Questions to Ask When Joining a Dental Practice
For a dentist considering an associate position. Twenty questions covering how pay is calculated, patient flow, clinical autonomy, support staff, insurance participation, malpractice cover, and the restrictive covenant in the contract.
The questions
Open any question for the note
Who owns this practice, and is a corporate or investor group involved?
Why ask it
Ownership determines who sets your schedule, your fee schedule, and any performance targets, and it is not always visible from the signage. If a management organisation is involved, ask which decisions sit with the local owner and which are made centrally.
How is my pay calculated: on production or on collections, and after which deductions?
Why ask it
A percentage of collections exposes you to the practice's billing performance, which you do not control. Ask what happens to write-offs, insurance adjustments, and courtesy discounts, since a generous headline percentage applied after heavy adjustments can pay less than a lower one applied before them.
Is there a guaranteed minimum, and is it a draw against future production?
Why ask it
A guarantee that is really an advance means a quiet first quarter leaves you owing money back. Ask how the reconciliation works, over what period, and what happens if you leave while still behind.
Who pays for lab work, and does it come out of my percentage?
Why ask it
Lab costs deducted from your share change the economics of every crown and denture, and they push associates toward cheaper labs than they would choose. Ask which labs are used, who selects them, and whether remakes are charged to you.
How many new patients does the practice see a month, and how many would come to me?
Why ask it
New patient volume is the single best predictor of an associate's first year, and the split between the owner and the associate is where the disappointment usually lives. Ask for the actual figures from the last three months rather than a typical month.
What would my schedule look like in month one compared with month six?
Why ask it
Associates are often hired into empty columns and told they will fill. Ask who is responsible for filling them, whether hygiene checks are routed to you, and what the practice did for the last associate during the ramp.
Which procedures do you expect me to do, and which get referred out?
Why ask it
Practices vary in whether molar endodontics, surgical extractions, and implant placement stay in house. The answer shapes both your income and your skill development, and a mismatch with your training is a common reason associateships end early.
Do I have an assigned assistant, and is it the same person each day?
Why ask it
Chairside support is the difference between a workable schedule and a stressful one, and shared or rotating assistants slow you down measurably. Ask about staffing levels, current vacancies, and how long the current assistants have been there.
Who decides the treatment plan, and has anyone ever been asked to revise one?
Why ask it
You are asking, plainly, about clinical autonomy. The second half of the question is the important part, and any hesitation deserves a follow-up about what the disagreement concerned and how it was resolved.
Are there production targets or bonuses tied to particular procedures?
Why ask it
Targets attached to specific treatments create pressure that can conflict with clinical judgement, and this is worth understanding before you accept rather than after. Ask what happens if you consistently fall short of a target, and whether it has been raised with anyone recently.
What is the equipment situation, and when was it last updated?
Why ask it
Ask what imaging is available, how old the chairs and handpieces are, and how a repair request is handled. Deferred maintenance both slows your work and tells you how the practice is investing, which is relevant if you are considering buying in later.
What is the insurance mix, and how many plans are you in network with?
Why ask it
Heavy participation in low-fee plans caps what any percentage of production can earn you, no matter how hard you work. Ask which plans, at what write-off, and whether the practice is planning to add or drop any.
How is hygiene scheduled, and how does recall work?
Why ask it
Hygiene drives restorative diagnosis, so a well-run recall system is worth more to an associate than most other benefits. Ask how many hygiene days run weekly, the recall failure rate, and whether hygiene checks come to you or to the owner.
What happens when one of my patients has a problem after hours?
Why ask it
Emergency cover arrangements vary from a rota to an expectation that you take your own calls indefinitely. Ask how often it happens, whether it is paid, and who covers when you are away.
Who pays for malpractice cover, and does the policy include tail coverage?
Why ask it
A claims-made policy without tail coverage leaves you exposed for treatment you provided after you have moved on. Ask which type of policy it is, who buys the tail, and get the answer written into the contract rather than described in conversation.
What about licence fees, continuing education, and association dues?
Why ask it
These recur annually and are handled inconsistently across practices. Ask whether continuing education comes with paid days off as well as a budget, since a course allowance you have to take unpaid leave to use is worth much less than it appears.
Why is this position open, and what happened with the last associate?
Why ask it
Growth, a retirement, and a departure lead to very different situations. If an associate left, ask how long they lasted and whether their patients stayed, and consider contacting them; a pattern of short associate tenures is the clearest warning available.
Is there a path to partnership, and has anyone actually taken it?
Why ask it
Partnership is offered far more often than it is completed. Ask whether a valuation method exists, what timeline has been discussed, and whether a previous associate was told the same thing and left without buying in.
What restrictive covenant is in the contract: what radius, for how long, and what does it prevent?
Why ask it
This clause determines where you may work next and whether you may treat patients who follow you. Have a dental-specific attorney read it, because a wide radius in a dense metropolitan area can effectively require you to move house.
What would you change about this practice if you could?
Why ask it
Owners who have been straight with you will name something real: the front desk vacancy, the equipment they keep deferring, their own hours. A claim that nothing needs changing suggests the earlier answers were being managed too, which is worth knowing before you sign.
Evaluating an Associate Position
Practical guidance for the conversation itself
Before You Sign
Spend a Working Day There
Ask to observe a full clinical day, not a tour. You will see the pace, how staff speak to patients and to each other, whether the schedule runs on time, and how the owner behaves when something goes wrong. Practices that decline a working visit are declining the most useful part of your evaluation.
Ask for the Numbers That Would Determine Your Income
New patients per month, hygiene days per week, the insurance mix and associated write-offs, and average production per day for the columns you would be filling. An owner who will not share these is asking you to accept a compensation model you cannot evaluate.
Have a Dental Attorney Read the Contract
Associate agreements have recurring problem clauses: restrictive covenants drawn too widely, tail coverage left unaddressed, guarantees structured as recoverable draws, and termination notice that is short in one direction only. An hour or two of specialist review is inexpensive against a two-year restriction on where you can practise.
Talk to the Previous Associate
They are usually findable through the state board register or professional networks. Ask what their schedule looked like at six months, whether the new patient split matched what they were told, and why they left. This conversation changes more decisions than any other single step.
How to Read the Answers
- A compensation percentage quoted without specifying production or collections, and without the deduction list, is not yet an offer.
- Vagueness about new patient numbers usually means the columns are being filled by hope. Ask for three consecutive months of actual figures.
- Any hesitation on the question about treatment plans being revised deserves a direct follow-up. Clinical autonomy is difficult to reclaim once the pattern is set.
- Multiple associates over a few years, particularly with short tenures, points at something structural rather than at bad luck in hiring.
- Staff turnover matters as much as associate turnover. Long-serving assistants and front desk staff are the most reliable sign of a practice that is decently run.
- Enthusiasm about partnership with no valuation method, no timeline, and no precedent is a retention tool rather than a plan.
- Note how the owner talks about patients who question a treatment plan or a fee. That attitude will apply to your patients too.
Confirm These in Writing
- 1The compensation basis, the percentage, and every deduction taken before it is applied, including lab.
- 2Whether any guarantee is recoverable, over what period, and what is owed if you leave early.
- 3Scheduled days and hours, and who controls the schedule.
- 4Emergency and after-hours cover, including whether it is compensated.
- 5Malpractice policy type, who pays, and who buys tail coverage on departure.
- 6Continuing education allowance and whether time off for it is paid.
- 7Notice periods on both sides, and what happens to your patients if you give notice.
- 8The restrictive covenant, in full: radius, duration, activities restricted, and any patient non-solicitation.
Common Pitfalls
Comparing Percentages Instead of Take-Home Pay
Thirty percent of production with lab paid by the practice can comfortably exceed thirty-five percent of collections with lab deducted from your share, and the difference is invisible until you model it. Build a simple projection for each offer using the practice's own insurance mix and daily production figures.
Accepting an Empty Schedule on Faith
Ramp-up periods are normal; unfunded ones are not. Ask what specifically will fill your columns, who is accountable for it, and what happens to your income if it takes twice as long. An owner who has thought about this will have a concrete answer, including any marketing planned around your arrival.
Treating the Restrictive Covenant as Standard
These clauses vary enormously in enforceability and in practical effect. A ten-mile radius means something very different in a rural county than in a city where ten miles covers every practice you might join. Negotiate it before signing, when you still have leverage, rather than discovering its reach when you want to leave.
Overlooking Tail Coverage
Claims-made malpractice policies cover claims reported while the policy is active, so departing without a tail leaves you personally exposed for work already done. Establish who buys it and at what cost, and confirm it in the agreement rather than relying on an assurance.
Ignoring the Support Staff Situation
An unfilled assistant position or a front desk with constant turnover will shape your daily experience more than any clause in the contract. Ask how many staff vacancies exist now and how long they have been open, and note whether the answer is offered readily.