The Icky Side of Associateships

For all the amazing, positive talk about associateships, there are aspects of it that are not glamorous or fun. In this episode, Dr. Kuba and Bethany talk about all of the sticky points that can come up between practice owners and associates. From who gets the credit on x-rays to fairly dividing up the new patients, issues can arise. Bethany encourages both the practice owner and the associate to have fair expectations of one another and to approach the relationship with mutual respect. She and Dr. Kuba discuss the importance of clear communication throughout the relationship.  

Previous Episodes Worth Revisiting: 

Interview with an Associate Dentist – Meet Dr. Michael!  

Clear Expectations and Sticky Conversations 

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Transcript

are you looking for a podcast where you can hear from real people regarding their real dental drama if so then
0:09
you've come to the right place join hosts Bethany Penny and Dr reena Kuba as
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we dive into the solutions we've created and the mistakes we've made while
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managing dental drama let's get started hey lady what's up what's up guess what it's April and
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our that means our April content is now available through the subscription and
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so I feel like our theme is really cool because it's all about if your practice is isn't doing what you wanted it to be
0:40
doing this year all those dreams that you had in January then April's the month to get back on track so we got a
0:46
ton of good content so my concern when you say that is if it's not doing what
0:52
you needed to be doing and how the hell do I know that i I don't even know if
0:58
I'm where I need to be or I haven't even stopped to think about if I'm there or
1:04
not or what I need to be doing yeah I know that's why you need the April Digest which is chocked full of where to
1:11
go what reports to pull what to do to get going so I don't think there's any
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reason that people should wait april has marketing content it has reports it's
1:21
got team building like you got to go check it out it's phenomenal this month so I'm excited about it okay i'm going
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to go do it okay now I got to shift gears because we've got a great topic
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for today which we're going to come back to this topic of associates because you
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I know you've kind of been through lots of associate type conversations lately i've got clients that are going through
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things but I kind of want to focus on what I would call maybe the yucky side
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of associate ships the messy part that can get kind of the drama the drama how
1:57
about we dig into that today so when I say the yucky side of associate ships
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what are some of the first things that come to your mind i guess I think about like the associate
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um what if their dentistry is not up to par and you're having to have a conversation about
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um you know I've been looking at your crowns and they're not like how do you have those conversations like that is my
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number one yuck factor right there i think I think the other thing that pops to mind is
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um you know how do you coach and correct with if there's things that they're not
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doing from a staffing standpoint like you know getting in the way of your systems or flows or your staff stuff I
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think about you know are they secretly planning their own office or their exit and taking my stuff like
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my systems or my paperwork or my staff
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been there done that right so um I think yeah all of those yucky things oh the
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other thing like compensation if they're starting to question and wanting more or think they
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deserve more um I know one thing that I always hate is when we get into the nitty-gritty of like who do the sealants
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go under who do the X-rays go under who do the you know like how does all of
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that work um splitting up you know how how to
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divide the treatment stuff because I think I think where because I've I've
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again been there done that um where it's well you know I'm I'm the one who's
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saving you from having to do this treatment that you don't want to do and I'm like the hell are you talking about
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like you're not doing me a favor um you're doing your job what you were
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hired to do um well you don't like doing
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you know anterior composits so I've just been taking all of those you don't like
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doing sedations so I've been uh No that would be me allowing you to do those
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things so that you can Anyway all of those yucky things that's
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Did I Did I hit any of the ones you were thinking gosh you hit all of them i'm like this may have to be two dang
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episodes because it really is these are all the shady sides the dark sides and I
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would say digging into this content I do hope is going to be relevant for both practice owners and associates because I
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think there's associate are hard on so many levels they're beneficial absolutely but
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there's so many icky points that you just brought up that both parties care
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passionately about and because they're so passionate about their stance it's can sometimes create a either a
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dissolving of that relationship or the associate deciding this is not the place for me and I want to move on but I think
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that's a lot of practice owners too don't bring in an associate for all of these reasons they're like this is not
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worth it and uh I can absolutely see that absolutely i'm still in camp
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associate um but I think that ties back to my own personal goals and philosophies of why I
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even got into ownership so I think it definitely is unique to each individual owner
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um I I think to and this may or may not quite fit in but then you add the extra
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onion layer of now with corporates all over the place um it it's it's made it
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much more difficult for us mom and pop because there are these other jobs where
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the associate can kind of have their way in that you know I want full benefits i
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want this I want these hours and corporates a lot of times are going to meet those demands and so it really has
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become even more like a needle in a haystack trying to find the right fit uh having said all of that I'm still in
6:06
camp associate um but again that that's very you know I think that's that's an
6:12
individual how which pile of beep smells worse to you you know
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what I mean like would you rather be on your own and have to do everything and manage all the brunt load of all the
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patients and all that but have full control and and deal with all of those
6:30
stinky piles of that come up or do you want to have the associate and deal with the associate piles of that
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come like either way you're going to be like kneede and dung but which one which
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texture is more suitable to you I guess is where I'm which smell which smell is
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worse yes yeah i think you're hitting the nail on the head and I think it
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takes mindfulness on the part of both the practice owner and the associate to
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me to the point that you make there's plenty of corporates out there that from a compensation standpoint are going to
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be able to look at that associate and go "Okay great here's some guaranteed income great here's health benefits hey
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you want retirement we got that too you you know want a certain schedule we can
7:18
accommodate you on that but it's going to come with the dark side of corporate
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which is you're going to work your tail off there can be some miscommunication
7:30
that occurs between ownership and associate there can be um expectations
7:37
clinically to perform at a certain standard which may mean you're pushing the bounds of your ethics on certain
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things and um so while corporate can often
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times give the associate what they want from a compensation standpoint or a package standpoint they can't usually
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give the environment that the associate would prefer to work in the um clinical
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autonomy that ultimately the associate wants and so there's some definite downsides to that corporate so for
8:08
associates to me when you're wanting to link arms with a private practice owner
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there's going to be some compensation things that have to register differently
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you can't you know the phrase have your cake and eat it too you can't have your cake and eat it too unfortunately you've
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got to be able to make some compromises when you go with corporate you're compromising
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on the team environment the sometimes the ethics side of things that you
8:37
struggle with when you go with private practice you're going to compromise a little bit on the compensation side of
8:42
things cuz most private practices can't truly compete with what corporate offers
8:48
but I think what happens a lot of times is associates can get in with a private practice they love the environment they
8:54
love that direct access to the owner they like working side by side with the owner from time to time and then it's
9:02
almost like that becomes the norm and they forget that in the corporate land
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that's not the norm but they hear about the corporate benefits and the
9:12
compensation and then some of that starts to weave into their expectations
9:18
and that can start to dissolve some things well I'm going to pick on the owners too then you can't have your cake
9:23
and eat it too yeah you know so there there's mindful things that you've got to do and and remember the value that
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this associate is bringing to you um and a lot of times you see that value and
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other times you're like wh why just let's part ways i got this on my own this is not worth it um so it's like we
9:42
forget too why we brought the associate in to begin with um and so having to
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remind myself and go you know like Yeah for when when the times get where it's like my head is hurting now why am I Why
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am I Yeah dancing this dance and um but there's a reason yeah so I think it'd be
10:00
helpful to talk through some of the examples that you gave when you had that list of the icky side of associate ships
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do you have one that's that you I don't even know what I just said so why don't you start with because you you brought
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this up with like you've been dealing with other offices with um you brought it up for a reason it's some of your
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clients are dealing with this so yeah this is I'm going to make you Yeah so I'll say then let's start with I think
10:28
probably the ickiest part that we get into which is the nitty-gritty of compensation i do feel like this comes
10:35
up repetitively not only when the actual
10:41
contract is being signed but oftentimes the nitty-gritty of compensation the the nuts and bolts of it are in the contract
10:48
but as far as who's getting sealants oh the assistant did sealants but the doctor was quote unquote supervising
10:55
those nitty-gritty type details usually are not unpacked in the actual contract
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so that's the stuff that develops on the back end a client of mine has been
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um the way that they have done some of their accounting in the actual practice management software isn't clear that the
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associate is actually I I'm advising my client the practice owner like we got to
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change this associate is banking off of false numbers because all of the
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adjustments are being routed under the practice owner rather than under the associate so
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the associates getting this production percentage off of fake numbers it's the
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because of all of the adjustments being tracked incorrectly under the practice owner so now that contract is needing to
11:47
be revised can you make that even more clear like so for example if your Let me see if I've I'm following you here if uh
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the office fee is a h 100red bucks insurance paid 80 bucks so
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$20 but the associate got paid on a h 100red even though the practice didn't get a h 100red the associate got the 100
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the practice took the hit on the 20 and so that's clearly unfair yeah and um so
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now the practice is taking like kind of this hit a hit because they had to pay the associate but also pay them on the
12:24
full not on the adjust not the amount they actually got which is why I do a percentage of collections um because I
12:31
don't think that that's fair to me to and even with our bonus system like we went back and forth with our bonus system because we do something that's
12:37
you know the overall production and I'm like but did I get paid on that right um
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so for example if if you know we said oh let's do you know 15 sealants or whatever it is we're doing permanent
12:49
primary and uh you know or the couple of preolars whatever it is 15 is not the
12:55
right number but what you you see what I'm saying but the insurance only paid for permanent mers and so now because we
13:01
made that mistake we didn't whatever so now we're writing off all the primary sealants but if we're doing bonus based
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off of that day it looked like we made 400 bucks on sealants but we actually only made 150 because we had to write
13:16
off the rest but now the team's getting bonused because it looks like it's 400 that clearly math doesn't add up there
13:23
exactly um so same concept though with the associate if if they're getting So that so this was this is what was
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happening so it's in favor of the associate it was in favor of the associate and of
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course this associate now has kind of been living under this beautiful
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contract and really to me inaccuracies in accounting documentation in the
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practice management software so to me that's solution number one that we've got to actually fix the way that
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we're documenting write offs and things like that so I think the icky part of
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this is if you haven't always been a super detailed person with those adjustments especially if you're just
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pulling on an associate one of the first things that you need to do is make sure that your
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accounting is correct so every practice management software has multiple
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adjustment codes right like when you were in network there might be a MetLife adjustment code a Delta Dental
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adjustment code an Etna adjustment code which is good the more detail on
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those adjustment codes the better friends and family discount is another one or employee discount which is
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different from friends and family so be detailed in those adjustments but you've got to make sure that those adjustments
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are being the software can usually put those towards production they can put those
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adjustments towards collections or they can put those adjustments in their own category of adjustments but it's got to
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hit if you're paying off of collections for example then my recommendation the
15:00
cleanest way is to make those adjustments go against collections because then the associates numbers are
15:05
going to be correct if you're going off of adjusted production which is another common payment method um that the
15:12
associate can get paid off of adjusted production then you need to make sure that when you're setting up those
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adjustment codes that those are going against production so that when you pull
15:23
that associates production numbers it's actually adjusted production so that if
15:28
you don't discover that until halfway into the associates's contract well now we got problems because this associate
15:35
was being paid off these beautifully inflated numbers and now 6 months into the contract you're like "Holy crap I've
15:42
shot myself in the foot now I'm having to go back and make these changes." Well that can cause obviously a lot of
15:48
problems so even down to like everything you just said i know I knew that stuff
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once upon a time ago probably about 12 years ago I used to you know for the first three-ish years of the practice I
16:02
did all of my own accounts receivables and I was doing all those adjustments so somebody must have taught me how to do
16:08
that because it's sounding vaguely familiar but then when I hired my AR person I've never looked at that again
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so all those nitty-gritty details are there courses people can take to figure out like who and adjustments and
16:20
adjustment codes and all of that like I don't even remember to me this is a very
16:25
um a category that is not well discussed so which which the reason I'm bringing it up is because now if my AR person
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were to retire and then now we're onboarding a new person this is where I'm going maybe
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you as doc understood it at one point like me maybe you never understood it maybe but with turnover is what I'm
16:46
thinking about and now new people are in there and if they're not I'm Is that what happened with this one is what I'm
16:51
betting that somebody you know like the doc's assuming Yeah because we're not the ones putting these we're not the
16:58
ones posting payments um and that which is a whole other point so the setup is
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one category like are is everything set up correctly but the second category is
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does your team know how to appropriately utilize those adjustment codes what if
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the associate doc brings her kid in to do treatment and they call that an
17:23
insurance adjustment right and then you're like "Oh wait a second that's not an
17:29
insurance adjustment that's free so we actually need to put employee discount and then $0." So even that there's so
17:37
many inconsistencies that I see just from a bird's eye view when I'm looking at ledgers when I'm with my clients that
17:43
I'm like these adjustments don't make sense or I can't I can't formulate a
17:49
line of thought when I'm looking at a particular you can't track it like if you're going back and looking at an EOB and kind of going this is where this
17:55
it's not clear and easy to track and figure out where these came from which again talk about a yucky topic like I'm
18:02
like oh god I don't want to deal with any of this but this mad matters in so many ways when you're trying to go back
18:08
and if you're later going okay should we drop this insurance should we not do this and that and if you're like oh no
18:13
you know Medlife pays us great we we look at this and then now you're if you really looked at it and if the
18:18
adjustment codes had been applied correctly you could have gone oh my god we're actually not getting paid right
18:24
like this affects a lot and this is the nitty-gritty that as as doctors even
18:29
those that are good with math and good with details we don't have time to worry about this stuff like it's all we can do
18:35
to please Mrs smith in the chair and make sure that the contact we put in was appropriate like th this is stuff that
18:42
it's like this is the gray dark hole that this is why we don't go up to the front desk like we don't want to deal
18:47
with this stuff right so I think this is um uh another I'm going to task you with
18:54
sorry ma'am but I'm like maybe this is another um podcast like for our subscribers like
19:00
a separate um uh what do you call it a separate like you um you know cuz our
19:06
our for our subscribers our bonus that's the word I'm thinking of our bonus episodes are far more detailed and far
19:12
more like practical tips and this is what you need to do like it's not just me bantering we've got you know um it's
19:21
it's less drama and more like here's how to and don't forget to so the feedback
19:26
we've gotten from our subscribers is those are super helpful to actually uh take something from talking about it to
19:33
actually doing it and then of course we've got the um playbook tips in the digest that kind of go hand inand with
19:39
that but I might task you with if if you're telling me that this is not cuz I'm trying to think how would I have
19:44
known all these codes and that too was like you know almost like 15 years ago
19:52
where insurance wasn't near as complicated as as it is now so now when I'm thinking back on it I bet you how I
19:58
knew how to do that i'm putting knew how to do it in quotes would probably been the dentric trainer that came in was
20:04
fantastic and she probably set up a lot of that for me and told me what to do and then I probably reached out to my
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current AR person who I knew from another office so if you haven't made friends in other offices and now you're
20:17
owning your own and you don't know this stuff like who are you you know that that's why even like lasers when I was
20:23
starting now there's a million classes for laser dentistry for pediatrics and all that when I got my laser there was
20:28
nothing right and I was like well I'm going to do water lays because my buddy who's writing the guidelines for the
20:35
AAPD laser she's the only one I really know who's got this in a systemized
20:41
fashion she's got a water so if I'm going to have trouble I'm going to need troubleshooting i'm going to call her
20:47
why did I incorporate dentrics because that's what I knew from the other office and all my buddies that's what they knew
20:52
so if I needed to phone a friend that's who I was going to reach out to so um
20:57
anyway it I guess now this is eye opening for me to go if there's no real good because there's a million in one
21:04
coding classes you could take at dental conferences but they don't get into this level of nitty-gritty of Yeah they
21:11
really don't and we've got fantastic dental CPAs like there's so many awesome
21:19
groups but they are limited in their understanding of the practice management
21:26
software like the dentrics or the Eaglesoft or Open Dental they're they're
21:31
going off the data reported to them by the doctor so there's only so much that
21:36
they can ultimately see from their side of things and so much that they can navigate through that i think they're a
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great resource it's definitely worth reaching out to dental CPAs but to me this is an area that's that's really
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vacant um I wouldn't say vacant i think there's uh
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very light resources out there that could help um okay i'm tasking you lady
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i'm tasking you this is And by the way um I know you were going to talk about
22:07
it later so I'm sorry i'm going to steal your thunder here now but um we are I
22:12
think you said by the end of April like all of our resources and playbook tips cuz there are people that are now
22:19
jumping on the bandwagon like "Oh my gosh I just heard about Jaw subscription oh my gosh I missed the oh my gosh can I
22:24
go back and get October's playbook items?" Uh no that ship has sailed but
22:31
uh you are creating a uh portal or a hub or something that's going to have
22:37
everything available for purchase so for somebody who was a late subscriber and
22:42
you're going "Oh my gosh I need that resource that walked me through how do I
22:48
onboard this or how do I do that?" you'll be able to go back and purchase that which you know subscription is
22:55
always going to be cheaper but if you just need the one or two documents to get you going um so I'm going to maybe
23:01
challenge you this may be a you may have to create something to guide people through these codes yeah we'll
23:07
definitely have that on the resource section so I'm super excited about this portion of our new platform that we're
23:14
building cuz we do feel like there's even if it's been in a former month of
23:19
our subscription um it may not be something that they need the whole subscription for they may
23:26
just need to go buy this one particular document and so we have put hours and
23:32
hours and hours of effort into building a really good resource section so that
23:38
as people are looking for kind of random things i mean there we've got all kinds of topics on there you know a hiring an
23:45
offer letter what does that look like okay great you don't have to go reinvent the wheel just go download the one that
23:50
we have available you can purchase that one or um like you're talking about how do I set up my codes appropriately my
23:57
adjustment codes appropriately there will be a document for that and this will be a living breathing thing that we're always adding things to but I
24:04
think we've got over a hundred things that will be available at the end of this month for purchase so it's going to
24:10
be a great resource for sure i just gave you more homework i I will get it done but I do want to
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really focus in May um for May content on this category of not only adjustments
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but also collections as well is going to be heavy emphasis in May so all of that's coming down the pipeline but I
24:32
think from an associate standpoint these are the nitty-gritty things that are going to come up then so it's like okay
24:38
do we have the the accounting correct beyond that then it's like who gets paid
24:44
for what hands down every single time when I'm talking to an associate they want to
24:49
know where the X-rays go or the X-rays going to the doctor or the X-rays going to the practice owner um application of
24:57
fluoride like if they're doing hygiene with an assist with a RDA not with a
25:02
hygienist who's getting that fluoride credit so to speak um who what
25:08
about sealants okay if I do that inoperative is that counting towards my
25:14
production what if I'm doing hygiene and the assistant does it for me do I get
25:19
the sealant credit then you take it to even more complex waters which is like
25:25
I've got some pediatric clients that do some appliances in their office and so
25:32
then there's that monitoring after you do an appliance they might be coming the patient might be coming monthly well
25:38
what if the associate sees that essentially ortho kit what if the
25:44
associate sees that ortho kit the initial credit or production for that ortho went to the owning doc so how is
25:52
then that associate being paid for that ortho visit which is like or even in a
25:59
in an adult practice i was just talking about this with a client of mine who's bringing in an associate and they're
26:04
like "Oh we do a clear aligners how does that work?" like they can't get 35%
26:10
production off of the clear aligners when the lab bill is a third of that
26:16
means the practice literally made nothing on this particular patient even though my assistance my sterilization my
26:23
room my practice is being used my scanner my yeah yeah so all of those
26:29
things if they're not fully thought out before the associate signs on they can
26:36
create drama So then what do you suggest for all that even now like even now it came up the other day something and I
26:42
knew somebody was about to ask me where does this get credited to i walked out
26:48
before they could ask just I was like I don't know even now I don't know how we handle those sealants i don't know how
26:54
we like I don't know i'm like talk to AR person and talk to Bethany i that is
26:59
beyond my um I I don't want to deal with that yeah um so I don't but um and
27:06
luckily you know again this goes back to I've got my current associate is very um
27:14
fair like he's very reasonable it's not like he's going I need but he he's also
27:21
not going to be like no never mind Kuba you take all the X-rays he's very fair and so we can come to a fair agreement
27:29
on that which when he asked me early on I was like I don't know man because I can see how we could do it this way and
27:35
this is fair to this person and that's fair to that person and then I sent him to you and AR person i don't know what
27:41
y'all decided and I've not looked back um but you go back to when I was an associate and and I had a hygienist like
27:48
I I you know I worked for this gentleman four days two days I had to do my own hygiene two days I got one of the
27:53
hygienists and I had to pay towards the hygienist i don't think that's a thing anymore is it it's a you know I mean get
28:00
with the times Kuba but part of me goes well I'm bitter like you know like you're not paying for your hygienist and
28:06
so anywh who fair is a is a very tough uh
28:11
topic and I think fair is subjective each person can have their
28:18
own opinion of what fair is that's what I'm saying yeah it's a it's its own topic unto itself so I'm going to task
28:25
you with again uh maybe maybe you're doing two bonus episodes in May um but
28:31
getting into the nitty-gritty of like you could use my office if you want to but what did you advise this client for
28:37
the aligners what did you advise the client and like how did you help them come up with their compromise what did
28:43
you come up with for my office for my associate because I don't know i still don't know i don't want to know um
28:49
I don't so I should just avoid commenting now and say "Hey catch it in the bonus episode i'll tell Coopa not to
28:55
listen." Yes yes i will skip that episode because I don't want to know but it's it's coming up again because maybe
29:02
that's what it was maybe it wasn't my current associate but maybe in my mind going as we're looking for our new
29:08
associate because current one's going to be heading out at some point here soon um how do I have these conversations
29:13
with that person so to me that is the point you have to have conversations we
29:19
want to you know sign on the dotted line get this relationship going and then just
29:26
assume that it will work out and that's just a very bad plan so to me the more
29:32
clear the conversations can be ahead of time the more you're going to know ahead
29:39
of time can I is our version of fair similar enough that we can actually get on the same page with this because the
29:47
last thing you want is drama 3 months into this contract and then life is
29:52
miserable for you and that associate while you finish out this contract we don't want to have the associate feel
29:59
like they've been gotten you know haha you signed on the data line and now I'm not paying you for anything but your
30:05
treatment that you do well that's not fair so to me you've got to have these conversations ahead of time and it can
30:13
be something as simple as if you've always had an associate or you've had an associate for a while you can say "Hey
30:18
this is what we've always done regarding x-rays regarding sealants
30:23
regarding clean liners or aligners." I mean our appliances you can say "This is what we've always done are you agreeable
30:30
to that?" And they're like "Yeah well the only one I'm can I can we talk
30:35
further about whatever?" And then at least the conversation is being had now
30:41
if you've never had an associate before that's a little bit harder to do because there is no history to it and so that's
30:48
where you again lean in on your resources figure out what is truly fair and then you put together your list and
30:55
go okay you know before we move further in this conversation and get to the contract I want to talk through some of
31:01
the nitty-gritty these are going to be some of the I think sticky points that we need to kind of work through this is
31:06
what I would like to do how do you feel about that so it's the same kind of conversation you just don't have the
31:12
history behind it i would say when you're building that list of what's fair
31:18
talk to the right people don't talk to the the guy on the street that everybody knows as the shrewd fox that is you know
31:26
conniving everybody out of their money don't use his example because what he
31:31
deems as fair is probably not fair talk to reasonable people about what they
31:37
what their rules of the arrangement are with the associate and use that as the
31:42
content this is where again lean in on your resources like if you do have a good dental CPA they may have some
31:48
opinions or they can at least get gather information for you on what's reasonable
31:54
from not only who gets the credit for what but what is a reasonable arrangement
32:00
dental lawyers are a great resource because they have looked at thousands of
32:07
associate contracts and they know what's typical in your particular area so you
32:12
need to build out a fair offer and I would say on the heels of that too you
32:18
don't need to be bitter about that offer if you're going to be bitter about it you do not need an associate if you're
32:24
gonna be mad about all the credit that he or she is getting for certain things or oh lucky you you get to use the laser
32:31
when I paid for that laser it's not going to go well for you if that's your mindset so you've got to
32:38
be okay with the terms as well and if you can't get okay with the terms it's not worth moving forward in my
32:44
opinion anything else compensation wise that you can think of no that was yucky
32:50
what else yeah other yucky stuff is going to be
32:57
um so this can some sometimes be related to
33:02
compensation but I think it's different who gets what i can't tell you how many times I'm in an office and all of a
33:10
sudden the um because the doctors the owning doctor's production has dipped
33:16
down all of a sudden the associate doctor isn't getting any new patients
33:21
like oh sorry my production dipped i got to you know this month I you don't get any any new patients what the heck that
33:29
is not fair at all i get it from a practice owner standpoint you're like I got to protect my own but your associate
33:36
is part of protecting your own and so we've got to be careful at making
33:41
knee-jerk decisions like that whatever the system is that you guys set up from the beginning if you're like "Hey I'm
33:49
really going to help you out in the first 90 days and give you all new patients." That's understandable and that's a good strategy if you're
33:55
planning to change that past the 90 days that needs to be said from the beginning for the first 90 days I'm going to give
34:00
you all the new patients and then once we get past the 90 days you're going to take 80% and I'm going to take 20% and
34:08
it'll be randomly assigned by our business team um so
34:13
conversations like that on who gets what or I diagnose the treatment but associate is taking the
34:21
treatment or vice versa associate diagnosed the treatment and owning dogs like oo a mouthful of crowns i'll take
34:27
that thank you you need to come up with okay what's our rule of diagnosis and treatment if
34:35
it's just fully shared and we know that we can do that fairly great if it is the
34:42
doctor is handpicking the treatment that they like eventually there's going to be bitterness over that and so that's where
34:49
that that uh my favorite like it's got to be a win-win and so if if I guess to
34:54
me that's where I'm like if I was the associate how would I feel right now if I'm the one who's here to see all these
35:01
limited exams and I'm the one who's treatment planning you know the fullmouth IV cases and I'm the one who
35:07
had to spend 45 minutes in there with that family and then I had to answer all those questions after oh but then Kuba
35:13
is the one who gets to go and go do the cases and she never lets me do them um
35:18
eventually I would leave yeah and so uh I think that's where now on the other hand if it's like now the owner doc's
35:26
not doing you know it is what it is it's the owner doc if they are at a point where they're like I don't want to do
35:32
this treatment anymore that's kind of why you were hired associate so you know uh at some point that will evolve but
35:40
it's got to be a win-win yeah and I think for the associate to be you know like oh well I should get to do all my
35:46
own treatment and I should get all the new patients and I are you sure about that like make sure you're in check with
35:53
your own you know both parties need to be uh looking at it as if I was in the
35:59
other's shoes how would I want this yes I think that is so critical
36:05
and to me that's the appropriate mindset in this associate relationship it really does need to be both parties have a
36:12
level of trust that they're they're both working for each other um speaking of
36:18
new patients you uh when you said that I was like "Oo this is another thing that I've seen come up and I want to really
36:24
challenge our associates out there on this there cannot just like the owning
36:30
doc can't be bitter about the production that they're giving to you you associate
36:36
doctor cannot be bitter about the expectation that you're there to help grow the practice can't tell you how
36:43
many times I hear little rumblings of well why in the heck would I go out go
36:49
out and do this community event or go out and meet our referring partners why
36:54
would I do that if it's only going to benefit the owning doc's practice because you want a job and you want a
37:02
job where you have enough patience to see and you want a job where you can actually earn income the every so just
37:11
to make this clear when a practice owner
37:16
is bringing in an associate this is what I tell all of my practice owners that bring in an associate there's going to
37:22
be a period of time sometimes three months some sometimes a year where their
37:27
pay is cut so the practice owner chooses to take a pay cut in order to bring on
37:35
an associate there's not usually enough money in the bank off of a one doctor
37:41
practice that's now adding an associate even if that's one day a week they're adding an associate there's usually not
37:48
enough income in the practice to fully pay for that associate there's a little
37:53
bit of a gap that they're having to jump to get to where the practice is viable
37:59
enough to pay for two doctors so it's always mindblowing to me when the
38:05
associate is resistant to helping out with those practice growth ef efforts you were brought
38:11
in to help the practice grow to grow it to be a two doctor practice so why there
38:18
would be resistance or bitterness over having to help the practice grow is absolutely mind-blowing to me i've heard
38:24
that too and I've I think for me that it it's such a piss poor attitude like why
38:30
would I build up your practice what what are you talking about um and I think a
38:36
lot of times too it's not realizing I guess it depends on how it's structured to begin with so if it is structured
38:42
like you are going to be getting your own new patients and so so I think I I
38:47
don't like that for the associate because to me I'm like how can you especially if you're only there one or two days a week how can you be expected
38:55
to fill your schedule and make a income if you're just starting off by yourself
39:02
floundering and you're having to build up your own patient base correct that doesn't make sense but then at some point yes owner doc is giving you the
39:11
opportunity to produce and to do all of that and I think that's where I've seen
39:16
some of that go off the rails where the associates like "Oh look what I'm doing for you i'm seeing these patients." And
39:24
my advice always is they're going "Uh owner doc." Yeah i mean maybe they
39:30
went on a couple of extra vacations they they didn't get to go on but it's still a hit to the practice and they're
39:36
looking at the big picture going "Okay but I am still here producing some." Um and then you've got some owners that
39:42
don't want to produce but the point is still you were still brought on to help
39:47
the practice grow and I think that's where associates that come in with that me mindset
39:54
um you're going to have a really hard time being successful long term as an associate and and maybe that's your goal
39:59
maybe you just wanted to come in and and get your feet wet and then your goal was to go start your own or do whatever but
40:05
I think it's a really uh lousy strategy it's a very selfish
40:12
strategy i think once the owner docs get wind of that then that's when they're like "Oh okay well if you're just the
40:19
associate and you don't want to help grow help market help coach team members
40:25
like you're just here to get your paycheck that's more of a corporate mentality maybe you should go on to
40:31
corporate exactly um because for small practice owners it's like the the
40:36
thought is this was supposed to be a camaraderie of sorts now same for the practice owner that's not allowing the
40:43
associate opportunities or opportunities to grow and you're just cuz I I hear that too there's owners that like you
40:50
know the associate is just doing the grunt work for me but no I'm going to go get all the new patients i'm going to go
40:56
do all of this and then you just do what I tell you to do you're shooting yourself in the foot that's also a very selfish strategy and associate's going
41:02
to leave and you're like well yeah I just needed that no it's expensive to bring on an associate and to incorporate
41:08
them in your practice and in your community yeah and the revolving door diminishes the quality that you can
41:16
ultimately give the patient um so it definitely needs to be both parties um and I I will say I feel
41:25
like this I've said it before and y'all are going to hate me and tune me out but I do feel like we're we're at a
41:31
generation that's a very me me from both sides actually for the associate coming in and going "Well look what I'm doing
41:36
for you." And I'm like "Hold up now." Yeah hold up um and then also for the
41:42
owners that are like "Me me me." Like I'm bringing in an associate so that I can go on vacations don't they know that
41:50
it It's a dumb mentality a long-term mentality it's It's not smart exactly i
41:55
think we've got to approach no matter what the associate arrangement is going to be we've got to approach it with a
42:02
level of respect and not with a level of bitterness or me
42:07
focus none of it none of this can be me focused to be perfectly honest in order for it to work well we've got to have a
42:14
mutual appreciation for one another that associate would not have a private
42:20
practice environment where they're learning they're growing they've got good collaboration with the owner doc if
42:26
that owner doc wasn't bringing in an associate and that owner doc would not have some of the freedoms that he or she
42:31
has um if it weren't for the associate and so there's it really is a mutually
42:37
beneficial arrangement and I love when a practice owner can bring on an associate that's a real mark of success in my mind
42:46
and it buys a level of freedom that I think is so helpful to practice owners so I really am in the camp of associates
42:53
i just think we've got to have the right mindset towards it we've got to have clear communication
42:58
um before and during the contract period of time and then there's a ton more subjects that I think we could get to
43:05
this but we're out of time for today's episode so we gota we got to cut it here and say we'll come back up yeah yes
43:13
thanks for joining the conversation today we hope that you are comforted in knowing that you are not alone but we
43:20
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43:25
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