Practice Fantasy #1 - “I Need an Associate”
So, you think you need an associate. As far as you’re concerned, it’s obvious. You are too busy. You have more work than you can handle. You are tired of putting in so many hours. You have plenty of patient records in the system to support another doctor. In fact, you are so ready you’re considering hanging a “Now Hiring” sign on the front door.
Slow down, doctor. It’s more likely that you’re living an illusion. “Busyness” is among the most compelling practice fantasies. When doctors are “so busy” they can barely keep up, they start dreaming up all kinds of imaginary scenarios. They convince themselves that it’s time to build a new office, finish the extra operatories, hire the associate, buy the Porsche, and start livin’ the dream.
However, employing an associate is unlike any other practice hire. This is one of the most important career choices you will make. It’s a marriage of sorts, as this person may become your practice partner. Let there be no illusions, this is a decision that has your financial, professional, and emotional wellbeing riding on it. You will pour thousands of dollars into this arrangement; you want some assurance that it will work. Sadly, many of them don’t. But, why?
Oftentimes, it boils down to unclear or mismatched needs and expectations. The hiring dentist may feel s/he is so busy that the only answer to the perpetual pandemonium is another clinician. Or the senior doctor may be nearing retirement, and wants to offload the less pleasant work to the new dentist so s/he can focus on preferred procedures. In some cases, hiring dentists view associates as extensions of themselves. They assume that the new person will come in, fall in line, produce, and keep their mouth shut. It’s yet another grand illusion.
The associate doctor, meanwhile, is likely entering the practice with a huge amount of dental school debt - $250,000 or more is not uncommon. The economic realities are such that most new dentists are not in a position in which they can take many risks. They require profitability and security. Therefore, they are looking for an established base of patients. They want to work with a trained staff that functions well as a team. And they’re looking for mentoring from the senior dentist in the management of the practice as well as in the diagnostic and treatment aspects of the dentistry. There’s a lot riding on this opportunity and they want to get the most out of it. And that is often where things start to fall apart.
In the “too busy” practice, the hiring dentist convinces him/herself that the new dentist can just step in and help control the chaos. Unfortunately, as I’ve often said, the “too busy” practice is often an indicator of key management systems run amok rather than too many patients to treat.
The associate, looking for a stable environment, instead walks into swirling mayhem. The office is operating in a perpetual state of crisis because the senior doctor will not address the problems, refuses to delegate, wastes valuable production time on tasks that the assistant should be handling, and so on. The senior doctor isn’t too busy; the practice management systems are too weak to function effectively. Aside from trying to put out fires, there’s not enough real work to keep the new dentist busy.
In other cases, the senior dentist has been cutting back in preparation for retirement. The doctor might have had a thriving practice that was bringing in $800,000 a year, but whittled it down to $300,000. However, overhead remained unchanged, and the senior doctor mistakenly believed that the associate would boost revenues right away, an expensive and incorrect assumption that neither could afford.
When it comes to determining the need for an associate, you must know without a doubt that there are enough patients to not only keep doctor and associate busy, but support the two of you as well as the practice. How much is enough? Generally speaking, industry data recommends that for a solo practice to remain healthy it should have a monthly new patient flow of 25, and 85% of those new patients should be accepting treatment. If you’re eyeing potential associates, you should be seeing new patient numbers in the area of 30-35 per month.
Next week, associates and their illusions.
For more information on this topic, visit my blog: The Lighter Side
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