Tuesday, February 18, 2014

Dental Associate Agreements

Here is a guest blog post from our friend Carl Guthrie from ETS Dental.

Associate Agreements (contracts) can suffocate us at a time we should be reveling in a new opportunity.  However, many dentists don’t understand what is in their contracts, in turn complicating the process and turning this joy of new opportunity into a whirlwind of anxiety and trepidation.

This article is not intended to be legal advice.  

ALWAYS consult an attorney or legal expert in your jurisdiction.

Here are a few points to pay attention to when reviewing your Associate Agreement:

1. Employee or Independent Contractor:  Regardless of the debate on what is technically legal or acceptable by the IRS, make sure you know which status you are agreeing to.  If taxes on income are not paid correctly, it could come back to bite both the associate and the practice.   Consult a CPA or Attorney on what is correct for your situation.

2. Compensation: Are you going to be paid on collections or on production?  These two do vary, but don’t get stuck in the mindset that production-based income is the only way you will accept to be paid.  Keep in mind that even if you are paid on production, many practices will adjust your future paycheck if there are any unpaid patient balances or write-offs.  In essence, you are being paid on collections anyway.

3. Notice Period: The length of termination periods are widely becoming 30 or more days long.  We’re seeing more and more asking for 60 to 90 days notice.  Understand what is required of you to terminate your employment with a practice.  

4. Restrictive Covenants and Non-Compete Clauses: Dental practices will protect their interest by requiring you to agree to some sort of restrictions upon the termination of your employment.  They will restrict you from practicing dentistry in any capacity within a certain distance for a specified length of time.  There will be other language that restricts you from soliciting patients or staff for a specified time period.   Distance varies upon geography.  For example, rural areas can have 20 miles or more of a restricted zone, while a metro area will be 2 to 5 miles.

5. Lab Expenses:  Most practices are paying these costs; however, make sure to ask if you will be paying for any lab expenses.  There is no real standard on this in the industry.  Practices will have associates pay for half or an amount equal to the Associate’s percentage of pay.  Also, make sure you understand the formula for calculating your pay with lab expenses.  You want the lab expense to be deducted from the total production prior to calculating your percent of pay.  {Pay = % of production * (Production – Lab expense)}

These are just a few of the “biggies” that develop in contract negotiations.  Again, refer to your attorney for precise legal advice.

Posted by Carl Guthrie, Senior Dentist Recruitment Consultant with ETS Dental. To find out more, call Carl at (540) 491-9104 or email at cguthrie@etsdental.com.

Friday, February 7, 2014

The Specialist and Dental Study Clubs

This is another guest post from our client Dr. Lurie.

It seems to me that the need and demand for continuing education is extremely important to our profession.  Obviously, so do the State Boards and licensing folks.  I would like to discuss study clubs and how to gain the most value for the time and effort it takes to begin a study club.  How to begin and maintain the viability of the entity is important but many other factors need to be considered.  I was fortunate enough to start a study club that was in place for about 18 years and was most successful and helpful to me personally as a specialist in Oral and Maxillofacial Surgery.  It was a venture that was close to my heart as are many endeavors that one creates from scratch.  This is a companion article which started from my recent post on the Specialist and Referrals

Continuing education has many virtues but comes at a price.  The large and major professional organizations have tons of meetings around the country and internationally.  The advantages are obvious but some disadvantages are also obvious.  One must leave the office for an extended period of time.  Some meetings are better than others and have greater draw; thus the partners in a group practice may bicker as to who gets to go and who stays and watches the store.  In addition to the time involved, there is a large expense for the meeting - food, hotel, transportation, tuition and time lost in production at the office.  There is no doubt that these large meetings with their fantastic instructors have a lot to offer.  In addition, the large attending group gives ample opportunity for exchange of ideas and experience.  Lunch time becomes an additional course of study as folks discuss what they just heard and how it is or is not applicable to them in their own particular situation.  Even so, I feel there is a great opportunity for the "Study Club" to also be part of this ongoing quest for information, knowledge, practice growth and expansion of referral base.  For the beginning specialist, it is a great supplement to the contacts and personal exchanges with the referral base.

I would suggest starting a study club that is narrow in its field.  This allows for expansion of topics as the club develops but keeps the group focused on a particular subject that can be creatively and exhaustively researched and expanded upon.  In my case, we created a club that was restricted to dental implants.  You must remember that this club was started at about the time that the first words of implantology were first spoken.  I was one of the fortunate ones chosen to take post- graduate training in this new field.  Now it is taught in dental school.  This peaked my interest and desire to share this with colleagues and referring doctors.  We had to learn a new field as best we could and take the courses that were out there - both good and bad.  The study club enabled our group to discern the good from the bad - what worked, was feasible, patient friendly and within our ability to achieve good results.  This process was ongoing throughout my career until retirement.  As the ability improved and the knowledge was enhanced, the complex cases became more routine and the results were more predictable.  Thus, the study club became an arena that open discussions, exchange of ideas, and special speakers embellished the information obtained from the formal courses given around the country.  So I would suggest that a beginning study club be a special interest within a specialty connotation.   

Invite prospective members who are within a 5 year (approximately) time of graduation with you so that you can grow together both educationally and socially.  I must comment on the wonderful relationships that the closeness of the club created.

I would also try to establish a membership that had other specialists in fields besides my own area.  After all, I am trying to create a referral base.  Input from ortho, perio, prosthetics, occlusion, TMJ, etc.  will add to the discussion and I found this to be true.  Everyone benefitted when we discussed implants from an occlusal standpoint for example.  I might invite another oral surgeon to present at a meeting but I certainly did not need one as a competing member. 

There are many ways to conduct a study club meeting.  You can have a classic lecture followed by question and answer.  It can be an actual hands-on class sponsored by one of the companies (with all their resources), a round-table discussion where everyone will present on the subject (as notified in advance) for 15 minutes per person, or even a field trip.  The possibilities are only limited by your imagination.  I would suggest allowing several minutes at every meeting for "good and welfare" so that logistics can be worked out and a consensus agreed upon. 

We actually had an evening where a patient was brought in (all consents signed), records, x-rays, treatment plans etc. presented, and the ability to examine the patient, ask questions---including fees and so on.  It was a fun night. So much so, that it was repeated once a year with a different doctor getting a patient for us to examine.  It was also invaluable when one of the patients was a problem from a treatment-plan standpoint and this gave the entire group the opportunity to help the doctor with the optimum treatment for his patient.  His patient was impressed with the help he was getting on his behalf and I think it was a mutual stimulating evening for everyone.

Always send out an agenda prior to the meeting.  Try to keep the meetings to an agreed upon time format (we used 2 hours).  Try to meet at the same, convenient location when possible with the exception being patient exams, field trips etc. 

Keep the format inexpensive and simple.  We started promptly at 7 PM.  This gave everyone time to get home, grab a bite, kiss the kids and get to the meeting.  We only met 6 times/year.  There were light refreshments in the back of the room at a convenient hotel in the area which included fruit, cheese, coffee, soda and cookies.  Thus, folks could go back and forth while presentations were occurring and not interfere with the presentation.  Our dues structure covered most of the cost of these arrangements.  I footed the bill for mailings and any other special needs. This was done to keep expenses in check.  We started with 12 members and ended with a mailing of 80 active folks.  As new members joined, we tried to get them to get their age-group peers to join with them and this was successful.

So, I think I have given you an idea on how to begin and your own imagination can do the rest.  It was a fun ride and I truly enjoyed every minute of it.  Needless to say, the learning process received was invaluable.  A great way to have "continuing education." with friends, and fellowship.

These are just a few ideas about "starting a study club" and I hope they are of help.  Please do not hesitate to send me your thoughts and questions.  It would be an honor to be of help. 

More Mistakes Made and Lessons Learned next time.

Dr. Donald B. Lurie, DDS
email:  donald.lurie@att.net
Phone:     717-235-0764

Cell:         410-218-2228