Many dentists have hiring an associate on their lists of things to accomplish in their practices. This is an important step in the growth of any office, and it can be a wonderful addition or a disaster. There are many keys to making an associate relationship work. The first key is knowing when to hire an associate.
Timing is everything. Hiring an associate before your practice is ready can cause a drop in the owner dentist’s income and other unwanted disruptions. I find that dentists often hire an associate before the practice is ready. This can result in the owner dentist and the associate dentist not being busy enough.
I currently have 22 associates working for me, so I have done this a few times before. This means I made mistakes that I can help you avoid. Here are some benchmarks that I look for when deciding if it is time to add an associate.
Office production
I start looking to add an associate when the total production is consistently at $140,000 per month or more—around $90,000-plus for the doctor and $50,000-plus for the hygienists. I find that most owner doctors want to hire an associate before they have reached these levels, which can be too soon. You really should be producing at least $25,000 to $30,000 per treatment room (doctor and hygienist) per month before adding an associate. This means you are reaching capacity and need help from another provider.
Number of patients
You must have enough new patients and recall patients in hygiene for the new associate. In a younger practice, we will need to see a higher number of new patients since there are fewer existing recall patients. Unless the senior doctor is planning on slowing down, a strong marketing plan will be necessary to bring in those additional new patients. In an established office, I like to see at least 30 to 40 new patients per month, per dentist.
Referrals
I want to see a 40% to 50% referral rate before adding another dentist. A referral rate lower than this means other internal issues need to be fixed before an associate is added. There is no use spending money on marketing if your patients are not staying and referring. If you are not getting a high number of referrals, your patient acquisition cost is too expensive. Fix the referral problem first, or it may just get worse when the associate is added.
Case acceptance rates
Case acceptance needs to be at least 80%. If the owner doctor has a low case acceptance rate, too many patients are not completing their dental treatment. A low case acceptance rate reduces profitability, which makes it very hard to profit from the associate. Associate doctors usually have a lower case acceptance rate than senior doctors.
Strong systems
An associate dentist will do what comes naturally when communicating with the patient, presenting treatment, scheduling, completing procedures, etc. If you don’t have strong systems for how everything operates in your office, your success will be dictated by the associate’s natural abilities in these areas. In other words, it will be the luck of the draw. I train my associates on our systems for a full week before allowing them to see patients. This helps to ensure the associate’s success and mine.
Physical office space
Ideally, the practice should have five doctor chairs and four hygiene chairs. This gives each doctor two chairs for treatment with one shared overflow room. This also provides two columns of hygiene patients for each doctor. If you don’t have the physical space for nine treatment rooms, you need to get creative by adding days and hours to increase capacity. One option is to do split shifts where the office is open 12 hours a day with each doctor working a six-hour shift. I would add expanded hours before spending a lot of money on expansion, remodeling, or building a new office.
Hiring an associate dentist can be exciting and profitable for your office. Work on growing your practice in the areas described above first. If you don’t know how to make these things happen in your practice, get help from someone who does know. Don’t try to learn or figure these things out on your own. It takes too long and costs way too much money to do it by yourself.
Michael Kesner, DDS, has a practice that ranks on the Inc. 5000 list as one of the fastest growing companies in America. He is the author of the book Multi-Million Dollar Dental Practice and the CEO of Quantum Leap Success in Dentistry, which teaches more production, higher profits, and less stress. Contact him at [email protected].
