All About Associates, Part I
By Gregory A. Winteregg, D.D.S.
(This is a two-part series. Click here for Part II)
Several times a week I field associate related questions. These come from dentists who need one right away, as well as doctors just entertaining the idea as a future goal. The pros to adding an associate are obvious: more service for your patients, potentially more time off, someone to cover emergencies, etc.
There are also plenty of cons: your patients may not like the new doctor, and you might worry about them making off with your patient base, etc. When discussing associates, close to thirty years in the dental industry (thirteen years in private practice and sixteen as a trainer/consultant), have taught me one hardbound rule: There is definitely a right and wrong way to go about this associate business.
If one or more associates are in your future plans (whether this is now or ten years from now), there are several things to consider:
- When should you get an associate?
- How would you structure compensation?
- What’s the best way to find one?
- What are the important points to cover when interviewing?
- How will you integrate them into your practice?
I’ll start with number one: When should you get an associate?
Arguably, this is the most important question. This is also where I see the most errors made. Let’s say you are doing moderately well, still have some openings in the schedule, and are getting about 10 new patients per month. You decide to expand your hours and bring in an associate to become more productive. The reasoning seems sound – you are adding more hours and providing more treatment opportunities for your patients – but this rarely works. New patients don’t magically show up, the associate is unproductive and unhappy. You either a) let him or her move on or b) start moving work from your schedule to make the associate busier/happier. The net result is less profit and a problem – “how do I keep my associate busy?”
In this scenario the office was in no position to justify adding an associate. How would you know as a doctor, when the “right time” was? The answer has to do with you.
I’ll give you another scenario: Your practice has expanded to where you’re very profitable. You’ve organized your schedule so as to maximize efficiency. You have an adequate number of trained assistants. You’re satisfied with your balance of speed and clinical skill – meaning you’re happy with how long it takes you to complete procedures while still maintaining a high level of quality. Despite all of this, you are physically incapable of adding more to your schedule. It’s packed and things start to book out. You just cannot do anymore without drastically expanding your hours, working weekends, etc.
Now, it is time to add that associate to serve three purposes:
a) To provide faster and more efficient service to your patients
b) To lighten your schedule so you can focus on the type of work you want to do and
c) to increase practice productivity.
I would not add an associate to a declining practice unless you were replacing one that left. I would instead get the practice reverted to the point where it was at least mildly expanding, or I had maxed out as a practitioner. If I started booking out a couple of weeks in advance, I would look at adding an associate – perhaps one to two days a week to start and roll from there.
From a practical standpoint, I would also look at how many charts I had. In my experience, 1000 charts, if handled efficiently can potentially keep a doctor and hygienist productive. Also, maintaining a 1:1 ratio of doctor to hygienist seems to work best. If you are already have two full time hygienists (who are booked), chances are you need an associate now.
Business survival is inexorably connected to expansion. If the office is well-run (which would manifest with at least mild expansion), there would come a time when you couldn’t produce any more yourself and would need an associate. The level of production that will require an associate will be based on your style of practice, fees, type of dentistry you do, etc. It may be at $60,000 per month or it may be at $160,000. It’s a personal thing.
At MGE we suggest you get an associate when there is more work than you personally can handle and patients are now waiting to receive their treatment. How long is too long for them to wait? You decide, but it shouldn’t be more than a couple of weeks. Too long of a wait is just not good service!
The other aspect of this associate question is new patient flow.
To start, are you even getting enough new patients to support yourself? How many should you be getting? This depends in a large part on how you practice, but I’ll give you a basic formula to use:
- Take your total number of active charts
- Multiply this by 20%.
- Divide “b” by 12 (months in a year).
- The figure from “c” above gives you the minimum number of new patients you should be getting on a monthly basis to maintain your practice’s health. Note that this is just to keep you going. You would definitely need to exceed this number to add an associate.
Example: Dr. Smith has 1200 active charts. 20% of this is 240. 240 divided by 12 is 20. To maintain a health practice, Dr. Smith should be getting at least 20 new patients each month.
Keep in mind this formula assumes a couple of conditions exist:
- The new patients are fee-for-service.
- The doctor has an acceptable skill level when it comes to treatment presentation and acceptance (which is reflected in production and collections).
Again, if you want an associate, I would recommend that you far exceed this 20% factor. This is where the MGE New Patient Workshop comes in handy – whether you want an associate or not. If you need to learn how to get more fee-for-service new patients to keep your practice healthy, to expand or to make it possible to add an associate, the New Patient Workshop is the solution.
For Part II of this topic, please click here.
Dr. Greg Winteregg provides this general dental practice management advice to furnish you with suggestions of actions that have been shown to have potential to help you improve your practice. Neither MGE nor Dr. Winteregg may be held liable for adverse actions resulting from your implementation of these suggestions, which are provided only as examples of topics covered by the MGE program.