Private Practice

© Springer International Publishing Switzerland 2017

Geraldine M. Weinstein and Mitchell T. Zientz (eds.)The Dental Reference Manual10.1007/978-3-319-39730-6_24

24. Private Practice

Annelise Ydstebo Driscoll1  
(1)

Department of Restorative Dental Sciences, University of Florida, College of Dentistry, Gainesville, FL, USA
 
 
Annelise Ydstebo Driscoll
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24.1 Defining a Dental Associate
24.2 Seeking Out Associateships
24.3 Expectations of Associateships
24.4 Reviewing Contracts for Associateships
24.5 Recommendations for Successful Associateships: Pearls for Private Practice
References
Abstract
Outside of choosing the dental school to attend and accumulating the associated debt load, the next most important decision for a graduating dentist is that of which career path to follow. There are many options such as the public health sector, the military sector, the nonprofit sector, the federal sector, the corporate sector, or buying and opening a dental office right out of school. This chapter will discuss the choice of the dental associate in a private practice setting as the postgraduate preferred choice. It will provide information on where associate opportunities can be found, the two classifications of associates, the expectations of both new associate and owner dentist, and review various portions of the agreement provisions for new associates. Lastly, it will provide insight into factors to consider for a successful associateship experience and resources for further knowledge.

24.1 Defining a Dental Associate

According to the American Student Dental Association (ASDA 2015), a dental associate is “a non-owner dentist who works in a dental practice.” As a dental student graduates from dental school, they seek to enter the dental workforce through many different options and opportunities. With becoming a dental practice owner aside, most dental student graduates will become dental associates in various areas of the dental industry, as nonowners. It is the next phase, and entryway into beginning their careers by working on patients in “real-life” dental facilities. It can be said to also be the easiest choice as it does not increase a new dentist’s debt load or financial burden. Increased debt loads through school loans, along with the need to build up their clinical skills in new settings, make the career option of a dental associate an attractive one. Working for someone else, or some other dental facility, postgraduation, can facilitate an easy transition from dental school to dental practice. Therefore, nonowner dental associates are a popular choice, as seen by a recent survey conducted by the American Dental Education Association, otherwise referred to hereafter as ADEA (ADEA 2013).

24.1.1 Two Types of Associate Classification

According to the Internal Revenue Service (IRS 2015b), there are two types of classifications for all workers (including the position of dental associate). The IRS provides specific criteria that must be followed to be classified as one of the two categories: employee or independent contractor (IRS 2015b). There are three different areas of control that are discussed further in the Role of the IRS section below that provide further assistance in determining which classification an associate dentist would, or could, be considered as.

  • Employee associate classification:

    • As an associate employee, the associate is an employee of the dental practice, subject to the policies, protocols, benefits, and legal protections (local, state, and federal) that any other employee of the dental practice would be subjected to. The dentist owner of the practice is the employer and as such will deduct all appropriate taxes from the associate employee’s paycheck and submit them to the appropriate government agencies, on behalf of all of the employees.
    • The associate dentist receives a paycheck that has had the necessary payroll taxes withheld and receives the amount that is left, post-tax. The associate dentist signs an IRS (Internal Revenue Service) W4 form on the first day of work in the dental practice and indicates whether they are taxed as a single person, married person, and how many deductions they will be taking, which ultimately affects the amount of taxes withheld from the associate’s paycheck.
  • Independent contractor associate classification

    • As an independent contractor, the associate is their own business owner, in a sense, and is considered self-employed. As such, they would be paying their own estimated payroll taxes to the appropriate government agencies throughout various times of the year. This requires an investment of time to study the tax laws and regulations that a small business owner (as an independent contractor) would need to know to submit the appropriate type of payroll-related taxes and the correct amount to submit, as well as to which government agency.
    • As a self-employed associate, the independent contractor would contract with a dental practice to provide services for a specified fee or percentage. They would complete a W9 form on the first day of work with the contracted dental practice. This would normally be detailed in a written agreement of terms. This type of associate would act independently, as opposed to being a supervised employee associate. An associate independent contractor acts as their own employer of their own business and can incorporate to protect themselves. They will and should purchase and/or provide all of the benefits for themselves, as their own employer. Therefore, they will not be protected by state and federal employment laws as an employee would be in a dental practice. The associate must make arrangements for their own insurances and benefits.
  • Roles of IRS (Internal Revenue Service)

    • The IRS Form SS-8 (entitled Determination of Worker Status for Purposes of Federal Employment Taxes and Income Tax Withholding) (IRS 2015a) can be found online and can be completed by an associate dentist if they are not sure how they are classified as an employee or independent contractor, or if they have potentially been misclassified.
    • The IRS reviews three criteria to determine whether an individual is, or should be, classified as an employee or independent contractor in their Publication 1779 (IRS 2015b). The three criteria involve which party has ultimate control over specific aspects of behavior, financials, and relationships of the worker (associate) to the firm (dental employer/owner).
    • Behavioral control examples: (A) The independent contractor associate controls the work environment and services performed, their work schedule, and their work is generally unsupervised as they are their own business entity. They are autonomous, independent, and usually supply their own labor, such as dental assistants, laptop with dental software or individual patient charts separate from the practice’s patient charts, and bring their own supplies to perform their work. (B) The employee associate is usually supervised and does not have autonomy in the work environment or with their schedule, may be given training and direction, and is provided all equipment, tools, and supplies needed to perform their work as a supervised employee of the dental practice by the practice owner/employer (IRS 2015b).
    • Financial control examples: (A) The independent contractor associate pays/supplies their own equipment used to perform dental services. Additionally, they pay or supply the materials, consumables, and tools used to provide their dental services to patients. They also determine their fee schedules and get paid directly from patients, and in many instances, lease or rent the space they provide their dental services in. (B) The employee associate generally does not determine the fees, nor collects the fees for services provided, nor pays for any material costs to provide the services to patients, including lab fees (IRS 2015b).
    • Relationship between the worker to the firm examples: (A) An independent contractor associate/worker would not receive benefits from the dental practice such as sick days, vacation days, insurance benefits, and would have a direct relationship with the customer/patient. The independent contractor associate/worker would be able to terminate the relationship with the firm/dental practice without penalty and would be able to advertise themselves as independent contractor associates without interference or geographic limitations from the firm/dental practice. (B) The employee associate/worker would be entitled to receive the benefits as the other employees of the firm/dental practice do and would need to give notice of leave, or termination, according to the terms in the written agreement. The employee associate/worker would generally have other staff members that would establish the initial contact with the customer/patient, gather information, schedule an appointment, etc. directly, before the employee associate meets or sees the customer/patient. Once again, the relational autonomy of the associate/worker with the firm/dental practice would become part of the consideration of how to properly classify the associate as either an employee or independent contractor (IRS 2015b).
  • Role of the Department of Labor: While the IRS oversees the classification of workers, the Department of Labor (DOL 2016) oversees how workers get compensated and whether or not they are considered salaried, hourly, and/or exempt from overtime pay. This is regulated through the DOL’s Wage and Hour Division (DOL 2016) and only relates to associates as employees of a dental practice. It does not oversee independent contractors’ compensation unless they were incorrectly misclassified as an independent contractor when they met the criteria for, and should have been classified as, an associate employee.
  • Misclassifying employees can be a costly mistake, therefore, careful consideration and abidance to the criteria for employee or independent contractor, as regulated by the IRS, is necessary to avoid an adverse event such as an audit or complaint response.
  • Role of state dental practice act

    • Each state has its own dental practice act with laws and rules that govern dentistry within the state. Dentist associates, whether employees or independent contractors, must read and abide by the rules and regulations of the Board of Dentistry of the respective state they are practicing dentistry in. It is important for all dentists, especially those just beginning their careers, to understand the laws and rules governing dentistry for the state(s) they plan on practicing dentistry in, before they begin practicing (Driscoll 2014).

24.2 Seeking Out Associateships

A 2013a, b, c, d, e ADEA Survey Study of Dental School Seniors (ADEA 2013a) indicated that the top three reasons for pursuing dentistry as a career were:

  1. 1.
    Control of work schedule
     
  2. 2.
    Service to others
     
  3. 3.
    Self-employment
    Since control of work schedule and self-employment refer to the eventuality of private practice ownership, this would lead us to believe that a dentist associate in this sector is the preference of graduating seniors. This can further be substantiated by viewing the average debt of graduating dental students in 2013 for all schools as $215,145 (ADEA 2013b). The survey indicated that 49.9 % of the 2013 graduating dental seniors stated their perceptions of preparedness for practice administration as underprepared (ADEA, 2013c), which would make the learning experience gained through a dental associate position within a private practice valuable. This, then, supports the survey’s findings of 50.5 % of graduating dental seniors’ immediate plans upon graduation, intended to become employed as a private practice dentist (ADEA 2013d). The dental associate in the private practice setting appears to be a valuable and intended career choice, according to the respondents. Potentially, it could be said to be the most attractive choice for 67.8 % of the respondents in the ADEA survey (ADEA 2013e); as the associate dentist in private practice.
     

24.2.1 Where to Find Associate Opportunities

  • Dental school vendor representative liaison

    • Each dental school has relationships with dental supply vendors. In many cases, there are representatives from the dental supply vendors whose job is to be the liaison between the senior graduating dental students and senior dentist owners within the surrounding communities (who are looking for new dental associates). These dental school vendor representative liaisons can be of great service, usually at no charge to the graduating dental student, in facilitating introductions to senior dentists in private practices looking for new associates (Pritchett 2015).
  • Dental school associate placement service

    • Many dental schools have an associate matching program or associate placement service that is provided to senior dental students and/or residents at no charge. There may be a link to their dental school’s website for senior owner dentists to upload their information as to what they are looking for or what they can offer new dental associates. The site may also allow graduating senior dental students to upload their own information on what type of practice they’re looking for and geographic areas of preference (UFCD 2015).
  • Local, state, national dental society/association meetings, and newsletters

    • There are two main national dental organizations that list associateship positions within their magazines and/or newsletters; the American Dental Association and the Academy of General Dentistry. As a member of either or both, one can view the listed positions open seeking dental associates and contact the senior owner dentist looking for a new associate in their private practice (Driscoll 2014).
    • From a state perspective, each state within the United States of America has a state dental organization that also publishes newsletters which contain listed positions for new associateships. Membership in a state dental association would allow the receipt of the publications with listed associateships offered.
    • Locally, there are regions, such as counties or affiliate regions, within each state, that are organized as dental societies. They also send out publications where associateship opportunities are listed. Membership in local dental societies would allow the access to the listed associateships offered and chances to network with prospective dental owners (ADA 2007).
  • Dental networking alumni associations

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Dec 11, 2016 | Posted by in General Dentistry | Comments Off on Private Practice

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