Freedom Through Associates: The Real Steps Owners Skip

It’s time for a reality check: hiring an associate isn’t a shortcut to less stress and more growth. In this episode, we break down what associates actually need to succeed and the real reasons they don’t work out or make your life easier — and it’s not usually about greed or laziness.

Learn strategies to help your associates reach production goals, the metrics that will keep them accountable, and what you can do to become a better mentor!

Topics discussed:

• Why associates struggle to produce or leave
• 3 key areas to focus on from day one
• Communication and calibration strategies
• Why Steve doesn’t use the word “associate”
• How to support and invest in associates’ growth
• The owner’s role as a mentor
• Metrics that keep associates on track
• Training for smarter scheduling and case acceptance

This episode was produced by Podcast Boutique https://www.podcastboutique.com

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We help dentists take more time off while making more money through systematization, team empowerment, and creating leadership teams.

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Chapters

• 0:00 The Associate Dream Versus Reality
• 3:32 Meet the Hosts and Their Practices
• 5:07 Defining the Core Problem
• 6:42 Cadence, Calibration, and Clarity
• 11:07 Mindset Shift: Doctors, Not “Associates”
• 14:52 Opportunity Allocation Without Filtering
• 18:42 Mentorship Time Blocks and Credit
• 22:02 Owner Role Change and Expectations
• 24:52 Production Per Hour Benchmarks

Transcript

Paul Etchison: 1:24

Every dentist dreams of bringing on an associate and having it feel seamless, like instant growth, less stress, and more freedom immediately. But the reality usually doesn't play out that way. Associates sometimes underperform, they disagree on treatment planning, or they feel unsupported and end up leaving your practice. Today, we're going to dive into the real reasons associates succeed or fail and how to set them up to be productive, profitable, and happy long term. You are listening to the Dental Practice Heroes Podcast, where we teach dentists how to step back from the chair, empower their team, and build a practice that gives them their life back. I'm your host, Dr. Paul Etchison, dental coach, author of two books on dental practice management, and owner of a large four-doctor practice that runs with ease while I work just one clinical day a week. If you're ready for a practice that supports your life instead of consuming it, you're in the right place. My team of legendary dental coaches and I are here to guide you on your path from overwhelmed owner to dental practice hero. Let's get started. Hey there, welcome back to the Dental Practice Heroes Podcast. We are so happy that you have decided to spend some time with us today. I'm joined by my DPH coaches, Dr. Steve Markowitz and Dr. Henry Ernst. Dr. Henry has an 18-op practice in North Carolina, practicing just two days a week. And Dr. Steve Markowitz on the East Coast with six practices practicing just one day a week. So docs that have managed large teams, Steve, a much larger team than Henry and I, but you know, large teams with large teams comes large problems and comes a lot of experience. So we are going to dissect an issue today, a topic that I think is really it's a good one. I'm excited about this one. I mean, Steve, you want to lead us in?

Steve Markowitz: 3:10

So we were talking with our coaching group last week, and a great topic came up about how we want to treat our doctors, how we want to treat our associates in our practice and how we can make sure that they feel that all of their needs are met and what that looks like. And I thought it would be a great topic for us to explore together. Now I'm gonna hand it right back to Paul because this is not my job. I'm just the guy who's supposed to talk out of his butt and gives answers. And Paul leads us into all of the discussion. So let's go back to the person.

Henry Ernst: 3:38

Paul is our point guard. We're basically like on the wings here. Yeah, just let me shoot.

Paul Etchison: 3:42

We're running play number three, guys. All right, cool. You know what, dude? That was great, Steve. Thanks for that intro, man. That was sweet. I want to give the listener some background of what we're talking about, is we had somebody asking and like kind of a bigger focus question, like what should I do next? But there were some themes there. There were some themes that some associates with this person didn't like doing treatment that they didn't diagnose. I'm trying to think, were there some other issues as well?

Steve Markowitz: 4:04

Yeah, I think the doctor attention was it was a challenge.

Henry Ernst: 4:06

Yeah, some doctor turnover and stuff. Disagreeing on treatment. Yeah. Yeah. Doctor treatment plan, one thing, and they didn't want to have it on their schedule because they didn't always agree with their particular treatment plan.

Paul Etchison: 4:16

Right. This person, particular person was mentioning that there's a lot of things that he wants to address and he wants to do, but yet I believe he was still four and a half clinical days a week. And it was what we were trying to get to is like, man, look at all the stuff you could be doing if you had more time. But he's chained to the chair. And I think that's a mindset trap. You know, it's a systemization trap. It takes time to get yourself out, but there's a right way to do it. But what say you, Henry? I mean, what are your thoughts on the whole thing? Like, I mean, it is a very broad topic on associates, but I think it's an important one. I mean, there's a right way to do associates, and there's a wrong way. And I'm not saying he was wrong, but I'm saying I have worked with coaching clients that have associates that are producing not much better than a hygienist. Yeah. And they don't know understand why there's no profitability.

Henry Ernst: 4:59

It doesn't always work. Some of these things just always reign true. So the first question that I asked for this particular person was Are you having cadence, a regular cadence of meetings? And most of the time when there's failures, when there's things aren't going well, 95% of the time, no, no cadence of meeting. So again, I know it reins true with a lot of stuff we talk about on this podcast, Paul. Is like we need communication, we need meetings. With associates, they need to be calibrated, whether it's one or two, just have a regular cadence of meetings where you discuss. And in the beginnings, it may be kind of boring. This is what we're gonna treatment plan for this case. Do we agree? Show x-rays, show photographs. So you're all as closely calibrated as possible. I think the number one thing that associates, from the associate point of view, that associates will say is they don't know if they're doing okay. They just go to work, they start doing dentistry, and they leave, and they don't have any idea. Is my practice owner happy? Am I doing okay? The day just goes. I think there needs to be some sort of expectations as far as, and this is a failure too that I feel of owner doctors. Share the numbers with them. Share the numbers of the practice reports every month. Share what your expectations. We do practice production per hour expectation for our associates. And it's not about the money, it's just about to see am I 95% of what I'm my goal, am I 110% of my goal? Man, maybe we need to ramp up that goal a little bit, you know, that kind of thing. So I think expectations, calibration, meetings, and let's have some regular cadence of seeing how we're doing. Don't be that owner doctor where your associates just sitting there going, how's your work going? I don't know. I show up for work, I leave, people are pissed off here and there, people are happy, but I just go. And that's not what you want. You want to have definition. A little more intentionality on it. Uh, follow-up question, Henry. Why calibrate? Great question. So, in our practice, I don't feel like we don't get what was mentioned by this doctor that we had in our mastermind meeting. I see patients from the other doctors, and they treatment plan a crown, they treatment plan a filling and a crown of root canal. And by some reason, they couldn't come on the day where the doctor, oh, no problem, put them in my chair. And the same thing goes back and forth. Well, we used to have this problem here and there, where, and it was usually this way, where the associates would treatment plan a really big filling, and somehow or another they sat in my chair, and then I had to stop and I had to sit there and say to myself, okay, I'm not gonna poo-poo the associate, but I'm just gonna stop and show a photograph and say, listen, this tooth really needs a crown and explain why. And maybe the other doctor was being a little conservative, but this tooth definitely needs a crown. So we did have that for a while, and all of a sudden, calibrating the other doctors and teaching them how we all should be on the same page got rid of that. So, as in a doctor's office of ours with five doctors, we always don't run in, we never say always or never, but we hardly ever run into this issue because we're all calibrated to treatment plan pretty efficiently the same way.

Paul Etchison: 7:51

Yeah, it saves you from having these disagreements where you're gonna work on someone else's patient and you're feeling that little like that uneasiness in your stomach. Like, is this the right thing to do? This is not what I would do. I think in our situation with the the person we were talking about, it was also a thing of like passing this person low production procedures too. Which is not a nice thing to do to your associates, but I gotta be honest, I do it. I don't do fillings. Why do you do it, Paul? Why do you do that? Because I just decided at a certain point that this is not gonna sound good coming out of my mouth, but it got to the point where I cut my schedule down so much, I couldn't do the procedures that only I could do, such as molar endo implants in my practice, because they were getting sucked up by fillings. And so I said, I'm not doing restorations anymore. And I looked the patient in the eye, I told the patient, hey, I'm gonna see you back for this crown, this implant. But just so you know, for this restoration, this is gonna be with one of the other doctors that are great, give them the endorsement. But yeah, I don't know. Like, what do you what do you think, Steve? I mean, I just I don't want to do fillings. I totally, I totally get that.

Steve Markowitz: 8:52

They're hard, they're tight-monsumic. You talked about different traps when you for Paul, when you were first talking about this issue. And I think for me, the biggest trap is the mindset trap. Meaning I don't allow the word associate in any of my offices. Because if they're gonna see me or they're gonna see another doc, we're all doctors. And if I don't want anyone to think that my work is superior to anyone else, in most cases it's not. So when I have my doctor hat on and I'm being a dentist, I'm a dentist just like everybody else. We're peers on the clinic floor. And when we get outside into our office and we're having conversations, then I can be, I can definitely be a manager or a boss or whatever the heck I am. But I think a lot of times we view these associates as people that work for us and that we're we know everything and and they're to serve us. And I feel like that's just backwards. I think the the doctors that last the longest in associates, I put that in quotes, is the ones that are happy, the ones that feel heard, the ones that feel like their manager or boss knows them. It's the same rules that apply for every position in the office. Most doctors that I talk to with that with have larger groups and associate doctors, they treat their team one way and then they treat their doctors another way. And they think because the doctors are highly compensated and they have all these things, they should be kissing the ring, being so thankful that they got the opportunity to work in this great place while the assistant who's making 20 something bucks an hour, they bend over backwards and go pick up lunch for. And I'm like, whoa, whoa, whoa, guys, we can treat the assistant that way, but we also need to treat our doctors the same way, or we can't be confused why the assistant's been there for 20 years and the doctor's left after two months. And I do think that the mindset should be we should take care of them and view them as just as important part of the team as the assistant, the office manager, the hygienist.

Paul Etchison: 10:49

Yeah, I totally agree. And I think you got to come from a level of service. And I and I do. I look at my associates and I say, Hey, I'm here to serve you, I'm here to mentor you, I'm here to help you. Anything you need, let me know. And I'm gonna give you all my shitty feelings.

Steve Markowitz: 11:03

It's totally okay, though.

Henry Ernst: 11:05

I mean, I look at it from a point of view of like opportunity. I feel like associates stay when they know they have opportunity. Like we have about 170, 180 new patients every month. And I don't want any of them, right? I tell the associates, I want you to have, you know, I tell them ahead of time. Like, you know, in our industry, people say 20 to 40 new patients per month per doctor is the average. I want you to get way above that. I want you to have all the opportunity potentially that's out there. When the patient comes, I'm not telling the staff, or if there's implants, put them with me, do this, you know. You get to see your all the patients. If you're comfortable doing the Molarandos, do them. If it's an implant case and you're not comfortable with that, because my associates are just starting to scratch the surface of basic implant dentistry. I give them all the opportunity. If they don't want to do it, then they refer it to me. Which for me, the two days a week gets plenty filled up with all of the implants and sedations and stuff like that. I even give my associates the opportunity. Hey, listen, if there's a sedation case, that doesn't mean you automatically refer to me. That means that I'll be happy to be the person who sedates the patient for you and you can do the work. Really? I think associates appreciate that they know that they're not being filtered. They're not saying, hey, you dude, you just get all the feelings. Because I would hate that. I'd be gone very quickly.

Paul Etchison: 12:17

So Yeah, me too.

Henry Ernst: 12:19

Opportunity. Again, I should have mentioned this too. Every week we have our numbers that we have on the board. How many new patients, each doctor, how many new patients did you see last week? What was your production per hour last week? How many positive reviews did you have on this way? It kind of gives that like a little bit of competitive juices flowing. Like, you know, oh man, I was the low man on the totem pole last week. I got to step up my game. But also, as the owner doctor, I can always say to them, if somebody ever comes to me and says, my production's not what I really want it to be, hmm, you had about 65 new patients last month. I think that's plenty of fuel, don't you? Let's look into what are you treatment planning? What's your treatment plan acceptance and all other stuff we talk about?

Paul Etchison: 13:00

Yeah, absolutely. And I have a coaching client I'm working with right now. Her restoration to crown ratio is 65 to one, which was never seen. I've never seen it that high. You know, that's a diagnosis thing, you know, and that's probably comes down to like some different mindset things. And this is what we're gonna work through on our next call. But let's switch gears here a little bit. We were talking about like, okay, so we've we've established we've got to be considerate to the associate, consider them an equal peer. We've got to support them. What about the angle that we also need to realize that when we start bringing in associates into our practice, we need to start thinking of our role differently. What would you say about that, Steve?

Steve Markowitz: 13:40

Yeah, it's it's a big change from going to the person who's making the decisions when it comes to patient care, influencing others to make decisions for patient care. So I would always recommend you have to schedule, just like you're scheduling your patient time, you have to schedule time to what you can call it mentor time, you can call it coaching time, you can go whatever the heck you want. But I would say at least an hour a week, at least spent on investing in this new doctor in your practice. And during that time, I would not see patients, I would listen to their exams, I would review their numbers, I would review cases with them, and I would be there for them. And I know for me, when I'm there for them, that may mean that I'm doing dentistry alongside them, and I am giving them the credit. If it's supposed to be in their column, even if I'm the one that untorx the implant or torques it, whatever the heck I'm doing, I'm gonna put it and give them the credit. And I want them to see that I'm there to serve to serve them and not take anything away, but also making sure that I have scheduled time to invest in their growth.

Paul Etchison: 14:48

Yeah, love that.

Henry Ernst: 14:49

How about you, Henry? Yeah, the best, the best and most efficient thing I've ever heard was somebody who said, once you have an associate in your practice, your practice will never be the same. And that's 100% true. When you get to the point where you have four associates, it's even multiple, like 10 times four. It's so true. I've never been more efficient when I took myself down, like this doctor we're talking about that came to us with the problem last week. We specifically told this doctor, you're working too much in the chair. You're chained to the chair, and it's really scary for a doctor. Oh my God, you're telling me to go from four days to two. Yes. And you're gonna spend that time being a visionary, you're gonna be a mentor. And I'm telling you, you're gonna it's the little time that you spend in that education and mentorship is gonna pay off not just this week, but it's gonna pay off for the next six months, for the next two years. And I just to jump on top of this associate thing, I always have a chart that I show my associates, and I've got three levels a basic associate, a media, like a semi-experienced one, and a master. And it shows what the expectations are, procedure-wise, money-wise, what you can expect to make. And nobody should ever be forced, like, oh, you have to do molar endo, you have to do this. You do what you want to. I've had doctors who just do crown and bridge that make perfectly fine money, right? I would get crazy but doing that because I'm I'd be bored, but I think the most it's very important to look at it that way that you have to be a mentor. And sometimes you don't have the personality type to do that. Well, either read some books, get some a life coach that'll teach you how to be a good mentor to others, because that's part of this gig.

Paul Etchison: 16:27

Yeah, I think it comes down to we've got to make this switch from I mean, producer to business owner. And it's hard because typically most owner producers are we're high producers. And most associate dentists, it's hard for them to get to that level, at least in my experience. We both mentioned we mentioned dollar per hour. I'll share mine, is $650 per hour adjusted. That is the bare minimum. I mean, I have never had a doc not be able to hit that. You know, I want more than that, but that is like the bare minimum acceptability for me for associate doctors like what is it for you guys?

Steve Markowitz: 17:03

My goal is $600 for all of our doctors. And I think the reason for that not only is freedom, but it also allows us to block schedule. Before that, you're not creating enough value in dentistry to create a schedule that is gonna do the type of dentistry you want to do. So once that once for us, what I've seen, once you get that $600 net an hour, you're able to create a schedule that's uh predictable. Yeah.

Henry Ernst: 17:26

How about you, Henry? I want success. I want like layups. So we start any new doctor, 500. And and we start seeing we produce those numbers every week. So, oh, you're hitting 110% of that. You're hitting 120% of that. Once we do that, we're off to the races. We go up to six. I think right now we have three associate doctors. We're about to hire another one. One of them is at 700. So we kind of raise it up to we hit that bar where they're maybe hitting it most of the time, but it's not easy. So I think we're always our associates are anywhere around 700 to 650. Maybe one's at 750, somewhere in there.

Paul Etchison: 18:00

You know what I want to add is I feel like a high dollar power has a lot of people would think it has to do more with speed. And that's part of it. But I think a lot of it comes down to case acceptance and do you have enough demand to create this template, this block schedule. That I mean, we do this for all of our clients. We create the block schedule so that we know we can hit our daily goals. And this is what we do with our coaching clients and in the programs. But I find if you start with the template, if they can't keep up to it, it's about how do we get you faster so you can keep up with this rather than let's make the appointments longer in the template, because that's just two steps backwards. I mean, if if you want to do $1,000 an hour, you cannot book an extraction just by itself, no bone graft, anything. A $200 extraction, you can't put that in your schedule for an hour. The math, it doesn't work, it's never going to work. If you need an hour to do a $200 extraction and you can't get the bone graft with it, you need to refer that to somebody else. It's just, it's not a good use of your time.

Steve Markowitz: 19:01

Paul, you can if you have two crowns in the hour and a half before it. So I think I agree with you completely. You got to front weight it, right? Speed is like maybe third or fourth on the list after diagnosis, treatment planning, and case acceptance. Then efficiencies come into place. So that's why for us, not all of our doctors are at 600, but that's the trigger for us to know that this there's enough value creation that we can start to create predictable schedules long term.

Henry Ernst: 19:30

Yeah. And I think having having the production per hour is a good barometer for a younger associate to understand what's in their window and what's not. So if my goal is $600 an hour, right? Hey, if I'm looking at, you just said it, a $200 extraction that's in gonna take me an hour, that's not at my wheelhouse. I'd be better served by referring it and doing something else. I think that's really important to understand that. But I think you're exactly right, Paul, is it's not about speed. I think it's most important is treatment plan acceptance. Yeah, the demands. Right? Did somebody walk into my chair and I gave them a treatment plan for 10 crowns and it was $15,000 and they ran out of the office and never came back? Or in our office, we give them what we call the backup treatment plan, where we instruct them just to pick one. And so this way they pick one tooth and it gives them the opportunity to say yes, and boom, right? They're off to the races. And maybe, maybe this patient does, you know, 10 crowns over a six-year period or something like that. The people that run out and say no are the biggest deterrent to that getting to those production goals. Don't you call that the tiny taco and the whole enchilada at your office? Very good. The whole enchilada, because again, for some reason, dentists are scared to give the patient the whole treatment plan, right? Maybe in their head they're, I'm not gonna include that one, I'm not gonna include that one. It's our obligation to give them what they need. So we call that the whole enchilada. Give them the whole enchilada treatment plan. It may be scary, right? But our staff is trained for that. When the patient says, Oh my God, $15,000, I've got kids in college. You know, you put your hand on, you treat teacher treatment planners or doctor, most of the time it's treatment planners, touch them on the shoulder and say, listen, we understand. That's why the doctor has the backup treatment plan for this tooth that he is concerned about. So treatment plan, I'm I'm a big believer that treatment plan acceptance is the biggest thing that will allow you to hit your goals.

Paul Etchison: 21:16

Yeah, I love that. And I think it's it's the thing that creates demand. A block schedule requires demand. If you've got openings in your schedule, you're like, should I start block scheduling? If you've got openings consistently, it makes no difference. No sense. I mean, you've got to be selective. So, like a lot of people, I'm working with this one coaching client, and we finally got her to block schedule and we created major blocks. So we're holding space for crowns. And her production went up a little bit, but it's still not where we want to be. And I said, you know, you've got to not only do you have to hold space for those big appointments, but you've got to limit those little guys because she was having four or for seven hours, we're just anything goes. You know, we held space for two crowns and then we're anything goes. But I mean, if you get a bunch of single fillings in there, that's gonna crush your productivity too. You can put like a single extraction that takes you an hour, like Steven mentioned, but you can't do a whole day of those. Like you need to make sure there's other stuff to offset that. So you got to limit those low production procedures too.

Steve Markowitz: 22:10

Paul, if you're an associate doctor and you're making more money than you ever thought you would, you have the support of an owner doctor who's gonna be there for you when things may not go like you expected them, and you're continuing to have doing the dentistry that you want to do. Why the heck would you ever leave? Yeah. What a way to to to love work and have longevity in your office.

Paul Etchison: 22:34

I would leave because I would find some way to be unhappy with what I have. That would be me personally.

Steve Markowitz: 22:39

Yeah.

Paul Etchison: 22:39

But then I would go see the grass is not greener.

Steve Markowitz: 22:41

That's why you have a life coach, a therapist, a second therapist, and you talk to Henry and I every every week. Yeah, that's my that's what I write about. There's so many teardrops on my journal. So it's sad. No, don't worry. My list of therapists is also just as long. So don't worry, Paul. You're not alone. Thanks, man. You are not the most messed up one on this call. It's Henry.

Henry Ernst: 23:02

I have, yes, I have four daughters and my wife. So I'm surrounded by ladies, so that's some therapy needed right there. Yeah. They keep me on an even keel. That's good. There we go. Surrounded by ladies is good.

Paul Etchison: 23:12

Nice, nice. I love it. All right. Well, hey, if you're looking to take your practice to the next level and you say, Man, I need to start thinking about my practice in a more business-minded way. What would your practice look like if you had one of these guys looking at everything with you for a full year? Do you think you might have a completely different practice and a completely different practice that is going to echo throughout your life, your relationships, and everything you do? I guarantee you that you would. So go to dentalpracticeheroes.com, set up a strategy call with us. Let's talk about what's possible. And thank you so much for listening today. We'll talk to you next time.