Training Course - https://ddssuccess.com/p/treatment-coordinator-training-course
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Questions From This Episode
What's the difference between a "conventional" associate setup and a "production doctor" setup?
In a conventional setup, a mentored associate typically earns around 30 percent and is expected to eventually help present and sell treatment. In a production doctor setup, the owner doctor moves entirely into diagnosing and selling, while the associate focuses purely on performing treatment, usually for 20 to 25 percent, with no sales responsibility at all.
In a conventional setup, what does Jeff say an associate needs to be able to do before presenting treatment on their own?
At minimum, comfortably explain a diagnosis and treatment plan to a patient in plain language they'll actually understand, and answer their questions, rather than using clinical terms like "periapical radiolucency" a patient won't grasp. He recommends role-playing this directly with the associate and having them explain a case to you first to catch these gaps before they're in front of patients.
Why does Jeff say an owner doctor paying an implant-placing associate 40 percent was a mistake, even though production went up?
The owner diverted marketing dollars toward implants specifically because the new associate could place them, but the 40 percent cut was close to specialist-level pay. Production rose sharply, but actual profit dollars fell, since so much of the new revenue was being consumed by the associate's compensation.
Why can one owner doctor acting purely as a sales doctor support two or three production doctors?
Jeff points out that presenting and closing a case, even a large one involving multiple crowns and root canals, can take as little as 30 minutes, while actually performing that same treatment takes far longer. As long as there's enough new patient and hygiene volume feeding the practice, one dedicated sales doctor can keep multiple production doctors consistently busy.
What does Jeff recommend for a new satellite practice where an associate will need to present treatment?
Beyond training the associate to sell over time, he says the more important piece is placing a genuinely strong office manager at that location, ideally someone already trained as a junior manager in the main practice, who can pick up sales responsibility while the associate is still developing that skill.
Episode Transcript
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Hi everybody, Jeff here. For this week's episode, I want to dig into what I'd call a niche question, a very specific piece of practice management we get from a lot of clients, especially once they've added an associate doctor. When a client adds an associate, the office gets busier, and one of the first questions that comes up is: should I let my associate doctor present treatment plans? The honest answer is yes, sometimes, and no, sometimes. I know that sounds like a dodge, but it genuinely depends on how you're planning to utilize that associate.
So that's what I want to cover this week: when you should, and shouldn't, let your associate present treatment, the role your treatment coordinator's experience and skill plays in that decision, and how to actually implement this well depending on your specific situation.
Let's start with why this question comes up in the first place. Picture a busy office, three hygiene operatories running, 80 or 90 new patients a month coming in. At some point, the owner doctor simply can't keep up with effective treatment presentations on their own. So they start passing pieces of it off, often to a treatment coordinator, and the doctor starts short-circuiting their own presentations a bit, not spending as much time on the financial side of the conversation, leaving that to the treatment coordinator instead. We actually covered the ideal end-to-end presentation process for a solo practitioner back in episodes 73 and 74, streamlining case acceptance from start to finish. As things get busier, the doctor has less time for the full process, the treatment coordinator starts picking up slack, and inefficiencies start showing up. That's usually the point where a client thinks, I need my associate to help with some of this, because I genuinely can't do it all anymore.
Before answering that, we have to look at how the client actually wants to utilize this associate. There are really two basic relationships we see across the MGE client base between an owner doctor and an associate: what I'd call a conventional setup, and a production doctor setup.
The conventional setup is the one that's been around forever, the associate-owner relationship most people picture. Maybe you're bringing on a newer practitioner, acting as something of a mentor, teaching them along the way, and handing off work you no longer want to do yourself, molar endo, emergencies, seeing kids, being on call, that kind of thing. In some conventional setups, the associate's expected to bring in some of their own new patients, and if it's genuinely their patient, they might present treatment for those specifically, it varies. In other conventional setups, the owner doctor still handles all presentations themselves. Typically, in a conventional arrangement, the associate is earning around 30 percent, a base pay plus some kind of override, which is a solid rate for an associate.
In a conventional setup, especially in a genuinely busy office, the associate doctor is likely going to end up doing some selling. So the next question I'd ask is: how strong is your treatment coordinator? If you have a treatment coordinator who's genuinely good at closing, this can work well. Even so, I'd still want the associate trained to sell before turning them loose, it doesn't make sense to send someone out to present treatment without the communication skills to actually get it accepted, you'll just end up with a string of lost opportunities. This especially falls apart if the owner doctor isn't staying busy themselves and starts handing the associate patients just to keep them occupied, patients the owner could have seen and closed themselves, while the associate fumbles the close because they're not experienced at it yet.
So I'd want this associate trained on sales, but let's say you do have a strong treatment coordinator. In that case, what I'd want the associate to be able to do, at minimum, before letting them loose to present treatment on their own, is comfortably explain to a patient what's wrong and what the treatment solutions are, including answering any questions the patient has. That might sound obvious, like of course anyone can do that, but it's genuinely not a given. I've met doctors who can barely make eye contact while talking to a patient. My wife once saw an ENT, someone who'd gone through four years of undergrad, four years of medical school, a multi-year residency, and additional years specializing, a genuinely excellent physician clinically, but he looked at the floor the entire time he spoke to us. Thankfully we were genuinely interested in what he had to say, or we probably wouldn't have retained much of it. We had one client whose associate was uncomfortable simply meeting new patients, so the client spent a full hour role-playing that exact scenario with them until they felt comfortable. I'd recommend doing the same. If you want your associate to help with sales and you have a strong treatment coordinator to lean on, you at minimum need them able to comfortably explain a diagnosis and treatment plan to a patient in language the patient will actually understand.
How do you know if they're ready? Have them explain it to you directly. You'll likely catch some things right away, they might say something like, "if you look at your x-ray here, there's a periapical radiolucency," and you'll immediately think, I'd never say that to a patient, they have no idea what that means. Or they'll use the word "abscess" instead of "infection." These are things you, as the experienced owner doctor, already know don't land well with patients, and you'll need to coach them through adjusting their language.
So, with a strong treatment coordinator in place, and the associate at least able to meet a patient, explain the problem, explain the solution, and hand the conversation off smoothly to the treatment coordinator without it feeling awkward, they can start helping with sales. I'd keep requiring ongoing sales training throughout this process, we have sales training available on our online platform, DDS Success, I'll put a link on the episode webpage, and we also run the MGE Communication and Sales Seminars, which a lot of clients send their associates to specifically for this. I'll link that too. So: strong treatment coordinator, associate being trained to sell while already helping out with the basics they can handle, that combination genuinely works. I wouldn't hand this associate large, complex cases to present in that scenario though, I'd handle those myself to maximize the odds of closing them, assuming I know how to sell. As the associate gets more trained and experienced, you can gradually expand what they're presenting.
This all comes back to how strong your treatment coordinator actually is. Say your treatment coordinator isn't especially strong yet, not great at closing, uncomfortable discussing finances, a little rough around the edges. You'll need to train and apprentice them too, which we help with, but you'll still need to walk them through it until they're comfortable. Here's an example of what a mature version of this looks like: a doctor and treatment coordinator who've worked together for a long time, both genuinely good at sales. When they present a case together, the treatment coordinator doesn't even need to sit through the entire presentation, they might for a large full-mouth reconstruction or All-on-4 case, but for something more modest, a $4,000 or $5,000 case, the doctor presents it, brings the patient over to the treatment coordinator, or the coordinator just pops in, and nine times out of ten it closes. Why? Because the treatment coordinator can close, and they've watched the doctor handle common objections and questions dozens, even hundreds of times, "do I really have to do all six crowns now, can't I just do two," so they already know exactly what to say.
The way they got there matters: that treatment coordinator sat in on full presentations with the doctor for a long stretch of time before reaching that level of independence. So if you have a doctor who's a strong closer working with a newer treatment coordinator, that coordinator should be stuck to you like glue during every presentation. You sit down with the patient, introduce them, "this is John, or Susie, my treatment coordinator, they're going to help us work out getting your treatment scheduled," and they watch you present, watch you handle objections, watch you answer questions, and gradually learn to replicate it themselves. That's how you build that kind of trust and capability over time. We also have a treatment coordinator training course on DDS Success covering exactly this. Once they've watched you do it successfully enough times and had some real wins themselves, you'll have someone who can genuinely close on their own, and a strong working relationship to show for it. That's when adding an associate doctor into the mix, while they're still learning to sell, works especially well, since your treatment coordinator is already picking up real slack, letting you increase overall production since you can address and close more patients. If volume gets high enough, you might even need a second treatment coordinator.
That's the conventional setup, the one that's been standard for as long as I've been in this industry, going back to the nineties, junior doctor comes on, gets mentored, and yes, eventually has to learn to sell. But you never want to just turn them loose with zero training.
One variation of the conventional setup worth mentioning: sometimes an owner brings on an associate, not a specialist, who performs procedures the owner doctor themselves doesn't do, implants, All-on-4s, that kind of thing. That's not inherently a bad setup. Where it becomes a problem is if you pour a large share of your marketing budget into promoting that new service without doing the math first. That kind of associate typically commands a higher percentage, since they bring a skill you don't have, I remember one doctor who brought on an associate who could place implants when the owner couldn't, and ended up paying them 40 percent, which is genuinely too high, closer to specialist-level compensation, and I've seen specialists themselves take less than that these days. That owner diverted a lot of marketing dollars toward implants, since it was a higher-ticket procedure they'd previously been referring out entirely. Production went up significantly, but profit margin actually went down, and not just the margin, the raw profit dollar amount dropped too, since so much of that new revenue was being eaten up by the associate's cut.
So be smart about this. If you already have a healthy, profitable practice and you're adding an associate who can do procedures you can't, that addition needs to pay for itself, and it shouldn't come at the expense of anything already working well in your practice, that's what got you to the point of being able to add an associate in the first place. And to be direct: if you're considering adding an associate who can do things you can't specifically because your existing practice isn't meeting overhead or isn't otherwise successful, I would never recommend that. As a general dentist, your practice should be able to be successful and profitable regardless of whether you've picked up additional procedures. Should you learn new skills? Sure, it lets you serve patients better and often comes with higher-ticket procedures, and I'm generally a fan of that path. But your practice needs to already be able to stand on its own financially. Adding new capability should build on top of an already-successful practice, not serve as a rescue plan for a struggling one.
So, to summarize the conventional setup: yes, the associate will likely need to help sell eventually, but not until you have either a strong treatment coordinator they can lean on while they're being trained, or they're fully trained themselves.
Now, the second relationship I mentioned: the production doctor setup. This is where the owner doctor moves away from full-time chairside work. They might stay chairside part-time, doing All-on-4s or other complex implant and restorative cases, maybe just one or two mornings a week, while spending the rest of their time diagnosing and presenting treatment. Other doctors, the production doctors, come in and actually perform the treatment being diagnosed and sold, though some owner doctors keep certain complex cases for themselves, and others hand off essentially everything.
This tells you a couple of things right away. First, you need enough patient volume to keep an owner doctor genuinely busy for a full 30-to-35-hour week just diagnosing, presenting, and consulting, no hands-on production. That typically means a practice bringing in at least 50 new patients a month, possibly 70 or 80, with two to three, maybe three and a half, full-time hygienists to sustain that level of diagnostic and presentation volume.
In this setup, the owner doctor is essentially the full-time sales doctor, and production doctors perform the actual treatment. A few things matter here. First, the production doctor and owner doctor need to be genuinely aligned clinically, and if there are multiple production doctors, everyone needs to be on the same page. You don't want to sell a treatment plan, have the patient come in for delivery, and have a production doctor walk in and say, "these don't really look like they need crowns to me, let's just do fillings instead." That's a recipe for chaos. This is worth screening for during hiring: pull out some x-rays, photos, or scans, and ask a prospective associate how they'd treatment plan the case, without showing them how you'd do it first, then compare. If their approach lines up reasonably well with yours, that's a good sign clinically, some divergence is fine and expected, people take different valid approaches, but you don't want fundamentally opposed philosophies trying to work together, that's a recipe for constant friction.
Assuming clinical alignment, the production doctor is essentially getting treatment plans the owner doctor diagnosed and the treatment coordinator sold, and simply showing up to perform excellent dentistry. It's genuinely close to a dream job for a lot of doctors, come in, do high-end clinical work all day, go home, no selling required. That role typically pays less than the conventional associate role, usually 20 to 25 percent versus the conventional 30 percent. When you first mention that percentage to a prospective associate, they might scoff and point out a corporate office offering 30 or 35 percent plus a signing bonus. The difference is volume: that corporate office associate might be producing $40,000 to $50,000 a month, while in a well-run production doctor setup, they could be producing $100,000 a month doing exactly the kind of dentistry they want to do, with none of the sales pressure. I've seen production doctors earning $300,000 to $400,000 a year this way, simply because they're spending all their time producing.
The other advantage of this setup, assuming you have the patient volume to support it, is that selling a case takes far less time than actually performing it. You might sell two root canals and six crowns in a thirty-minute consultation, but performing those same procedures start to finish takes vastly longer than thirty minutes. So realistically, one owner doctor acting purely as the sales doctor can keep two, potentially three, production doctors genuinely busy, assuming you also have enough treatment coordinator support to match that volume. I know a client who runs two to three treatment coordinators on their busiest days and multiple production doctors doing the bulk of the clinical work, with the owner doctor doing implants one morning a week and otherwise focused entirely on new patients and patients of record. That relationship works well specifically because selling takes far less time than producing.
So if a client asks me whether their associate should sell in this kind of setup, my answer is no, you should be doing the sales, and let the associate focus entirely on production, assuming they're a genuinely excellent, clinically aligned clinician.
Here's what usually happens over time in a production doctor setup: eventually the owner doctor wants to take time off, maybe they hurt themselves skiing and can't work for a few days, and while that's happening, nobody's presenting or selling. So long term, it's worth identifying whether one of your production doctors has a natural inclination toward sales. Say you're running a high-volume operation, two or three treatment coordinators, two or three production doctors, strong hygiene, strong new patient flow, doing anywhere from half a million to $600,000 or $700,000 a month. One day you're unexpectedly out, and a couple of new patients end up staying on the schedule anyway, seen and closed by one of your production doctors. That's worth paying attention to, that person might be worth investing sales training into, even while remaining primarily a production doctor, as a backup who can eventually cover the sales role part-time or whenever you're away.
You could approach this a couple of ways: have all your production doctors learn at least a little bit of selling on an ongoing basis, even if they're not doing it regularly, just so the skill exists in the practice, or identify the one who shows a genuine inclination or interest and train them specifically as your backup. Looking further out, say you want to take a month off and travel, that trained backup covers sales while you're gone, and you bring in another production doctor to cover the gap they leave. At that point you genuinely have options: come back and shift toward more of a CEO role, taking a smaller personal cut in exchange for more freedom, or step back in as a second sales doctor, whatever suits you. It creates real flexibility, though obviously it affects your income depending on which direction you go. And that's part of why the production doctor pay rate sits lower than the conventional rate in the first place, you'd typically pay 30 percent to someone still actively producing, but 20 to 25 percent reflects that they're not carrying any sales responsibility. If you do train someone into that backup sales role, you'll want to compensate them appropriately for the cases they close, we have some ideas on structuring that if you ever find yourself there, feel free to email me directly at jeffb@mgeonline.com and I'm happy to talk through it.
So bottom line on production doctors: eventually, would I like that backup person to know how to sell? Sure. But is it a requirement for every production doctor? No. In a conventional setup, yes, the associate will eventually need to sell, but there are real prerequisites I'd want met first, largely dependent on how strong your existing treatment coordinator is.
There's a third scenario worth a brief mention: buying a practice, or opening a new location from scratch, and placing an associate there. Maybe the previous owner is sticking around briefly during the transition, or you're starting fresh. In that case, yes, that associate is going to need to learn how to sell at some point, since they're the one diagnosing treatment on-site. If I were doing this with an associate I didn't know especially well yet, say I'm picking up a small four-operatory satellite practice doing $40,000 a month for around $300,000, a nice little addition, but not a massive operation, I'd want a genuinely good clinician, and I'd absolutely want them trained to sell over time. But the more important piece from a sales perspective, in my view, is having a genuinely strong office manager in that location who can sell, possibly someone you've already trained as a junior manager in your main practice and are now moving over to run this new one. That manager picks up the sales slack while the associate is still developing those skills, similar in spirit to leaning on a strong treatment coordinator in your main office. You'll still want that associate comfortable discussing treatment options and answering patient questions directly, that part doesn't go away.
So that's what I wanted to cover this week, walking through the different scenarios so you can think through whichever situation actually applies to you. This question genuinely doesn't have one universal answer. But if there's a single unifying principle across all of it, it's that someone interfacing with the patient has to be able to sell, whoever that is. I'm a fan of everyone who touches that conversation, whether it's the associate, the office manager, or the treatment coordinator, having real sales skill, because ultimately the goal isn't the close itself, it's getting the patient healthy, and you can't get them healthy unless they agree to move forward with treatment.
I hope this helps. If you have questions about MGE, you can find us online at mgeonline.com or call us at (800) 640-1140. Folks, have a great week, and we'll see you at the next episode.