By Greg Auerbach, MBA

Unfortunately, most doctors do not look closely enough at their office to determine the true necessity of having an associate and making an uninformed decision can be detrimental to the practice. Whether it is the office size or internal systems, diagnosing the need for an associate necessitates as much diligence as finding the right associate.

In many cases, the size of an office precludes hiring another doctor. Simply put, an office without enough operatories cannot be shared by two practitioners working at the same time. For a general practice, five equipped operatories (two for each doctor, one for hygiene) is the minimum, while probably inadequate when considering future growth. Six operatories can work, when the associate is to lead to a buy-in/out but if this is for a longer term arrangement, seven operatories is really required.

Physical size, though, is not the only size consideration. With current practice overheads averaging 60-65%, the financial breathing room of the past has evaporated. So, assuming the physical plant is large enough, the next consideration is practice income. Basically, there must be sufficient revenue to ensure that everybody gets paid. Adding an associate usually means additional expense to the owner doctor until the associate actually pays for him or herself. Further, an associate may require additional staff costs, even if just an extra assistant. Take this under consideration since as overhead increases, the profit of the practice decreases. Only after all other expenses are covered can the owner doctor be compensated.

The associate needs patients; where do they come from? If the practice is not seeing at least two new patients per day (average) the associate will need to have patients referred from the owner to keep busy. To grow the associate’s business though, and maintain your own, new patient flow needs to be much greater – how much depends on the size of the practice. To keep an associate busy for one day per week, expect to have approximately 200 unique patients assigned to the associate. Also, expecting an associate to only do simple restorative procedures, as opposed to comprehensive treatment, will be a good way to become an associate’s stepping stone to another opportunity, quickly.

If your practice has the physical plant, revenue and excess patient base to accommodate multiple doctors, the question remains: “why do you want an associate?” Usually, the answer has to do with being “too busy”. Being “too busy” though, can be a symptom of other problems in the office: poor scheduling, team problems, patient profile mistakes, treatment planning issues or even poor payment systems. While systems management is a topic for another column, if your internal office systems are not sound prior to adding an associate (or any variable) to the office, your busy-ness and chaos problems will only be magnified.

So, why do you want an associate?  Maybe you have come to the point in your career that you would like to slow down and begin to back out of the practice into your exit strategy.  Possibly you would like to specialize in a specific dental niche but still maintain the larger general practice. Most often the answer is that you feel the office is just too busy. In any case, if the right questions are not asked and the information analyzed, your problems may be compounded, not resolved, by hiring an associate.