Why so many private office associateships fail....

[I_Love_Huskies]

I recently posted this on reddit but I figure I share it here too.

This is a bit of a rant. But I find it humorous when I see job postings online from private offices that want experienced associates (at least 3-5 years experience) with training in implants, invisilign, 3rd molars, molar endo, etc. Yet they don't offer any buy-outs or buy-ins.

I don't know about you guys but being 5 years out now, I start to realize, why the f should I work so hard for another dentist's office? Where is the incentive? Especially if they're not offering a buy-in or buy-out. Especially if they have the same degree and qualifications as I do. They're not better qualified than I am. And especially if their spouse (who has no background in dentistry) works there as the OM, and they're reviewing your treatment plans. NOTHING is more demoralizing then that. At this point in my career, it's not so much about the money anymore. It's about fulfillment. There is NOTHING fulfilling about working hard for someone else's practice as an experienced dentist.

I just think those with strict job postings are completely out of touch with reality in recognizing that. The only candidates they would attract are new grads or dentists with limited experience and they're not going to stick around long once they realize they're getting screwed.

I currently work for a corp with 2 other dentists (who are not the owners) and I love it. In my experience, it's a "level playing field" with corp. I don't try to tell the other dentist how to do his job and he doesn't try to tell me how I do my job. I realize not every corp is like this but this is just my experience. I also practice in Canada, so corp may be different here than in USA. It's better than working under some random dentist at a private office (which rarely works out). Because staff loyalty will always be with the person who is signing their paycheques in private office. Also, patients' perception of associates in private office is that associate dentists are seen as inferior quality to the owner dentist. Patients and staff aren't usually very receptive towards an associate dentist. Not so much in corps ("level playing field").

Do you guys agree with any of this?

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[charlestweed]

I recently posted this on reddit but I figure I share it here too.

This is a bit of a rant. But I find it humorous when I see job postings online from private offices that want experienced associates (at least 3-5 years experience) with training in implants, invisilign, 3rd molars, molar endo, etc. Yet they don't offer any buy-outs or buy-ins.

I don't know about you guys but being 5 years out now, I start to realize, why the f should I work so hard for another dentist's office? Where is the incentive? Especially if they're not offering a buy-in or buy-out. Especially if they have the same degree and qualifications as I do. They're not better qualified than I am. And especially if their spouse (who has no background in dentistry) works there as the OM, and they're reviewing your treatment plans. NOTHING is more demoralizing then that. At this point in my career, it's not so much about the money anymore. It's about fulfillment. There is NOTHING fulfilling about working hard for someone else's practice as an experienced dentist.

I just think those with strict job postings are completely out of touch with reality in recognizing that. The only candidates they would attract are new grads or dentists with limited experience and they're not going to stick around long once they realize they're getting screwed.

The incentive is you get paid well and not have to spend any money to set up a practice… and not have to deal with all the headaches associated with running a business. You show up at 8am and go home at 5pm. Many associate dentists have student loans. Being out for 5+ years is not long enough for them to pay off all their debts. Therefore, they have to continue to work for someone else.

Another incentive is it’s a private office. Many dentists don’t want to work for a chain because they think all chain offices are evil and greedy. Some dentists don’t want to work at a medicaid office and most chain offices accept medicaid.

Yes, the owners have the same degree but they are much better than you in many other things. They are willing to take the risk to open a practice and you are not willing to do so. They have great leadership skills and their employees listen to them. They are good at managing, budgeting, keeping their practice profitable. They have a lot of money and you don’t. Here in the USA, money = power….that’s the sad reality but you have to learn to accept it. If you think you are better than them, then I think you should start your own office and compete against them.

You may not want to work for these private practice owners but there are plenty of other young dentists out there who are willing to. With a huge surplus of dentists (due to the openings of new dental schools in the last 10 years) and student loan debts, many of these owners shouldn’t have any problem finding associate dentists to work for them. In many oversaturated areas, the owners even have the luxury of not having to give their associate dentists full time work hours….part time only.

I currently work for a corp with 2 other dentists (who are not the owners) and I love it. In my experience, it's a "level playing field" with corp. I don't try to tell the other dentist how to do his job and he doesn't try to tell me how I do my job. I realize not every corp is like this but this is just my experience. I also practice in Canada, so corp may be different here than in USA. It's better than working under some random dentist at a private office (which rarely works out). Because staff loyalty will always be with the person who is signing their paycheques in private office. Also, patients' perception of associates in private office is that associate dentists are seen as inferior quality to the owner dentist. Patients and staff aren't usually very receptive towards an associate dentist. Not so much in corps ("level playing field").

Do you guys agree with any of this?

Yup, it’s not bad working for corp offices. I’ve worked for corp offices for 20 years and I love it. I have the full autonomy in making all treatment decisions. I’d rather work for a boss at corp, who only has a HS diploma, than working for another orthodontist owner, whose tx philosophy (ie extraction vs non-extraction) may be very different from mine. Nobody from above tells me how I should treat my patients. I think new grad dentists need to be open minded. They shouldn’t just listen to people on this forum and believe that all corp offices are bad and evil.

Pay off all your debts and you will have more freedom to do whatever you like....you will enjoy working more....and love your job more.

 

[Mauricio45]

They have great leadership skills and their employees listen to them. They are good at managing, budgeting, keeping their practice profitable. They have a lot of money and you don’t.

Absolutely not true. Many private office owners have poor leadership skills and don't know squat about running a business. Employees "listen" to them because of the paycheque. I'm amazed at the amount of stories on DentalTown.com from dentists who regret buying their own office and dealing with staff issues and running a business. Loads of private practice owners who are unhappy and miserable and "want out".

I bet most dentists get "pushed" into buying their own office after a string of crappy associateships. Not because they have "great leadership skills".

 

[DrJeff]

Absolutely not true. Many private office owners have poor leadership skills and don't know squat about running a business. Employees "listen" to them because of the paycheque. I'm amazed at the amount of stories on DentalTown.com from dentists who regret buying their own office and dealing with staff issues and running a business. Loads of private practice owners who are unhappy and miserable and "want out".

I bet most dentists get "pushed" into buying their own office after a string of crappy associateships. Not because they have "great leadership skills".

100% agree!

There seems to be this almost mythical notion that some have that if they buy, or even buy into a private practice that starting almost immediately that they will be bringing home a robust paycheck, without having to do mich more than just show up. If that is the case, it certainly is in the vast, vast minority of situations.

Most succesful practices became that way from years, of work, and that work entails everything from developing rapport with patients, refining one's own skills (both clinical and interepersonal), learning the nuances of running a business, and then putting in the hours and hours of work it takes to bring it all together, and even then, with the ever changing society we live in, one needs to continually refine and adapt how they're going about many of those systems and skills they put in place to stay succesful.

 

[charlestweed]

Absolutely not true. Many private office owners have poor leadership skills and don't know squat about running a business. Employees "listen" to them because of the paycheque. I'm amazed at the amount of stories on DentalTown.com from dentists who regret buying their own office and dealing with staff issues and running a business. Loads of private practice owners who are unhappy and miserable and "want out".

I bet most dentists get "pushed" into buying their own office after a string of crappy associateships. Not because they have "great leadership skills".

That’s why these dentist owners fail and are unhappy. They have poor leadership skills. They don’t know how to manage their staff and let the staff do whatever they want. They don’t know how to control the cost….too many employees, high rent, high supply cost etc. I wasn’t talking about these struggling solo practice owners on my previous post.

When I talked about great leadership, I was referring to the successful owners who have busy practices….. they are too busy that they have to hire associate dentists (and in-house specialists) to work for them. These successful owners have great leadership skills. They know how to hire the right staff who help make their practice successful. You may not like their managing style (ie being unreasonable to the associate dentists, being cheap on the supplies etc) but that’s how they are able to maintain the success of their practices, especially in highly competitive areas.

 

[Rambunctious]

I recently posted this on reddit but I figure I share it here too.

This is a bit of a rant. But I find it humorous when I see job postings online from private offices that want experienced associates (at least 3-5 years experience) with training in implants, invisilign, 3rd molars, molar endo, etc. Yet they don't offer any buy-outs or buy-ins.

I don't know about you guys but being 5 years out now, I start to realize, why the f should I work so hard for another dentist's office? Where is the incentive? Especially if they're not offering a buy-in or buy-out. Especially if they have the same degree and qualifications as I do. They're not better qualified than I am. And especially if their spouse (who has no background in dentistry) works there as the OM, and they're reviewing your treatment plans. NOTHING is more demoralizing then that. At this point in my career, it's not so much about the money anymore. It's about fulfillment. There is NOTHING fulfilling about working hard for someone else's practice as an experienced dentist.

I just think those with strict job postings are completely out of touch with reality in recognizing that. The only candidates they would attract are new grads or dentists with limited experience and they're not going to stick around long once they realize they're getting screwed.

I currently work for a corp with 2 other dentists (who are not the owners) and I love it. In my experience, it's a "level playing field" with corp. I don't try to tell the other dentist how to do his job and he doesn't try to tell me how I do my job. I realize not every corp is like this but this is just my experience. I also practice in Canada, so corp may be different here than in USA. It's better than working under some random dentist at a private office (which rarely works out). Because staff loyalty will always be with the person who is signing their paycheques in private office. Also, patients' perception of associates in private office is that associate dentists are seen as inferior quality to the owner dentist. Patients and staff aren't usually very receptive towards an associate dentist. Not so much in corps ("level playing field").

Do you guys agree with any of this?

Well you have to realize that not everyone wants to or is built to be an owner. There's a lot of people only wanting to work 2-3 days out of the week and spend the rest at home. Do you think they want to be offered something like that? Also, why even rant about this? If theres an associate job posted with no offer of partnership or buy out, why even apply there? Just move the hell on or open your own office.

 

[yappy]

Absolutely not true. Many private office owners have poor leadership skills and don't know squat about running a business. Employees "listen" to them because of the paycheque. I'm amazed at the amount of stories on DentalTown.com from dentists who regret buying their own office and dealing with staff issues and running a business. Loads of private practice owners who are unhappy and miserable and "want out".

I bet most dentists get "pushed" into buying their own office after a string of crappy associateships. Not because they have "great leadership skills".

I would wager that the people who make poor office owners make even worse employees.

 

[nealofgrafton]

i'd wager you have no idea what you are talking about
i didn't mind being an associate. i greatly dislike being an office owner. now every problem in the office is my problem and 80% of my brain power per day goes to non clinical things plus the owner get paid last

 

[I_Love_Huskies]

Just because one owns a practice doesn't make them a great dentist or "above" anyone else. Some (or many?) dentists end up owning a practice because they develop a bad reputation as associates (I.e. bouncing office to office within a short time frame). So, they have no choice but to own a practice because nobody else will hire them due to their shady resume.

And they end up becoming jaded and bitter practice owners who take out their frustration on their associate because "that's the way they were treated when they were the associate". So, it's like a vicious and dysfunctional cycle.

 

[2TH MVR]

There is NOTHING fulfilling about working hard for someone else's practice as an experienced dentist.

I just think those with strict job postings are completely out of touch with reality in recognizing that. The only candidates they would attract are new grads or dentists with limited experience and they're not going to stick around long once they realize they're getting screwed.

Agreed. No incentive. .Just a temporary job for an associate until something better comes along.

I currently work for a corp with 2 other dentists (who are not the owners) and I love it. In my experience, it's a "level playing field" with corp. I don't try to tell the other dentist how to do his job and he doesn't try to tell me how I do my job. I realize not every corp is like this but this is just my experience. I also practice in Canada, so corp may be different here than in USA. It's better than working under some random dentist at a private office (which rarely works out). Because staff loyalty will always be with the person who is signing their paycheques in private office. Also, patients' perception of associates in private office is that associate dentists are seen as inferior quality to the owner dentist. Patients and staff aren't usually very receptive towards an associate dentist. Not so much in corps ("level playing field").

Do you guys agree with any of this?

It is a level playing field in Corp. Agree that there are no owner-associate intra-office politics to deal with.
But. Working for a Corp as a young dentist in their prime is a deadend proposition. It's fine as a temporary situation for new grads trying to make a dent in their DS debt. It's fine for us older dentists who have done private practice for many years and are now looking for a less stressful way to practice.
When I was younger there was no greater pride than owning my own practice. My own business.

I work Corp now. I'm paid well. It's less stressful than private practice. But my best memories were when I was growing my private practice.

 

[Saddleshoes]

The nature of a solo practice and it's owner in nothing like the corporate practice relationship.
In the corporate setting its all about money. (Short term, long term, capital investment, HR investment, etc.) It is all very impersonal.
For the solo practitioner money is only part of the arrangement. The solo practice guy has his heart and sole bound into this practice. It is VERY personal with that guy. The Solo Practice/Owner Operator relationship is not unlike a marriage i.e Marriage/Spouse relationship. When a 3rd person gets involved with a Solo Practice/Owner Operator relationship there will be bad results, just like a 3rd person getting involved in a marriage.

Moral of the Story: Don't come between a Solo Dentist and their Practice.

 

[gryffindor]

I don't know about you guys but being 5 years out now, I start to realize, why the f should I work so hard for another dentist's office? Where is the incentive? Especially if they're not offering a buy-in or buy-out. Especially if they have the same degree and qualifications as I do. They're not better qualified than I am. And especially if their spouse (who has no background in dentistry) works there as the OM, and they're reviewing your treatment plans. NOTHING is more demoralizing then that. At this point in my career, it's not so much about the money anymore. It's about fulfillment. There is NOTHING fulfilling about working hard for someone else's practice as an experienced dentist.

I don't follow. You realized all this (smart of you btw) and then you... went to work for a corp? Why didn't you open your own practice?

Going to work for a corp doesn't make your decision to leave a private practice any better.

Anyone can post anything they want in a job ad. It's up to the applicant if they want to apply despite the strict requirements and then if they do interview, it is up to the applicant to accept or decline the position. There are good and bad associateships in private practice and at corps. I have never worked in a corp but where I am, I don't ever hear much good when patients come to us after having been to a corp. I've had associates leave my private practice because they didn't agree with my treatment philosophy. I welcome them to leave and start their own practices and treat the way they want because like you wrote, there is no difference in qualifications to open a dental practice between the associate and I. I've also had associates be thrilled to work for me because it was better in many ways than the corp jobs they left. So it goes both ways.

I agree on the spouse thing. It can be a bad power dynamic if the wife is in a manager position.

 

[I_Love_Huskies]

I don't follow. You realized all this (smart of you btw) and then you... went to work for a corp? Why didn't you open your own practice?

Going to work for a corp doesn't make your decision to leave a private practice any better.

Like I said, not all corps are the same and not everyone has same experience. I believe the corps here in Canada are different than in States.

It's just been my experience working at corps that nobody ever tries to tell me how to do my job (for the most part). I have freedom to tx plan things the way I want and I have freedom to refer out cases without question. Staff doesn't feel they're loyal to one doctor over the other because none of us is signing their paycheques. This is fulfillment for me. Sure, I have some patients that didn't always agree with my tx plans and they're free to leave. I've had people come from private office that were unhappy there. This happens everywhere though and not necessarily a "corp vs private" thing.

Sure, I could go out and open a practice but then deal with staff headaches, running a business, advertising, etc. It's nice at corp to come home and leave all that baggage behind. I'm fortunate to work with great staff as well.

I agree on the spouse thing. It can be a bad power dynamic if the wife is in a manager position.

Nothing good ever comes out of nepotism. 👍 Spouse and owner will always be loyal towards each other and will work to screw over the associate. And that's not counting the DAs and hygienists! Hell, the associate would be better off working at a crappy Corp gig than that arrangement.

 

[Mauricio45]

One of my associateships is at a private office where owner doesn't do any endos. So, about 70-80% procedures I do in the office are all endos. I find this is a really good arrangement because owner doesn't lose out money on referring out simple endo cases, and I get to hone my endo skills. That's when you know you're needed when the associate can do a procedure owner cannot do. The office politics has to favour me to work there. I try to look for associateships like that. It has to be a really good reason to keep an associate there.

Otherwise, rarely does it work well when you work under some random dentist. Dentists in general don't play well or nice to each other. We tend to be territorial ("My way or the highway"). I once turned down an associateship job where there were going to be 10 dentists in one building. Sounds like a recipe for a cut-throat juicy soap opera. And they were pretty open about it during the interview! I'm sure the staff loves to witness all the drama. Free entertainment for them.

 

[yappy]

i'd wager you have no idea what you are talking about
i didn't mind being an associate. i greatly dislike being an office owner. now every problem in the office is my problem and 80% of my brain power per day goes to non clinical things plus the owner get paid last

Id wager I am correct and you were not a good associate.

Every associate position I have had to manage/train staff, develop systems, order supplies, play a large role in hire/fire, market myself and the practice, manage my schedule to maximize productivity, and ensure the front of house is billing/collecting correctly.
I have never had a job where I just show up and work.
I think most owners want associates to play a bigger role in the office than just patient care so things are operating as efficiently as possible. However, that means you’re building someone else’s business. Therefore, I recommend that almost everyone move towards owning or partnership.

 

[clarkbar]

Agreed. No incentive. .Just a temporary job for an associate until something better comes along.

It is a level playing field in Corp. Agree that there are no owner-associate intra-office politics to deal with.
But. Working for a Corp as a young dentist in their prime is a deadend proposition. It's fine as a temporary situation for new grads trying to make a dent in their DS debt. It's fine for us older dentists who have done private practice for many years and are now looking for a less stressful way to practice.
When I was younger there was no greater pride than owning my own practice. My own business.

I work Corp now. I'm paid well. It's less stressful than private practice. But my best memories were when I was growing my private practice.

How is corp less stressful. The manage has unrealistic corporate goals of production. Dentists are pushed to do unnecessary treatments. You have no control of your schedule. Even with an associate, he has to see you every day and that lessens the tension I would assume?

 

[Molar Whisperer]

How is corp less stressful. The manage has unrealistic corporate goals of production. Dentists are pushed to do unnecessary treatments. You have no control of your schedule. Even with an associate, he has to see you every day and that lessens the tension I would assume?

You're spot on. A lot of Corps push you to do too much (unnecessary) treatment to reach their monthly goals. If you're lucky to reach those goals, then you need to surpass them the next month or you're viewed as a failure. It's not their Dental Licenses on the line. It is a continuing cycle where once you leave and there are more candidates to take your place. I turned down an associate offer for $150 per hour. I disagreed with the owner treatment planning unnecessary work. I am so blessed at my current financial situation where I'm 51 and paid off my house (I couldn't write off the mortgage interest anymore and the Military paid all my school expenses).

Every situation has its own frustrations. I worked Medicaid for over 20 years. RCTs, surgical extractions, removables are usually predictable, fast and low stress for me. I'm usually their top paid dentist. My problem is the other dentists are usually new grads that can't numb, can't diagnose, can't anything. I usually get tasked to bail them out. There are many patients that drive over 2 hours to see me. I want to cruise into retirement but I'm getting overwhelmed and stressed out because we had lost a lot of experienced dentists. I have this new colleague I was so excited knowing she graduated in 2009 with "plenty of experience." Instead, she doesn't do anything (refer all extractions, RCTs, removables). Patients don't want to see her anymore. I got into a yelling match with her out of frustration when she refused to see a pt in pain (I almost got fired by design).

One of my favorite authors Mark Manson said in one of his books that "right opportunities will find you." Just keep your network current and improve your skills. I eventually want to teach after a few more years (teaching gigs don't pay well).

 

[2TH MVR]

How is corp less stressful. The manage has unrealistic corporate goals of production. Dentists are pushed to do unnecessary treatments. You have no control of your schedule. Even with an associate, he has to see you every day and that lessens the tension I would assume?

It's less stressful in my situation. You don't have to sell ortho tx. The patients can see it (crooked teeth) and want it fixed. So I don't have these ethical dilemmas that Corp general dentists have to deal with. I've said it before. Working Corp is not ideal longterm. It's just a job and not a good one.

Ideal is a private practice where you control everything. The problem is that your small practice (business) is now competing with all the big corporates. When I graduated .... the Corps were a JOKE. Unfortunately ... the Corps are now a serious trend.

It's not just dentistry. Corporate has spread to many other areas.

 

[yappy]

It's less stressful in my situation. You don't have to sell ortho tx. The patients can see it (crooked teeth) and want it fixed. So I don't have these ethical dilemmas that Corp general dentists have to deal with. I've said it before. Working Corp is not ideal longterm. It's just a job and not a good one.

Ideal is a private practice where you control everything. The problem is that your small practice (business) is now competing with all the big corporates. When I graduated .... the Corps were a JOKE. Unfortunately ... the Corps are now a serious trend.

It's not just dentistry. Corporate has spread to many other areas.

You’re really only competing with the dentists around your locale. I could care less that an office down the street is in the portfolio of some PE firm, dentistry is not capital intensive enough. If it wasn’t owned by PE, it would have been owned by a dentist.