Dr. E. Todd Scheyer answers questions about his experiences joining a group practice as an associate...

2005 Student Event: Scaling to New Heights in Periodontal Practice
STARTING AS AN ASSOCIATE

Below is an interview with Dr. E. Todd Scheyer.
PhotoE. Todd Scheyer, D.D.S., M.S. is in practice in Houston, Texas. He completed his periodontal residency at University of Texas—San Antonio in 2001.

What was your ideal plan after graduation?

I wanted to have an established associate agreement in place with potential for partnership. I had also planned to have begun assimilation with staff and daily office procedures.

What appealed to you about starting as an associate?

Immediate un-financed income, the opportunity to learn form an established successful practitioner and trained staff, limited start up cost and risk.

How did you go about searching for an associate’s position?

Guidance from Program Director/Chairman, went on practice visits beginning at the end of my first year of residency, initial and follow-up letters provided correspondence to Doctors visited.

Was location an issue for you?

I began with a broad demographic area and willingness to relocate to various areas. By the 3rd year of residency location became more selected base on family/personal reasons.

Did you have a niche to assist in marketing yourself (i.e., cosmetic surgery, dental implants, etc.)?

I attended a comprehensive training program with a broad range of experience including clinical research. Practice management ideas to share with an established practitioner that would assist growth for both parties. I had a desire to become involved with the opportunities presented and a specific interest in prosthetic based implant reconstruction and advanced bone grafting techniques.

What were you looking for in a practice?

I was seeking a safe environment with established leadership and mentorship/partnership/friendship opportunities. It needed to include clinical excellence, research opportunities, financial stability, urban setting, potential for implant dentistry growth and multidisciplinary dentistry.

What realities did you encounter?

No matter what type of private practice setting one enters there are certain realities that others cannot express to you and must be learned by experience with the specific environment you are in. Practice management, public relations, relationship building is extremely time consuming and necessary. A large established practice has a complex personality with many individual personality dynamics. This type of practice has long established protocols based on the way the loyal/long-term staff developed them. A young energized associate has many ideas that must be introduced slowly. An associate with aspirations for partnership and leadership roles cannot control certain parameters and must, therefore, be patient. One may never establish full autonomy when compared to solo practice. Significant time is needed to create growth for the associate even in a busy established practice.

What did you do and why?

I believe this question is answer in my response to the following questions. But basically I was patient; a team player with the established office; and I tried to implement my ideas that improved office efficiency, public relations and productivity. A team of consultants created productivity projections to establish goals and track growth.

How did you obtain new patients?

Good correspondence with referrals and patients, meetings (breakfast, lunch or dinner-based on desire of GP), lunch and learn sessions, study clubs (multidisciplinary and implant), lecture to other study clubs-dental societies-hygiene societies, got involved!

What is your situation now?

Practice growth has caught up to meet projections established by consulting/accounting team to allow for 50% partnership by January of 2004. Partnership completed in August 2004.

What factors affected your plan and decisions about your career and future?

Personal aspirations, opportunities available in accordance with my time-line (graduation time), and family acceptance to my goals and aspirations.

What risks were involved?

It was a risk to move to an unfamiliar urban area. Then there was the possibility of the associate/partner relationship not working, or an inability to create growth and/or establish relationships and perhaps the inability to maintain happiness for self and spouse.

How did you assess and manage those risks?

I managed those risks with patience, diligence, communication, accounting, positive attitude, guidance, and scheduled and un-scheduled reviews of my practice situation.

What resources (i.e., people, publications, groups) did you find the most helpful?

Practitioner advice, AAP community of new and old practitioners, allowing adequate time to be spent in the private practice with our team and slowly becoming involved with management issues. G

iven what you know now, what might you do differently?

Spend even more time in the desired practice/city pre-employment. Consider not having a financial draw scheme of compensation involved with employment contract. If a practice has been in function for more than 10 years it will take at least 3 years to feel like you have assimilated in my view.

What suggestions do you have for individuals transitioning as an associate into practice?

If it is to lead to a partnership consider the opportunity with great time, adequacy and learned understanding of the specific situation. Have a practice evaluation, contracts and agreements for the practice available and reviewed. Create a strategic plan for success with the partner including timely reviews, set projections, and analyze individual and practice numbers. Have a personal consultant/accountant who has dental experience from the onset. This will be a worthwhile investment. Understand that you want to become a part owner ASAP from a financial standpoint if your compensation is set up fairly. As a partner you will be gaining income from the hygiene collections that alone may service your buy-in debt. So again as soon as you know you are in the right location/practice and can afford to possibly take a small reduction in salary (maybe not) you should buy in at some level (15%, 25%, 50%).

Did you and your partner work with an attorney to develop a solid employment contract?

Mostly with a practice consultant and accountant but an attorney was utilized for the final contract review.

What did you learn from this process?

A draw is stressful due to the fact that it is a type of non-interest loan from the practice based on collections.

Life after academics is more about relationships with unfamiliar individuals. Time becomes incredibly valuable. You will/may work harder than ever before in the academic setting. You will not be entirely prepared for the private practice setting. I also learned to become more patient with certain aspirations and personal time-lines. Learned to become more organized and learned to manage a multi-functioned private practice setting. Learned how to implement clinical research into the private practice setting, and learned how to become a better communicator with patients, staff, GP’s, and other new acquaintances.

Please explain your financial compensation arrangement, using real or fictitious figures.

As an associate: Base salary of x amount of $ with benefits which include: Health insurance, malpractice, CE, marketing budget, licensure, board certification, organization fees (ADA, AAP, SWSP, AO, local society) other misc. benefits.

The draw salary works like this: I was compensated at a base of x amount of dollars per month or 35% of collections for the 1st year of employment and 40% the second year. If my collections did not meet my base (which it did not for the 1st 4-5 months, then the difference between my collections and base salary was drawn from the practice and I had a balance owed to the practice which was decreased by increased collections month to month.

On one hand, I have some beliefs that a graduating post doctoral student deserves a salary without a draw if they are working as hard as possible but cannot increase collections because there were not patients in the chair---on the other hand there is a positive side to a draw philosophically. “Nothing comes for free!” By having the draw, when the day is done and you have paid your debts there should be a greater sense of self-worth/respect for the accomplishments and earned compensation.

What was your biggest mistake as a new practitioner?

Possibly my biggest mistake was having unrealistic expectations to exhaust debts and create new referrals. I have found that I have been more successful at growing existing referrals through successful relationships and case management.

How many employees were in the office at which you were an associate?

15-18

What is the most important thing you have learned about managing people?

Follow your personal past. For myself: be kind to others, love your profession, maintain your desire to help others, be a team player, and remain humble. Make many sacrifices to allow for the ultimate success in relationship/partnership building.

What is the most rewarding part of what you do everyday?

There is nothing more rewarding to me than analyzing successful treatment outcomes! Unfortunately, there are times when we must analyze our failure too, but this is also a valuable process in becoming a better clinician. On a broader perspective I enjoy the relationships developed with patients, staff and referring doctors.

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