The world has changed for dental graduates. Instead of launching their own practices, many of them are opting to join established offices as associates. This decision offers advantages and disadvantages alike, and Dr. Joseph McManus of Columbia University encourages many grads to give it serious consideration.
“We have an extremely bright core of young men and young women coming to dentistry today,” said McManus, associate professor of dental medicine at Columbia. “They’re extremely well prepared to engage in professional education and much brighter than the previous generation.”
These talented students have multiple options once they leave school, including specialty training and the military. Yet a lack of money is primarily keeping recent graduates from opening their own practices these days, McManus said, with debt ranging from $203,000 to $289,000. The equipment a new practice requires is expensive, too.
“The costs of technology are a major obstacle for a young man or a young woman establishing their own practice,” McManus said. “This is not elective technology. This is necessary technology. The patients of today demand it. They demand digital radiography. They demand different types of impression systems that can scan the tooth.”
Also, today’s dental schools don’t have the time to teach aspiring dentists about practice management, according to McManus. Columbia University, for example, requires 3,872 hours before graduation, with only 22 devoted to management. Many state boards don’t allow courses about management to count in continuing education, either.
An associate position with an existing firm, McManus explained, gives new dentists experience, immediate income, and community status as well as an opportunity to learn without any capital outlay or significant management responsibility. Plus, there may be an opportunity to purchase equity in the practice later.
Yet disadvantages also are possible. Income may be restricted. Associates might not have input in management, equipment, personnel, or hours. Staff may treat associates inappropriately. Restrictive covenants are common for associates as well. And, compatibility is key as associate relationships make marriage look like a sure thing, McManus said.
“Dentists are difficult to deal with. We are very set in our ways. It comes from spending all our time in a 10-by-10 treatment room,” he said, adding that the overwhelming majority of associate positions fail for a number of reasons, including poor communication, unfair compensation, and unrealistic expectations.
An inadequate patient base and new patient allocation also can play a role in doomed relationships, McManus said. To support an associate, a practice needs a base of 1,800 to 2,000 patients, with 15 to 20 new patients a month. In fact, many established dentists take on young associates to help attract new, young patients.
“It’s people with gray hair who have practices,” he said. “It’s people with gray hair who have associates.”
Despite these potential pitfalls, McManus encourages upcoming and recent graduates to investigate associate positions. Before they begin their search, though, they should have reasonable expectations for compensation. They should know their professional and personal expenses. Also, they should prepare to be humble.
“You’re going to have to get used to rejection. You’ve got to get out there,” he said.
Geography is key, too. Before they begin their search, new dentists should ask where they and their spouses want to live and raise a family—and make sure their spouse will be happy there. They also should look beyond the city or state where they grew up or went to dental school.
“You should start to think about expanding your geographic horizons,” he said. “If one more dentist opens a practice in Manhattan, the island would sink.”
The ADA offers young dentists career resources, McManus said. Aspiring associates also should check with state and local societies, practice consultants and brokers, ads in journals, and faculty, hospital staff, and supply companies. They could even place their own ads seeking an associate position.
“Every time you meet another dentist, that’s another opportunity,” he said.
Online, dentists can try dentaljobs.net, dentalworkers.com, dentalresources.com, dental-career.com, and dentalopportunities.com. Regardless of the lead, though, he advised young dentists to approach positions with a mix of humility, appreciation, and get-up-and-go. Plus, associates should never work without a written agreement.
“If it starts with just a handshake, it’s doomed to failure,” he said.
These new associates will be entering a profession that has changed since their potential employers first set up their practices, too. For example, tooth decay overall has declined but affects many patients based on their socioeconomic status, McManus said. And, he values his work with the next generation.
“I understand why we have such limited training in ambulatory care management. Nonetheless, that doesn’t diminish its importance,” McManus said. “So, every opportunity I have talking to young dentists, I like to try to make them aware of these kinds of things because it’s not gone over in school, and they just don’t have the time to do it.”