Limitations of Dental Associateship

Associates have little say on how an office is run, especially at the start of employment.

They do not oversee hiring or firing, the purchase of equipment, or office fee schedules. They don’t schedule their own patients, nor do they decide how many patients they will see in a day. Some associates may not even get to dictate how much time they need for a procedure. Understanding the limitations of associateship can help you anticipate roadblocks to find the best first job.

One roadblock in dental associateship arises in treatment planning. Imagine a second molar endo that has been treatment planned by the office owner. The patient arrives at the office expecting a root canal, but the radiographic and clinical evaluation reveals that the tooth doesn’t need it. What does the treating doctor do? Does this office expect associates to follow other doctors’ treatment plans? And if the treatment planning doctor is not in, are you expected to complete their procedures? 

Consider another example. An associate is sees patients for comprehensive exams after their cleanings. The office protocol is such that after treatment planning, the owner dentist keeps higher paying procedures for himself. The owner only distributes the lower paying procedures to associates. Over time, the associate is stuck in a cycle of performing fillings and does not get to develop a prosthodontics technique.

Sometimes an office has no hygienist so associates take on the cleanings in the office. This is an excellent opportunity to establish rapport with patients and spend extra time evaluating the dentition prior to treatment planning; however, the associate needs to ensure a healthy mix of procedures scheduled for the day.

Young dentists have learned the way to deliver comprehensive care at school.

They will realize, however, that offices have their own ways of doing things. It is important to be mindful of how easy it is to pick up bad habits throughout dental associateship. Some offices want the associate to treatment plan the same way as the owner. They may also have managers that change surfaces on restorations after treatment planning. Be mindful that the doctor who completes a procedure is the one who gets in trouble when coding is fraudulent.

As an employee, the associate is using his own time building someone else’s practice. Most of one’s energy as a new doctor in an established office will go toward building patient rapport and earning trust. For that reason, throughout dental associateship, it will be useful to self-reflect. An associate who finds that they strongly dislike reporting to others and wants complete autonomy should plan on learning as much as possible and saving money to open a practice.

Associates might also find that they are ok with not driving the car. Some dentists don’t want to be responsible for management and the administrative aspects of running a business. For them, foregoing a large percentage of production to the owner dentist is worth not having to invest time and money into overhead, staff, equipment, and software. For those who are ok with remaining an employee into retirement, corporate dental contracts are likely more appealing.

Find an office that best aligns with ones values will help mitigate the stress of dental associateship. Associates should ask to look at a typical day’s treatment plan and look for a job where they can treatment plan their own cases. Even with all of the limitations, associates can both help people and bring home money —  as long as they listen to their gut and stick with their ethics.

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