Surviving your first associate/potential partner is fraught with hundreds of twists and turns. One of the easiest ways to avoid these pitfalls that lead to failed associateships 93% of the time is to begin with the end in mind. I am actually writing this article as a way to discuss what I see in many offices, but to mainly help an Endo practice that is struggling with a new doctor as an employee hired with the intention of having him buy in. Guess what? It’s not working well. Both doctors are looking at each other as if they are from a different planet. Kind of like those books about males and females: Women are from Venus, Men are from Mars. So let’s create a list of the most common problems and fixes so that we can smoothly move towards a successful transition.
One note: I will not dwell on the fact that employee dentists don’t usually last past the 15th month without some offer of ownership. If a doctor does stay over that time, you have the wrong doctor. The good ones, the ones with a fire in their belly and a desire to grow a practice, will leave and go do it. The ones that will stay are like a parasite: What’s in it for me?
1. Timing is everything. Finances, new patient load, great systems, and a strategic plan and vision are paramount to a successful transition. Dentists spend more time planning their vacation than they do strategizing a transition. Everything matters, and anything you forget will create a very predictable ripple effect in your plans. This strategy for practice growth must follow the “R E A D Y, aim, fire” process. Cowboys that shoot from the hip will die every time. More than any other business strategy in dentistry, transitions demand that everything be in order. These mirror many of the benchmarks of a Super General Dental Practice. I will just list them here for your reference.
a. 50-75 new patients per month/per doctor and the ability to double that at will.
b. $20-25,000 of production per employee per month (at least $15-20,000 as a bare minimum)
c. Recall of at least 70%
d. A wide range of services meeting the demand of the demographic of your area.
e. An overhead being no greater than 65%. (Ideal would be 50-60%)
2. Beginning with the end in mind. What will this practice look like if everything could work out right: Overhead, production, new patients, hours, types of patients, services, duties, etc. You should take the time to create a word picture of exactly how you hope this will turn out. In a perfect world, what would this look like? Write it down. You will get what you deserve, not what you expect. This is a time in your practice where you have to be intentional about modeling and staging for a particular result. You need to know what that result looks like.
3. Clear Expectations. Not cloudy, not grey, and not fluctuating. Crystal clear. If you can’t write down your expectations, how will anyone else know what you expect? It’s always surprising to me that the senior doctor as well as the new hire have never sat down and discussed and recorded how they both expect this to go. Generally you have two people who are clueless about what is required and what to expect. Kind of like two ticks and no dog. Is it any surprise that this will end as a disaster? One thing to keep in mind: New doctors don’t decrease stress and problems. They multiply them. In fact, most, if not all, of the systems which may work fine for you will be woefully inadequate for the new transition. Here’s a short list of things you both should consider before continuing:
c. Clinical setups
g. Treatment planning
h. An organizational chart for communication
i. What the long term relationship will look like
j. A time table for these expectations
k. Productivity expectations
l. Needs of both parties
m. People skills
n. Being on time
o. Case presentation
4. Measure their performance. In other words, measure their progress and give them a constant source of feedback from you and the staff. They need to stay on purpose and on track to make sure you both arrive at your objective. That’s why as the senior doctor you must be engaged in the process. Calls should be made to patients by your staff to make sure things went well. Lab work needs to be checked in order to be sure that the quality you seek is there. If not, train the doctor to an acceptable level of competence. Measure, give feedback, do again, and repeat is the only way of getting a consistent product. As they get better, back off. This should only take about 4-6 weeks before you no longer need to micromanage.
5. An incredibly detailed contract. Summit was helping a senior doctor draft an associate agreement. In the process the client was given a contract drafted by us, to compare to the one his attorney drafted. The comment we got from the attorney is that we were making the contract too long and detailed. His justification for this was: “Why would you want to address every possible problem and expectation in the contract? It’s just a small business and you doctors can just work it out latter.” A contract should address every possible problem that might occur and create remedy for them through a thoroughly thought out plan that meets both parties expectations and desires. Short of that, you have a worthless piece of paper that serves no one. This should contain your expectations along with your business draft that both parties have agreed upon. Use a mentor or coach to help you with this.
6. Any transition should be based on a profit motive for each party. The senior doctor wants to grow the practice and lower the overhead. The junior doctor wants to pay off debt while beginning his/her career. That’s a profit motive. Anything that would diminish the return for either side will be a mistake. It’s requires a “do whatever it takes” attitude by both parties guided by the expectations you’ve outlined.
7. Never hire someone just like yourself. By far the worst thing you could do is to go out and get a “Mini-Me”. Do that, and you have effectively hired someone who will halve your practice and both doctors will starve. You need to find someone who “complements” you. Someone that brings something additional to the table. If there are procedures you don’t do or types of patients you don’t enjoy, then hire someone that does like and can do them. If kids are not your thing, get someone that loves to work with them. You get the idea. Expand the range of patients you can inspire with this transition. Do this and the practice will grow.
8. Hire slowly and fire quickly. It is counterproductive for you to take more than a couple of months to figure out if this is the right person or not. With clear expectations and a measured progress report, the trend will be apparent and then you must take action to move to the next level or free up their future.
9. From day one of the search, involve the Staff. Partner with your staff to find the very best candidate. Their participation will go a long way in making the process move to a successful completion. Failure to involve them early on guarantees that you will fail in the process of bringing in and keeping your doctor happy and productive. Involving them also goes a long way in creating a bond with your staff so that they begin to have this “staff ownership” mentality. It’s no longer just your practice, but “our” practice.
10. Become the leader you should have been all along. So often I find doctors bring in associates as a “burnout” strategy. They’re just tired and worn out and in debt and think that this new doctor will stem the bleeding and lead to new momentum. Leadership filters down from the top, not up from the bottom. Leadership can be learned, but is seldom practiced in the offices I visit. If you think you’re struggling in this area, just give me a call and let me walk you through a leadership discussion applicable to a dental practice.
I hope this gives you food for thought as you begin to move toward a successful transition and adding another doctor. As always, feel free to pick up the phone and call when you have questions. If you don’t have any questions, please don’t try this at home. You will get hurt.
Michael Abernathy, DDS
PS — There are no perfect transitions or doctors. Just like Kmart’s blue light specials: All objects being sold have some defect or problem. That’s the doctor pool you are selecting from. Just like you, life isn’t finished with them yet. Look for doctors that have people skills and self-motivation and everything else can be learned. Being in dentistry for over 40 years affords me the perspective to know that individuals with these two traits end up doing well, those with just clinical skills end up struggling.
PSS — By the way, I did write the book on it. If you would like a copy of The Roadmap to Wealth & Security: Your Complete Guide to Dental Transitions, just go to www.summitpracticesolutions.com/our-products to order. Or call 800-252-0955 for more information.