Dentists - What to Know Before You Accept an Associate Position

This is a guest post from our friend Morgan Pace at ETS Dental.

Finding a new associate position can be a daunting process for both new and experienced dentists. While making a good impression on an interview is important, it is equally important to learn as much as possible about the practice. Here is a compilation of questions from job seekers who I have worked with over the years. I hope that this list will make the decision process less intimidating.

Relationship
-Employee or Independent Contractor?
-Employee at will?
-Is the doctor open to restrictive covenant in case of future ownership?
-Is the doctor going to stay on PT for some time or can he, if needed (After purchase)?

Type of Practice 
-How the practice is set up (family, Pedo, or dentures)? Pedo: what age?
-Age of the practice?
-When/what do you refer out?
-Place or Restore Implants? Which system?
-# of operatories
-# of Hygienists. Hrs of operation?
-# assistants
-Will the associate have their own assistant?
-How much is the practice overhead?
-How long has each employee been there?
-What does the practice do to market itself?
-How many FT and PT staff?

Patients
-What is the patient pool like?
-Have the number of active patient records been reviewed?
-Is the practice growing or declining in number of patients seen, new patients attracted, and young patients?
-Average number of cancellations per week?
-Average number of patients seen by associate per day?
-How far ahead is the doctor book filled?
-How far ahead is the associate book filled?
-How far ahead is the hygienist’s book filled?
-Discounts/Bartering/payment plans?
-PPO type of insurance? Insurances: accept all kinds or just selected ones?
-How much is the discounted price of the PPO compared to the fee schedule?
-Medicare or Medicaid acceptance?
-How much of the practice relies upon capitation programs, PPOs, HMOs, Medicare or Medicaid?
-What percent is FFS, cash and discounted PPO?
-When was the last fee increase?
-Are the fees low, high or average for the immediate area?
-Do you offer patients credit?

Schedule 
-Days, hours, on call, etc.
-How many office hours and days per week is the office open?

Duties
-Job description (separate document) or general description
-Is the associate expected to check hygiene of other doctor’s patients? If yes, will the associate be compensated for it?
-Will the associate be expected to perform hygiene/prophy?
-Does the doctor do any procedures other than regular general dentistry?
-What were the most of the cases being done by the associate?
-Will the associate be placing Implants for the practice?

Facilities
-Supplies, equipment, support, etc...
-What type of PMS (Software) is used?
-Implant surgical set up? Who finances to get that set up if NOT already in place?
-What is the square footage of the office? Can it be expanded?
-Average age of equipment?
-Is the practice left-handed, right-handed, or ambidextrous?
-Do you have a confirmation system for appointments?
-How do you deal with NO Show?
-Digital X-ray?
-Intraoral Digital Camera?

Term of contract 
-How long?
-What is the required notice period should either party wish to terminate the relationship?

Compensation
-Is there a guaranteed salary, draw, daily rate or hourly rate?
-Is commission determined from collections or production?
-If collections, what is the collections rate in the practice?
-What percentage of production/collections is used to calculate income?
-Is there a chance to increase compensation in the future?
-Is the associate responsible for my own lab fees and expenses?
-Taxes withheld?
-How will the associate be paid? (Weekly/bi-weekly/monthly)
-How much on average was the last associate making?
-What was the average associate production per day?
-Does the associate production include hygiene exams and x-rays?
-Can I get a fee schedule of the practice?

Benefits
-Medical Insurance: health and dental?
-Malpractice insurance?
-Disabilities insurance?
-Required CE courses? How much and for how many hours a year? Are they paid for/reimbursed? Is there a stipend?
-Retirement?
-Sick days…….. # allow per yr…..
-Personal days/vacations…..# per yr allow……
-Holidays?
-What benefits are given to the staff?

Expenses
-Define, list, when paid, lab, etc…..
-What Lab do you use? Use different lab for different lab orders?
-Will the practice support the acquisition loan (in case of future ownership), pay the overhead expenses and can afford a reasonable income?

Other Questions and Notes:
-What is your practice Philosophy and Goals? For the Practice and with new pt’s tx?
-% of implant surgeries
-Have you had associate before? How many? How long they stayed? What was the reason for the associate resignation?
-How do you advertise?
-Will most dental insurance dictate pt’s Tx plan?
-Do you deal a lot with EMERGENCY pt? Separate operatories for that?
-Average number of emergencies per week?
-Will I be doing hygiene/prophy when I don’t have pt?
-Who determines how long I have when spending with new pt/initial exam and record?
-Do I have a separate apt to do comprehensive exams and record, or do I perform the TP when pt comes in for cleaning?
-How long does a hygienist spend on their recalls?
-Is there a particular doctor in the area who is your main competitor?
-Who sees the patient first (Doctor, hygienist, associate)?
-Why was the partnership offer turned down by an associate (if applicable)?
-Will I be able to visit the office during regular working hours?
-Does the doctor have a report showing how much treatment is treatment planned?

Partnership/Buy in/Sale
-Discussion/Formula/Price
-What is the time frame for an associate position before we can talk about partnership/buy in/buy out?
-Is there an option for future ownership? Are you considering a move out of state?

Restrictive Covenant
-Define


Morgan Pace is the Southeastern U.S. Account Executive and Senior Recruiter for ETS Dental. He can be reached at mpace@etsdental.com or 540-491-9102. ETS Dental is a Dental Recruiting firm specializing in finding and placing General Dentists, Dental Specialists, and Dental Staff throughout the United States. www.etsdental.com 

The Four Most Common Mistakes Dentists Make When Hiring a Website Developer

This is a guest post from our friend Kim Grimsley, an intellectual property attorney at Oliver & Grimsley.

We meet a lot of clients that fail to obtain a written agreement, or blindly sign the form provided by the developer - and when a dispute arises, only too late realize the problems created by that lack of diligence.  This post addresses critical provisions in a website development agreement.

First, you want to make sure you will own the material and content created by the developer.  Thus, you want a provision in the agreement (which must be in writing) that recognizes that the developer’s work for you is considered a “work made for hire” and you want a copyright and intellectual property assignment as well.  These clauses ensure that, although the developer is not your employee, you are the owner of the website materials and intellectual property rights.  You do not want to find that your website designer created something unique for you only to discover the same unique layout on another website.  Many businesses are surprised to learn that in the absence of this statement in a written agreement, an independent contractor (in this case the website developer) typically is the owner of work they create, and the business at most would be a licensee of the material. This means you don’t own the work; rather, you only have permission to use it. 

Second, you want to have a provision in the contract that states that the work on the website is the website developer’s original work and/or that the developer has the necessary permission/licenses from the owners to use the work on your site.  For instance, the website developer may place photographs on your website – you want the developer to represent that the developer has the right to use those photographs on your website (i.e. either the developer took the photos or it has the permission to use them).  If the developer uses photographs owned by a third party on your website without the third party’s permission, the third party could claim you are infringing on their copyright by displaying their work on your website without their permission, and would demand you cease use of the photos and may demand damages as well.  Thus, have your website developer represent the work is original or that he has permissions to use all work on your website.

Third, make sure to have an indemnification provision in your agreement.  This provision should provide that the developer will indemnify you in the event you incur damages or a loss due to a third party claim that you are infringing their intellectual property rights – where they claim the work on your website is actually their material.  For example, a business thinks the graphics on its site are original, however, it receives a cease and desist letter from a third party alleging that its use of the works on its website without the third party’s authorization is copyright infringement and demands damages.  Under Copyright Law, if the third party is the owner of a registered copyright in the work, the business as an unauthorized user could be subject to statutory damages ranging from $700 to $30,000 for unintentional infringement, and up to $150,000 for willful infringement. Thus, if material placed on your website by your developer is subject to a claim or legal action for infringement, you want your developer to indemnify you for these actions since you are relying on their knowledge, creativity and skill in developing and designing your website.

Finally, it is important that you make sure that the developer periodically delivers all source codes and native files to you, and that you control all passwords and access to critical website assets, such as the domain registration.  You want to make sure that such files and access rights cannot be withheld in the event of a dispute.  Thus, if a dispute arises, the developer's sole remedy should be money damages.  You should not be prevented from transferring the work done (to the point of a dispute) to a new developer, so you can finish your site, and deal with the dispute separately.  

For more information, please contact Kim Grimsley at Oliver & Grimsley, LLC -  kim@olivergrimsley.com 

Dentist and Spouse Roles - Financially Speaking

Here is another guest blog from our client Dr. Lurie.

It seems to me... the role of the wife (spouse) in a dental practice has not been discussed enough.  We take it for granted that the husband and wife are on the same page, but this is not necessarily so and has cropped up in discussions at many study clubs. Since I have written several articles on retirement preparation, I would like to interject that retirement begins with the start-up of practice. The role (or roles) of the doctor and spouse will obviously play a big part in the success and continuation of the practice and for the eventual plan that the team for retirement carry out.

There are several different scenarios to look into.  The doctor (male) with a non-working wife seems to be a common model.  When a good marriage is present, stable and open, financial interests will be discussed and the future planned for, with budgets for essentials and "fun", including shopping, vacation, hobbies etc...  Even with the so-called good marriage, sometimes the mate does not think that the cash flow will ever change or diminish and that status quo just continues.  Unfortunately, this does not always happen.  One of the problems is the lack of communication between the two.  Or worse, in unstable marriages, the lack of caring about the communication.  This can be a prelude for disaster.  Credit card debt is the killer and many doctors and wives are falling into the credit card debt chaos that then makes the practice a place where there is pressure to pay the personal debt along with the overhead of the practice itself (which, in today's times is getting more and more burdensome even for the mega practices.). One can only hope that the two can sit down and get a handle on this. Then, if needed, meet with the financial adviser to face the crisis and the facts.  Sometimes, it is the doctor who is the one who abuses the credit cards, or it may be the wife - or worse, both of them.  This added strain then makes the practice a pressure cooker and the joy of dentistry begins to fade.  We find that the emphasis is on paying the debt (at the sacrifice of quality) rather than reinvesting into the practice and escalating its return.  If the parties are not able to resolve this, then the situation might be doomed (as many of you know.) 

I have been there and was able, early on, to get the adviser to help us (and to reign me in since I was the abuser.)  We actually went a step further.  My wife started working in the office one day per week.  This was a great benefit in several ways.  The most important one was that she saw how hard I worked and what the overhead margin was all about.  It also enabled her to meet with the staff and she was directly under the supervision of the office manager.  This was made quite clear in the beginning.  She then was better qualified to work our personal household budget and to maintain our entertainment budget on a level compatible with the office.  The second benefit that we obtained was social security benefits that now (in retirement) really come in handy.  I was lucky (in that this conference with my team ) was early in my years of practice and marriage. 

Obviously, every practice (and doctor) has differences.  Not all doctors can have their wife in the office with them.  It can cause problems with staff if not addressed properly.  Conversely, it may be a benefit with staff knowing that the spouse is there. The communication and the personalities of the entire staff and doctor are the key. My Dental CPA has told me countless number of cases where credit card spending has caused practices to fail.  I urge you to look at this carefully and adjust wisely.  Remember that the beginning of practice is the beginning of retirement. There are many facets to this discussion and this is but one of them.  I wanted to share with you my personal story.

It seems to me… that we may have many variations on this.  I would love to hear from you and share experiences.

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie

donald.lurie@att.net

Phone:  717-235-0764

Cell:      410-218-2228