When I was an associate dentist, I thought the owner made so much money “off of me.” I thought I had it rough because I worked the crappy hours in the office, didn’t get to do some of the bigger cases I wanted to do, took weekend calls and overall felt taken advantage of. In my eyes, the owner had it better.
During dental school, I took some time to shadow my family dentist. I clearly remember him stating that he didn’t know why anyone would go to dental school and never own their own practice. It put the idea in my head that ownership was the appropriate natural progression after associateship. Ownership was success as a dentist in my eyes, at that moment. Ownership was what happened when you graduated from working for someone else.
Today, I own my own practice as a solo practitioner. I think of my time as an associate without running a business in addition to handling patient care, and I realize what a great gig associating is. I look at all of the additional stresses I deal with having my name on the door, and on certain days, I dream of giving up the responsibility and going back to the freedom of just doing the dentistry. That’s the part I like, anyway - so why not stick to just the good stuff?
Now that I’ve worn both hats, walked in both shoes, danced the salsa and the tango, I don’t think there’s a right answer. I think that there are clear pros and cons to being in both of these positions, and recognizing some of them may facilitate deciding which is best for you. At the end of the day, one is not superior over the other. You don’t “graduate” to practice ownership. Being a career associate has some definite benefits, and I greatly respect those who have chosen that path. Sometimes I even envy you!
Here are the top pros and cons of each side of the fence from my own experience. There are so many ways to practice dentistry today, and your experience may not parallel mine. I’d love to hear some of your own thoughts in the comments section.
Pros of being a dental associate
You don’t have to manage a team of employees and all that comes with it - hiring, firing, disciplining, planning team meetings, scheduling and executing employee reviews.
The hat you wear is usually your dental hat. As an associate, you are primarily concerned with doing dentistry. Your job is to provide clinical care to meet your patients’ needs.
Your schedule has more flexibility. You’ll see this in the “cons” section as well, because it can also have less flexibility. However, when you’re an associate, it typically means there is an owner dentist that works in your office. Taking time off for an extended vacation, time to take care of a family member, maternity or paternity leave can be more feasible.
Your options are wide open. As an associate, relocating to a new state, deciding to go back to a residency or taking a year off to be with family are all fairly easy options. As an associate, you can leave your job for a bit and come back to it. Perhaps it won’t be the same office working for the same dentist, but you can usually find another associateship after taking time off.
It’s not your problem. Even when some things are your problem, like a patient of yours that has become disgruntled, it’s not really your problem. The name on the sign is usually the person in charge of putting out fires, making hard decisions and filtering issues as they arise.
Cons of working as an associate
You aren’t in charge of your dentistry. While you are ultimately operating the handpiece and deciding what procedures you are comfortable doing, when you work in someone else’s office, you typically play by their rules … at least to some extent. That may mean something as small as using the cement or impression material the owner dentist uses even though you have a different favorite, and it may mean following a schedule that isn’t ideal, like having hygiene see all new patients when you would really like to be seeing them. Maybe it also means struggling with insufficient time to take photographs and discuss comprehensive care.
Your schedule is less flexible. Because you are essentially an employee, you are typically given the hours that benefit the practice the most by the owner dentist. That will usually include the days as well as the times during the day. When you work for someone else, you may not be able to work your earlier hours on Wednesdays instead of Thursdays this year just because your child’s soccer schedule has changed!
Less financial potential. I put this one here because I felt this way when I was an associate, and I think it’s a common feeling amongst associates. I always thought you made a lot more money owning a practice. In certain circumstances, you may be limited in terms of how much money you can make at a practice based on how the schedule is run, the hours you work and the types of procedures assigned to you. I would caution that I’ve seen very successful associates and very unsuccessful owners, however.
You don’t get to pick a lot of things about how your day goes. As an associate, you usually aren’t the one who selected the team members you work with. You probably didn’t design the layout of the office. You didn’t choose which insurance companies the office is in-network with. You more than likely didn’t decide to be open on the Saturdays you work or the evening appointments.
Pros of owning a dental practice
You are largely in charge of your own destiny. You create your schedule, your team and you even choose which patients are welcome to stay in your practice. When you own your own business, you have the decision-making power over most of the factors that affect your day-to-day. If you don’t like something, more often than not, you can change it.
Practice freedom. You can do dentistry the way you want to - when the patient lets you! You choose all your own materials, which lab and specialists you work with, how long you need for a procedure and when you want to do something at a different price.
Increased flexibility in your schedule. Just like for associates, I have this as a con as well. When you are the owner, if you decide you are too tired to work evening hours, you can stop working evening hours. If you want to have a longer lunch hour for meetings, you can do it. If your personal life requires you to alter your schedule one year, you can do that, too.
You can create an office that is a direct reflection of you. Your office can exude your personality, from the interior design to the energy level of the team. It can be really fun to create an environment your patients know is your own, especially when they choose to come to you and respect you because of it.
Cons of being a dental practice owner
You wear a lot of hats. Dentist. Business owner. Marketer. Boss. It can be a juggling act of sorts. There aren’t always enough hours in the day to get through all the dentistry, emails, phone calls, bills, etc.
The responsibility can be exhausting. If your name is on the door, a lot falls in your lap. The administrative responsibilities, in addition to the clinical ones, can be inundating. I didn’t realize how many moving parts there were to running an office until I ran one! On a lot of fronts, there’s no one else to pass the baton to.
Decreased flexibility in your schedule. There is a certain pressure that exists when your employees need their hours and your bills need to be paid. When you are an associate and you take time off, you go without pay. When you are an owner and you take time off, you go without pay and your practice bills still have to be paid. If you want to take time off for a residency, a month vacation, or relocate, these things are much harder to do when you have ownership over a practice.
Greater financial pressures. The overhead of running a dental office is immense: rent, payroll, equipment costs, lab bills. They all come with a large price tag. Making sure there is money in the account to cover these expenses can put pressure on making sure the schedule is full and clinicians are producing.
While some of the pros and cons listed here will vary depending on what time of an office you own or are an associate in, I think it’s important to recognize that one choice is not better than the other. The old adage “the grass is always greener” can easily apply here. One may be a better choice for you and your needs or desires at a particular time in your life, but each position has its own set of perks, as well as disadvantages. Finding a practice situation that brings you more joy than strife should be each of our goals as we navigate our role in the profession!