Here's a list of key questions that you should consider asking yourself or others as you go through the process of choosing a corporate or large group associateship. By clicking on the "+" sign, you find an answer that has been provided by people that have gone through the same process.
General Information
There are so many questions that relate to a corporate dental organization. The following information touches on some the most commonly asked questions.
Although there may be some flexibility in the way that associate dentists are remunerated in corporate dentistry, most often the compensation is approximately 30-40% of the collected fees.
For new graduates or associate dentists, typically there is a commitment from the corporation to help the associate become a better dentist and to ensure they can make their student debt loan payments. In some instances, they may be guaranteed a salary (e.g. $120K base salary) if a commitment is made to stay for a certain period of time; however, this varies from entity to entity.
This varies based on the contracts that have been negotiated. As an example, an owner dentist who has sold to a large group or corporate entity may have received a higher purchase price in exchange for a smaller percentage fee as an associate. Typically, any associates that the practice had at the time of sale will remain at the same rate of compensation as outlined in the initial contract with the owner dentist.
With respect to recall checks, usually the dentists are paid a percentage of the recall exam fee. Fees for interpreting radiographs taken by the hygienists during a recall examination may or may not be part of the compensation.
In some situations, there is an ability to buy both shares and equity. For an owner dentist selling to a corporation, he/she may have the option to obtain shares in the group or the individual dental practice. As an associate, it is unlikely that buying shares at the corporate level is an option. However, it is a changing environment and corporate entities understand their models only work if people choose to work within them and sometimes this involves owning a “piece of the pie.” When shares are offered, they can sometimes act as an incentive, because the shareholder may be more willing to work hard and make sacrifices to earn his/her return-on-investment (ROI).
Some of the incentives offered to associates may include but are not limited to:
- Access to continuing education (CE)
- Signing bonuses
- Reducing or lifting the financial burden which allows dentists to focus on providing dentistry and not business
- Dental Corp >300 clinics
- Altima 50-80 clinics (mix medical/dental together)
- 123 Dentist ~135 clinics (60 partnership and 70 in corporate model)
Large Group Practice
While corporate dentistry organization may look or feel similar to large group practices, there are some fundamental differences. The following information loosely defines a “large group practice.”
Mentor Advice
The following responses come from our pool of experts who were consulted and interviewed as they relate to both corporate dentistry and large group practices.
With respect to ethical concerns and bonus structures, the ethics are dentist-specific and not related to the bonus/quota structure which may be in place. In fact, it is more likely for corporate and large group entities to be scrutinized more carefully with respect to their operations and as such, these entities are very aware and sensitive to “overtreatment” issues.
When it comes to bonus structures, typically anything produced over a certain baseline would be incentivized in some way. The bonus may be individual-specific or team-specific and again, varies from practice to practice.
With respect to ethical concerns and bonus structures, the ethics are dentist-specific and not related to the bonus/quota structure which may be in place. In fact, it is more likely for corporate and large group entities to be scrutinized more carefully with respect to their operations and as such, these entities are very aware and sensitive to “overtreatment” issues.
When it comes to bonus structures, typically anything produced over a certain baseline would be incentivized in some way. The bonus may be individual-specific or team-specific and again, varies from practice to practice.
Volume-based treatment does exist. As an example, some orthodontists are encouraged to do a certain number of Invisalign cases in a period of time and are then given a rebate.
Keep in mind that dental regulators generally take a dim view of billing/treatment quotas and targets that put corporate profits ahead of patient-centred care. As the clinician, the dentist is ultimately held responsible by the regulator for the care provided, not the corporation.
As always, peer support can also be sought from colleagues elsewhere including local component dental societies.
This will differ from practice to practice; however, it is likely that the schedule with a “hole” will get filled with the new patient unless the new patient has requested a specific dentist. Early career dentists are more likely to have new patients allocated to their schedule to help build their patient base and become better known in the practice’s community.
In some provinces, the dentist may be required to disclose any conflict of interests or financial interests he/she may have when referring patients to a particular clinic(s).
In a group practice, it’s important that the dentists/team are aligned with respect to treatment philosophy to avoid these scenarios. As far as possible, the goal is to try to keep complicated treatment plans with the same dentists and not to move patients from dentist to dentist. At times, if the patient can only attend at a certain time of day, the patient may be seen occasionally by another dentist for a more routine aspect of their care (e.g. simple filling).
However, when a situation like the above does occur, it is imperative that there is an open discussion with the patient about why there may be a change in the treatment plan and how that may affect him/her and the cost of treatment. Ultimately, it is the dentists’ responsibility to ensure that our patients receive the best care.
As long as the dentists have the experience and training to perform a procedure, they will be permitted to practice within their scopes. In reality, however, sometimes what an associate believes he/she can do is different from what they can do comfortably and reasonably from a patient care perspective.
At times, staff may voice a concern to the owner(s) to ensure that optimal patient care is provided at all times. In this way, a culture of openness is paramount to having good patient outcomes.
Typically, however, laboratory use is not dictated at a corporate level but more on a local level.
Continuity of care for patients is important. As such, wherever possible, patients will see their assigned dentist. In an emergency, where the usual dentist may not be available or working, the patient may be given the choice to see another dentist.
Yes, it is always recommended that the contract is read and reviewed by a lawyer. The contract is meant to protect the corporation and the business. If while working as an associate in a traditional practice, the practice is sold to a corporate entity, it is in the associate’s best interest to avoid signing a new contract on the spot. Instead, seek the advice of a knowledgeable and experienced lawyer.
Typically, corporate entities tend to have longer and more detailed contracts with stiff penalties built in for any associate that leaves a practice and takes patients or existing staff members upon departure. At times, these contracts may be intimidating for young or less experienced dentists.
If provisions are broken by a departing associate, a traditional solo practitioner may not seek damages. This may not be the case in the case of corporate dentistry where the power imbalance lies with the corporation from the outset.
As a potential vendor, to meet with the corporate entities initially may involve signing lengthy non-disclosure agreements.
Generally, associates are not expected to pay for marketing, staff or equipment. However, for specific procedures or systems like endodontics or implants, it is preferable for the associate to have his/her own system and in the event that he/she leaves, it can be taken by the associate. With respect to compensation in such cases, the associate may receive a higher percentage of the fee to account for the fact that he/she has paid for the materials/equipment.
Although the formal marketing is provided by the corporate or overarching structure, it is helpful for the associate to market him/herself by asking for referrals, handing out business cards and/or establishing a rapport within the community. It is inadvisable for a new associate to become dependent on the practice to do all the marketing “work” to fill his/her schedule.
This is good to know as it can give insight into what previous expectations there were for the associate or whether this is a new position and establishing new parameters etc. If possible, it would be a good idea to speak with the previous associate(s) and ask questions of the practice before accepting the position. The number of previous associates that have come and gone from the office may also provide valuable information.
It is important to understand that “corporation” is a complex word when associated with dentistry. For tax purposes, many individual dentists as practice owners incorporate and have, therefore, created a corporation. This is not the same as a “big box” dental corporation that owns a string of dental practices across a wide geographic area.
While the information may not be available or even under consideration, again, this will allow the associate to test out options for some sort of partnership in the future.
Staff turnover can vary as each practice will have its own qualities. In some offices where the main dentist may be more “unique”, there may be more turnover. However, in general, the aim is to have consistent, long-term staff who are close to their homes.
Ideally, most owner dentists would like to act as a mentor, but sometimes the limiting factors including the associate and principal schedules do not coordinate. In this situation, it will be the associate’s responsibility to ensure that he/she makes time for the mentoring. It may even mean coming into the office on a day-off or before or after a shift. Some corporate entities offer in-house learning opportunities for dentists with systems and tips that have been proven to help more inexperienced dentists.