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New Dentist Committee
Revisiting "The Rule": Associateship in the New Marketplace
Christopher M. Johnson, D.D.S.
A colleague mentioned a certain statistic to me the other day. It wasn't the first time I had heard it. In fact, I'm sure that all of us have heard this number before. He called it the "80% rule", in reference to dental associateships. More specifically, that 80% of all dental associateships fail. I couldn't argue with him. One hundred percent of my associate positions didn't pan out. Most of my classmates have been associates at one time or another, and sometimes we sit around and share favorite war stories from various practices over a cold libation. Inevitably the "80% rule"
comes up, like some sort of empirical conundrum, or better yet, dentistry's own urban legend.
Out of curiosity, I decided to do my own highly unscientific research. I asked around to see if there is any truth to "the rule", and if there is, what is the problem? We are all professionals with goals and skills. Why can't we just get along and practice side-by-side whistling while we work in a communal dental utopia? Seasoned dentists say they are too busy, not enough time for family and fun. New dentists say they are steeped in debt and need to be busier. All reports indicate that there are fewer dental grads than retiring dentists. It seems to me that the dental community is ripe for associateships, exciting opportunities for new dentists and seasoned dentists alike, but then that nasty rule rears its ugly head again.
I was recently at a continuing ed course and spotted some older dentists discussing the fall of the market and how it was affecting their retirement plans. This sounded much more exciting than my previous discussion on bond strengths of seventh generation adhesives. Wanting to be noticed, I brought up "the rule". The response I received wasn't what I expected. The collective opinion of this group was that new dentists, recent grads in particular, don't have the same work ethic that they had when they graduated. They nodded in agreement that it seems like many new dentists are very particular about where and when they want to work. My overall vibe from this group of respectable dentists was that new dentists want to work the minimum hours for the maximum compensation. I couldn't argue that point, but what was more intriguing was their generalization of new grads as unambitious and overly confident. I harkened back to my graduation day. I felt like I would work seven days a week if the opportunity presented itself. Moreover, my financial life depended on my being busy Ü very busy.
A week later I was speaking in front of the U of M School of Dentistry class of 2003 on the topic of transitioning from dental student to D.D.S. One point that became very clear is that most of these students have very significant debts to service. As shocking as it may seem, it was also clear that dental students have no idea how associateships work, even though it is supposedly covered in their practice management course. Needless to say, I didn't mention "the rule". The vibe I got from this group was that the dental community has little appreciation for the debt load the average graduate carries; furthermore the sky is falling and the focus of this tragedy will be directly above Moos Tower. More importantly, they need employment that offers maximum compensation for minimum perspiration to maintain sanity. Again, I couldn't argue that point.
To make sense of my new-found information, I contacted one of Minnesota's transition specialists, Dr. Mike Prazich. I asked him if "the rule" was accurate. He felt that an 80% failure rate was high, and his educated guess was that about 50% succeed. I liked his glass-half-full theory, but I still wanted to know why the other half fails. Dr. Prazich said without question that personality conflicts are what end associate agreements. Like any relationship, two dentists may start out hot and heavy and cool off quickly if they are not compatible. In Dr. Prazich's estimation, the only way to avoid conflict is for the dentist to check references and make sure that a grace period is installed to protect both parties.
My own experience has taught me that many new dentists enter associate agreements with unrealistic expectations. Every graduating dentist knows what the published average income of dentists is. Every dentist thinks that he or she should at least be average in his or her level of success. The lesson that's hard to learn is that 50% of dentists, by definition, will be below the average. And guess what Ü it takes time to build patient base, hand speed, and more importantly, reputation. When you're steeped in debt and eating microwave dinners, it's hard to have the patience and insight to give an employment position a serious chance.
On the other side of the coin, dentists will take on associates for the wrong reasons. According to Dr. Prazich, many dentists may think they are ready for an associate when they aren't. Maybe they see contemporaries adding associates and feel the need to keep up. Maybe they feel compelled to take time off or want to wind down a little bit. Whatever the case, the best reasons to consider an associate are when patients cannot make appointments in a reasonable time period due to a large workload or if you're ready to retire and need to transition out of practice. Under these circumstances, one can't help but keep an associate busy.
My grossly inadequate and highly unscientific research has the following conclusions: dentists don't realize each other's needs; new dentists often have unrealistic expectations; and hiring dentists don't know what they're in for. Add those three, and "the rule" stands. Perhaps someday I'll hire an associate and devote my time to surveys and statistics to find out if "the rule" is valid. As for now, it's a moot point, a myth, a number as elusive as the perfect associate arrangement. I've been to enough practice management lectures and team building exercises to know that there will never be a cookbook recipe for associateships that calls for two or more parts dentists and an equal part patients. The nature of dentists won't allow it, not even if you filter out the egos. The only advice I can give to new dentists is to be patient, take the time to figure out how you want to practice, and when the day comes when you might consider hiring an associate, just make sure it's for the right reasons.
CMJ
Copyright 2003. Minnesota Dental Association
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