Dr. John and Wendy address concerns that practice owners think or fear about bringing an associate into your practice. How to hit the ground running with bringing an associate into your office. Start serving a larger patient base and rocking the numbers by creating a smooth transition and incorporating incredible patient service.
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“EP33: Am I Ready For an Associate? The Answer May Surprise You!” Transcript:
Who are in the trenches.
Who know exactly what you’re going through.
And now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs. [music]Welcome everybody to this episode of the Double Your Production Podcast. I’m Dr. John Meis and I’m here with the amazing Wendy Briggs. How’re you doing Wendy?
I’m amazing. Thanks, Dr. John.
We have a call that we do for all of our members. We call it the monthly huddle. And at the monthly huddle, we had a great discussion this last month about associates and about what happens when you add an associate and what can you expect and how can you financially plan for it. And it was a really fascinating conversation. And after that, we got a series of questions that I thought were really, really good, and I thought would make a great episode for our W Production Podcast. So I’m excited to jump into some of these questions and just really get down to the bottom of some of the things that people think or fear about doing this. And so I thought we could just kind of jump right into it. Are you ready?
Of course. I think it sounds great. It’s seriously one of the most common questions we get. So it’s always, always good to refresh and review. And as situations change, the questions change. So it’s good to hear what people are wondering about today when it comes to associates.
So the first question is, how much time does it take for an associate to ramp up? And it’s a great question. And the answer is, like most good answers, it depends. So I’m going to rephrase the question to be this, what should we do in order to reduce the ramp-up time for an associate as much as we possibly can? Okay. Because I believe that’s the basis of the question. We have an associate. We want to ramp that person up quickly so that we have a positive for our practice and not a delay to that positive. So here are some of the things that I think are essential for a fast ramp up. First of all, get them credentialed with whatever insurance plans. If you have any, make sure they get credentialed ahead of time so that when they start working the fees that they charge, the reimbursement will come in right away. You don’t credential them ahead of time it may be 60, 90, 120 days or longer before you’ll receive payment from any of those insurance companies. Some of those insurance companies will not pay you for any work done ahead of their official credential date. Some will let you backdate or submit claims from before they were credentialed, but some won’t. So make sure that they’re credentialed with insurance companies ahead of time. Number two. Do a marketing blitz at least 30 days before the start. So that means the marketing hits 30 days, not we’re going to start thinking about it and start planning it 30 days ahead of time. We are doing the blitz 30 days ahead of time. So some things that I have seen practices be really successful with for marketing blitzes would be Facebook ads, direct mail, and neighborhood door hangers. So Facebook ads and direct mail, obviously, you pick the area nearest your office. And neighborhood door hangers the same. So the neighborhood door hanger a strategy I prefer, when possible, is the associate is out there knocking on doors and introducing themselves, leaving a business card and a practice brochure. And if they don’t get anyone to answer, which will be most of the doors they’ll knock on, they can leave a door hanger with a practice brochure.
That’s an interesting strategy, Dr. John. Of course, I’m going to be the devil’s advocate here. If I’m a doctor and I’m being hired on by a practice, that’s the last thing I’m expected to do– be asked to do. So tell me how you sell that to the associate.
Yeah. So I get that. And the other one that I’ve heard is, “Oh, it doesn’t seem very professional.” Or, “I might be showing myself as being needy.” Or something like that. Something along that line. And I say that that’s hogwash. People appreciate people who are out working. People understand a new practitioner. They understand that that is something that is different and that all practitioners need. So dentistry is a relationship business. And that relationship, if you can start it eye-to-eye, and with a firm handshake, is you’re off to a much better– much, much better advantage than if you don’t. A lot of people, depending on where they live, they may get saturated with direct mail. And you’re just another one. But the guy who shows up at the door, that’s the one that people are going to remember, for sure. And if you have a pleasing personality, and you are going to be friendly and be excited about meeting new people in your neighborhood, new people that you can help, it’s a very, very effective strategy.
I would agree with that. Another thing that I think people might be thinking, and you’ve mentioned this before, sometimes, I think, the associate misunderstands their role. And then they think that that’s the practice’s job to create high demand or build their schedule full of patients. And what you’re really teaching them early on is that they play a part in that too. Isn’t that right?
Oh, it’s exactly right. It’s exactly right. That it’s all hands on deck when it comes to patient attraction. And if the associate is not part of that process, and if they aren’t putting their own activity, their own blood and sweat and tears into patient attraction, they can– it is very easy for it to form a kind of an unhealthy thought process about it. And that is, well, I, as an associate, don’t have to do anything. The practice has to do it. Think of that movie, Little Shop of Horrors. And that plant gets bigger and bigger, and– Seymour, I think, is the plant’s name, right? He says, “Feed me.” Associates can become, not necessarily consciously, but unconsciously, they can be Seymours, just wanting to– “just give me more and more new patients.” And unless they are part of the process, it’s very easy for that dynamic to develop.
Very, very good point.
Yeah. And the next item on the fast ramp-up is to expand the hours of the practice into patient-friendly hours. And patient-friendly hours are when patients don’t have to miss work. Okay? So that means early evening hours. And if I want a fast ramp-up, I would add Saturday hours. We know that Saturdays are the highest demand appointments in the dental schedule, as well as evenings. Anyone who opens into patient-friendly hours, those hours fill up quickly. So it will drive more new patients by opening into those hours so the next one for a fast ramp-up is to give the associate all of the new patients for a specific period of time. Now, those new patients that call with a request for a specific doctor, obviously, they get that doctor. But by giving the associate the rest of the new patients, it helps them ramp-up more quickly. So you might do that for the first 30 or 45 days, maybe even a little longer than that, just to get them a core of patients to treat. Again, you don’t want to do that forever, because you’ll run into the same [Seymour the plant?] issue if you do that. But, often, that helps them get a good start. Next fast ramp-up item is to master with the entire team, same-day dentistry, the ability to diagnose and do dentistry in the same day. So that anything that’s diagnosed in the office is given the opportunity to be done that very same day.
This is such an interesting element, [Dr. John?], because I think there’s a lot of assumptions made with same-day dentistry. I see dentists, owner dentists, that are just assuming that that’s part of what’s happening, but then we both have witnessed situations where we have a fresh, new associate, wide-open schedule, and the patient still walks up front and schedules an appointment.
Yeah. My favorite story about that is a practice that was not far from where you live, [Wendy?], and that the practice was a new startup, a young dentist, and a super-nice guy. He just didn’t understand how to manage a practice very well. And so he started out working four days, 9:00 to 5:00, Monday through Thursday, and after a period of time, he wasn’t doing very well, and he realized he could do in three days what he was producing in four. So he closed another day per week. And, of course, he closed Monday, so that he could have a nice, long weekend. Monday, the day with the most emergencies, the highest call volume day of the week, that’s the one he picked to close. He didn’t understand. He was not a bad guy. He just didn’t understand. And then pretty soon he could figure out he could do in two days what he was doing in three, and when I met him, we were negotiating to acquire the practice from the bank, because the bank had taken the practice back from him. And the day I was in his practice, he had two patients on the schedule. One of the patients had an exam, needed a crown, and much to my amazement, they walked the patient to the desk, and they scheduled that patient for the next week when they had the whole dang day open. I mean, it was so stunning to me. And so that’s an extreme example, but it’s super common that we see opportunity for treatment to be done today and it’s just not. And when people [inaudible] focus on it, it can become 30% to 40% of their practice very, very quickly, and 30% to 40% that they wouldn’t have had otherwise or at least a good portion of it they wouldn’t. Because when people do have it offered to do it the same day, the case acceptance rate goes up, and you don’t have the opportunity to suffer a cancel or fail because they’re already there. They can’t cancel or fail.
Yeah. It’s almost always a systems issue, isn’t it? Just having the team really understand that it doesn’t have to be just because this is the way we’ve always done it, have the patient schedule. We really need to identify better systems so that we can drive more of that same day, while the patient’s here, and ready to go, especially if we have providers available and ready.
Yep so the– and 30 days, you’re going to– it’s going to take longer than that to master same-day dentistry, so you’re going to run a ramp that up even more than 30 days before the associate comes up so that you are able to do it extremely well and extremely effectively when the associate puts on their white coat and starts to serve patients. The next part of the fast ramp-up is daily mentoring with the senior doctor and team. So what this looks like, this is every day saying, “What went right? What didn’t go right? What are we going to do differently? What we do to help you? Here are some things that we think are important for you to learn and understand. And so the daily mentoring really is– has to be consistent and it has to be the entire team that’s doing that. So the assistant is going to notice things that the associate doctor can do to improve their result, the hygienist is going to observe it as well, and the senior doctor can be the one that is doing that coaching but also giving a lot of encouragement and making sure that he is working hard to maintain the associate’s confidence because that’s one of the challenges that we all have as young dentists, our competence level isn’t very high and we are relatively easily shaken. So the senior doctor has to be there to make sure that it’s– that all of that mentoring is done with love and with kindness and with a true attitude of support. So the next thing for a fast ramp-up is having an instant philosophy with the current doctors on how you’re going to treatment plan things. So, for instance, what is your– what is the offices perio protocol, right? What is the office’s philosophy on preventive dental services? What is the office philosophy on the replacement of missing teeth? What is the office philosophy on referrals? Those kinds of things. Making sure that everybody has a very consistent philosophy. It doesn’t have to be the same but it needs to be consistent and relevantly close. So you can’t have a, I’m going to patch everything mentality along with I’m going to do the finest dentistry that’s available mentality. Those two are not going to be– that’s not going to be a successful, philosophical and values match, and it’s going to end up with the team not trusting the associate dentist because they already have a lot of trust in the senior dentist that’s going to come with not trusting the associate dentist. And if a team doesn’t trust the associate dentist, they can negatively affect the success potential of that associate, let’s say that.
Absolutely in too many times. And that leads you into your next one, which is an activity bonus based the associate’s production. And that with the previous element, they are so connected but we’ve seen stories like this where the entire practice goes backwards. One example that I can think of, we have associates that have been in the practice for years. One specifically was 10 years and still didn’t have the trust of the team, and so the team unknowingly was just not directing opportunity to the associate. And so here we are after 10 years, they are still parttime and all it really took was a series of communication between the team and the associate and the senior doctor to boost the team’s confidence in that associate that made all the difference in the world. And here we are just a few short runs later and this associate is not fulltime and everybody is happy and the practice is thriving. So its so critical.
Yeah. And so the next item was an activity bonus based on the associate’s production. So activity bonus in our language means it’s a short-term bonus. This might be for a month or two, and it might be that the team shares a percentage of the associate’s production. And the reason why I say production is that’s the fastest. That’s what you really want people to focus on. Long-term bonuses based on production are usually disastrous, but short-term bonuses that are trying to boost a specific thing can be extremely helpful. So now you’ve aligned the team, the associate, and the practice. So the team now has personal financial incentive to help that associate become successful. They’re a part of that daily mentoring. So the associate is part of it, and the practice, obviously, is as well. And by doing that, the practice will certainly benefit from that increased associate production that would come from a team really driving it. And the last time for a fast ramp-up is make sure that you’re working your unscheduled patient list. It’s surprising to me when I look at practices, and there are hundreds and hundreds of patients that are active but unscheduled. And if someone isn’t actively working that list, those patients will not necessarily respond, and they’ll time-out and become inactive. So make sure somebody is working that list. The more flow you have coming through hygiene, the more restorative care your practice is going to need, your patients are going to need, the practice is going to be able to perform for them. And if they can do it same day because the associate has time, you could see how that would have a dramatic impact in a fast ramp-up. Okay. So the next question that we got after this huddle call, was how long should profits go down when an associate is added? All right? So I’m assuming that the practice that asked this question has an associate that has a guarantee. Right? So they have an income guarantee. And they’re concerned that the associate will not produce enough to cover that guarantee or collect enough to cover that guarantee. So first of all, if you do all of the things that we just talked about in the fast ramp-up, it shouldn’t go down at all. It’s that simple. It shouldn’t go down at all. If you don’t do all those things, it may have a negative impact on the profitability of the practice for months. And we’ve seen practices go as long– when they weren’t prepared for an associate, they didn’t have enough practice demand, they didn’t do the things that were necessary to get the new patient flow and existing patient return flow, that they went 9, 10, 11, 12 months without having an increase in profitability.
And, ultimately, when we see that happen, that’s a very high chance that the associateship is going to fail. The owner doctor will cancel it, or the associate doctor will opt out because things are not going well.
Yep, that’s exactly right. So once that guarantee is gone, that associate, if they don’t have the opportunity to earn what they were getting as a guarantee, they’re going to be looking. They’re going to be unhappy and they’re going to be looking. And most likely when they’re unhappy, they are going to make other people unhappy too. Right? So the next one is what should I pay my associate percentage commission or guarantee, and if a guarantee, for how long? So my belief is that when we’re all paid as providers a percentage of what we collect, that that works the best. So that has people get personal responsibility for their pay. If I do more and collect, I’ll earn more. And that’s really how real life works and real business works, right? So a percentage of collections commission is my favorite. I’ll have to say that when you have an associate coming in, that often, they’re going to demand a guarantee in order to sign with your office. Guarantees when– 30 years ago, were not heard of. But today, they’re kind of the standard. And one of our dentist recruiters, Nick Cease, went through and proved to me that the average dentist coming out of school to have a relatively minimalist existence needs at least $10,000 a month just to get by. I know that sounds like that may be a lot of money, but that’s kind of– when he put into perspective student debt, all the things one has to pay for and how they would budget that, $10,000 was kind of the minimum amount. In some markets, obviously, the cost of living is higher than others, and so in some markets, it’s higher than that. And what I’m seeing from dental groups is a $10,000 a month guarantee is not unusual. So if there’s a guarantee, for how long? My rule of thumb is six months. And the better job you do with the fast ramp-up items that we talked about earlier, you may want to make that shorter. But I know that when people go off their guarantee, their behavior changes. Their productivity rises. So you don’t want to handicap the associate by having a guarantee that’s unusually long because it will actually reduce their development. Okay. And then percentage of pay– I was just recently at the Scaling Up meeting, which is a group dental conference, and one of the breakout sessions was on associate compensation. And in that room, there was maybe, oh, 40 dental groups or so, and they were comparing what their compensation models were. And in the room, almost all were paying on collections or net connection. And if your systems are proper, net production is another reasonable alternative. And the range was from 25% of collections to where most people were and up to 40%. And the 40% group, I sought out after this little breakout session, and I said, “Well, how is that affecting your profitability?” And the leader of the practice said, “Well, I don’t know how it’s affecting our profitability because we don’t have any.” So that obviously wasn’t a model that was going to be successful. And so when I compare DSOs and I’ve seen the compensation model for quite a few of those when you take out all of the language and the adjustments and all that, they are really right in that 26 to 28 or 29 percent range of collections. Practice paying all of the expenses. So obviously, if the associate plays their lab or a portion of their labs, that number would be higher. But when you kind of adjust for all of those different kinds of adjustments and deductions, 27 to 28, somewhere in there is where they are. Places where it’s higher than that, places that are very hard to recruit to, and those may be not great practice locations, practices that are in rural areas, sometimes they– in order to get a recruit, they have to pay them more than that. So that’s kind of what I have on associate compensation. What questions do you have, Wendy?
Well, I think that was really great information. And really the question I have is, I want to include a bonus for our listeners. So we wanted to let you know we’ve got a PDF that has some highlights and some of the most valuable strategies and tools that we’ve just discussed on our podcast here today. So if you will go to our W Production podcast homepage, we’d gladly share that with you. And that is located at theteamtraininginstitute.com/podcasts. So again, if you will go visit us there, we would be glad to have that download for those that want, I guess, just a summary, if you will, of some of the highlights that you shared on today’s call. Dr. John, I always appreciate your insights here when it comes to associates because I can tell you that this is such an important element. And it’s the same thing with hygiene, right? If we don’t have the compensation aspect figured out, we can see diminished profitability and productivity. If we don’t have the demand thing figured out, it’s just like a lot of the different elements within a practice. Whenever we have failures, it’s typically a systems failure. It’s nobody’s fault. It’s not one person’s fault. And so there are things that you can do to set the practice up for success. And we’ve certainly our share of practices that have a successful associate relationship, but we’ve also seen our share of practices that struggle here. So really great insights.
Well thanks, Wendy. I hope it was helpful for everybody. So go to our podcast homepage and get that additional information. And we’ll talk to you next time on our next leader production podcast. Thanks, everybody. [music]