Associateship vs. Ownership

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Yesterday, an owner of my office informed me they would be letting one of my assistants go – effective immediately. It is perhaps worth noting, this decision was not made on my recommendation. Nor was it based on any ineptitude the assistant had exhibited while on the job. In fact, the assistant had wonderful chair-side manner, patients adored them, they were always punctual and reliable, and got along extremely well with others in the office. I cannot dispute that there was certainly a valid reason for deciding to lay the assistant off; but it was not a clinical one and the loss of this employee is devastating to our entire office.

This is not the first time staff has come and gone without my having a say in the matter. My bosses are very considerate of my input and often times ask me about the goings-on of our location. They have given me ample leeway to practice dentistry the way I want. But moments like this make me realize I am not in the drivers seat for many aspects of how this office operates.

I graduated in 2014 from my pediatric dental residency. By now, I am confident enough in my clinical skills to be an owner of my own office. A couple of things weighed in on my decision to remain an associate.

First and foremost, outside of the patient exams and treatments and the corresponding clinical notes, I leave work and I go home to my family relatively carefree. My two kids are still young, and I enjoy being able to spend some time with them without the distractions and worries of running an office.

Second, I have it on good authority from several friends that own offices already, that staffing by far is the biggest headache. Employees call-out, quit, embezzle, and constantly demand raises; all of that minutiae I currently have the luxury of being oblivious to. Of course, it impacts me and I have to be at least a little concerned. If claims are not being collected adequately, it could likely impact my pay. Likewise, if we fall short too many assistants, some patients may need to be rescheduled on account of the insufficient staff and our production numbers are not the best.

Third, I have considered and investigated turn-key dental offices and new build-outs; and no matter what option I go with, the debt burden is ridiculously high to buy an existing or to start-up a new dental office. Pediatric dental offices especially do not come on the market very often, but the couple that I have seen would have set me back $500k-$1M easily. The wound from my student loan debt is still too fresh, and I did not feel ready to take on yet another ginormous loan.

Last, I have yet to learn the human resources and front-office side of the practice; all the billing and coding, the hiring and firing, the employee benefits packages, etc. Not that I couldn’t pick it up quickly, or even out-source a lot of it, I just have not taken the time to learn it. That is not as much of a deterrent for me as some of the other issues I mentioned above.

While I absolutely love my life as an associate, I would be remiss if I did not mention that there are two recurring fears I live with every day. The first is that I am not in control of my own fate. They could suddenly decide to close the office down one day, or I could be replaced with a new graduate willing to take lesser pay. Fortunately, I have a severance clause in my contract that helps protect me (in part) from the latter. As for the former, my family and I live a lifestyle so below our means that I could literally be out of work for years without feeling the pinch of unemployment.

The second, and probably most unbearable part of being an associate is honestly, incidents like the one that happened yesterday. We lost a phenomenal member of our team, and I had zero say in it. That really sucks. I guess there are going to be pro’s and con’s to everything in life.

And this probably goes without saying, but I thought it might be worth mentioning – your earning potential as an associate is of course always going to be less than if you were the owner of the practice. For me, that difference in income is worth it because I do not have to worry about the staffing, payroll, office supplies, leasing, you name it.

I would be interested to hear other people’s thought processes and internal reasoning on their own professional decisions with staying an associate vs. opting for ownership. Thank you so much for reading this post!

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