Associates, Carrots and Sticks

I visited a lovely practice this week, which is typical of manyThe principal earns around 70% of the gross fees despite working with two associates and two hygienists. Without the principal’s contribution to the gross, the practice is simply unviable as a business. This puts an enormous load on the principal and in many cases (including this one) they earn far less of their gross than if they worked as an associate…

Many principals I meet feel that their associates are simply:

  • Not pulling their weight in terms of how much clinical dentistry they produce.
  • Receiving a disproportionate amount of pay for the dentistry that they do produce.

And that’s not all. Paradoxically, the associates are often unhappy too, many of them feeling undervalued, uninformed, out of the loop and unappreciated. This is not a formula for a successful, happy, profitable practice and in these straightened times, some practices are being brought close to the edge of the financial cliff by these behaviours.

Owning a dental practice means that you have the opportunity to grow a great business, earn a great income and create a valuable asset that you can sell. Working as an associate in a dental practice should be both fun and very well paid. So, how is it that I meet so many principals who are dangerously stressed because, despite having one or more associates to help increase both the practice turnover and profits, the success of their practice is still too dependent on the volume of dentistry that they diagnose, treatment plan, sell and produce.

There is a better way and many practices that we work with are very profitable with (relatively) relaxed principals and content associates. So, below I’ve summarised the 10 most effective strategies and behaviours that you and your associates must demonstrate in order to create long term, rewarding, win:win working partnerships:

The Top 10 Ways To Have Happy, Profitable Associates!

  1. Hire associates who share at least some of your values. This will mean that you fundamentally understand each other and just as important, like each other! Don’t hire anyone that you wouldn’t want to get into a lifeboat with!
  2. Share your vision for the future of your practice with your associates and ask for their help in putting this into place. Tell them what’s in it for them.
  3. Hire a different and complementary skill set to your own so that you both bring clinical strengths to the practice patient base by cross referral.
  4. Coach, mentor, consult and train your associates. Good associates can get even better by watching and listening to their principals, particularly when they are working in surgery. It is rare these days for associates to sit in a principal’s surgery. As a young dentist, I did it a lot and learned some valuable skills, both clinical and patient management.
  5. Find plenty of time to communicate with each other! Many principals find it impossible to have meaningful conversations with their associates and vice versa. Discuss, disclose and share your personal agendas. Find out what’s working for one or both of you and what isn’t working. Talk about money and whether you feel you both are getting paid enough!
  6. Use a sliding scale (35 to 65%) to reward high earners and protect yourself from low earners. Set targets for everyone (including the principal, make them available to the whole team and have the whole team help in achieving the, with a bonus for going beyond the targets.
  7. Learn together. Go to conferences, courses, cpd evenings together, try something new together and compare results. Go into each other’s surgeries a lot every day. Resist the biggest threat facing all dentists – boredom!
  8. Use praise a lot. As a generalisation, principals are quick to criticise and slow to praise. Everyone on the team needs praise from their principal that they are doing the right thing. We are all longing to be lead.
  9. Zone all of your dentists’ diaries to create the right mixture of high earning, hourly rate and below hourly rate dentistry into every day, so that every day is a good day.
  10. Have a contract so that everyone knows what the rules are. In particular, agree the amount of time that your associates spend in your practice, including the hours they will be available in the day (no going home early because there wasn’t a patient) and the precise amount of holiday and cpd. Agree all this and timetable it for all clinicians, a year in advance.

It’s not enough to be the practice owner and the lead clinician. Principals have to be skilled in leadership and the 10 points I have highlighted are mainly leadership skills. As the leader, you have to be inspiring and motivational, a great communicator, empathic, a good listener and walk all of your talk. You have to be clear where your practice is going and surround yourself with people who want to help you get there.

Now, does this sound like the kind of principal you would like to be?


Simon Hocken Director of Coaching, Breathe Business


For more guidance on running a successful practice, contact the Breathe team on 0845 299 7209 or


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