The times they have a changed since the opening of a private practice, its growth and expansion, and the search for an associate. This report takes a close look at the challenges one might anticipate encountering when seeking to identify an associate to join ones practice setting. The views expressed are from an academician and private practitioner of almost 40 years who seeks to wind down and ultimately retire from a private practice setting.

While expansion of university and hospital-based programs in pediatric dentistry have witnessed increased numbers of graduates/residents over the past two decades, interests of such individuals on all sides appear more diverse than earlier times. Notable facts include a predominance of women pursuing this field which has potential to impact on the availability of persons seeking associateships or ownership of practices, an area ripe for exploration beyond the context of this paper.

Training programs for the greater part, have sought to lessen the extent to which aspects of their curriculum involve sophisticated use and applications of sedation techniques, comprehensive orthodontics, and surgical care. While true for many programs, the preceding statement is certainly not universal. Some programs with well trained and experienced directors continue to expand in these arenas with dedication and commitment toward the pursuit of excellence. Private practitioners do well to attract graduates from such programs. Motivations of graduates from many programs today however, do not necessarily share these ambitions. This discussion will focus on the variability a practitioner is likely to encounter when seeking to acquire an associate or potential partner. Alternatively, perspectives of the prospective associate are explored which attempt to reflect his or her immediate, short and longer term goals of employment. Finding a balance that complements both sides of the relationship is key to the ultimate success and enhancement of the practice.

Never before have expectations of both practitioner and potential associate evolved more divergently. This editorial explores the perspectives of all parties with regard to what constitutes reasonable guidelines to fulfill mutual needs. Practitioners, established or looking toward cutting back or retirement, seeking to increase or maintain practice growth with the addition of a younger or less experienced clinician must reach a consensus to the benefits the addition of an associate brings to the table.

Incentives must be sufficient to entice an associate’s opportunity to satisfy intellectual and financial expectations. A commitment to participate in a manner that further enhances practice productivity and patient pool must coincide with financial rewards. Unrealistic expectations from either side can be expected to result in less than optimal success in the relationship.

The financial side of the relationship no doubt plays a huge role in discussions and ultimately in consummation of an agreement between parties. Both need to a certain extent a degree of soul searching regarding their capabilities and realistic achievements. Determination of one’s worth can become complicated under circumstances where the associate brings little or no private practice experience to the discussion. Cliché criticisms are not uncommon from practitioners who surmise that young graduates and clinicians with little experience want it “all” immediately without a sense of need to “pay their dues,” or appreciation for what it takes to open let alone maintain and grow a practice. Frequently expectations are that practice schedules will immediately be full, offer lucrative fixed salaries or commissions with various incentives upon which to guarantee greater income.

In some cases, new graduates have been quoted as having asked for assistance in relocation expenses, paying for one’s liability insurance, continuing education costs, “signing bonuses,” and guaranteed salaries. This author recalls at interview a few young candidates inquiring what type of “Mercedes” would be leased or provided upon their acceptance of employment. Such interviews were not surprisingly abbreviated or terminated in short order. The fact of the matter is that both parties are subject to what is representative of the area they reside, what expectations conform to their specialty, area demands, and future relationship.

From the Perspective of the Practice Owner:
Much of what can be reasonably proposed to establish fairness and incentive to an associate will be subject to the goals of the relationship being sought. Does the current growth of the practice warrant an associate, part-time or full time? Is the associate viewed as one who provides relief to the owner, or does the associateship seek to lead to a partnership or ownership transition? Short-term vs longer- term relationships play a role in commission/salaries. Is the owner seeking to slow-down and transition its clientele to the associate? Is the associate expected to in full capacity to build upon its patient base?

On what available information are decisions based regarding what benefits a new associate can expect or demand? Is there need or desire for mentoring of a minimally experienced or new graduate to bring an associate “up to speed?” Are there special areas of the practice that the new associate lacks to be viewed as contemporary by one’s patient base? Conversely, does the associate bring new and updated skills the primary owner lacks and finds beneficial to grow and advance the practice. Mutual trust, respect, and appreciation for what is brought to the relationship contributes to a gratifying outcome. Herein lies many fundamental pre-conceived notions both parties need grapple with. What was involved in the opening and growing of the practice? What financial commitments were made for lease and leasehold improvements, bank and equipment loans, particularly during the first three years of the practice? Acquisition, training, maintenance and expansion of support staff, upgrading of equipment and facilities, regulatory compliance, continuing education are amongst the demands made on a practice owner may not often be appreciated by an inexperienced associate whose priorities are distanced from the hiring process.

From the Perspective of the New Graduate or Experienced Clinician Seeking Associateship:
While many an owner may have profound recollection of what it took to get their practice to the need to expand to include additional practitioner(s), the new graduate or young clinician likely holds a different perspective to priorities that are far removed to address their needs. No doubt, communication between graduates for similar positions compare notes and seek to match benefits that others report securing from their searches. Some may report lucrative and guaranteed salaries, optimal benefits and incentives. Not uncommonly when asked, program directors may suggest expectations that can be demanded, accurate or otherwise. The adage of “if it sounds too good to be true, it usually is, ” is probably a safe guideline to keep in mind.

The new graduate may or may not be at a station in life where beginning a family, purchasing a home, paying off school loans, automobile and living expenses impact on requirements when pursuing an associateship. Those of our generation, while also having experienced similar experiences where educational loans existed, albeit in far lower, but relative amounts, think only of the diligence, dedication, and hard work expended to make ends meet. Whether this extends to the newer generations will likely remain in debate. Nevertheless, the other end of the adage remains “to get something good, you need to pay for it.” Reminded by my children, middle-aged, on a daily basis, the times they have a changed.

For the Owner Seeking to Slow Down, Retire and/or Sell his/her Practice:
Effective guidelines to follow for the practitioner slowing down with intent to retire and sell their practice, key words to live by are flexibility, latitude, compassion, and generosity. Recall ones challenges and energies devoted to establishing a trusted following, devoted staff, and a desire to pass such on to a gifted, similarly motivated colleague will necessitate nothing short of these motives.

Fair practice evaluations by external sources and experts, equitable and fair negotiations with prospective buyers, and sound fiduciary advice will effectively guide one through these waters.

If this author of nearly forty years of experience can follow his own advice and direction, the results should enable pursuit of the next segment of life in a most gratifying way (barring of course, the uncontrollable impact of pandemic viruses, less than optimal political administration effectiveness, and stock market instability…)