November 3, 2025 • 24 mins
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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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Paul Etchison (01:06):
Every dentist dreams of bringing on an
associate and having it feelseamless, like instant growth,
less stress, and more freedomimmediately.
But the reality usually doesn'tplay out that way.
Associates sometimesunderperform, they disagree on
treatment planning, or they feelunsupported and end up leaving
your practice.
Today, we're going to dive intothe real reasons associates
(01:29):
succeed or fail and how to setthem up to be productive,
profitable, and happy long term.
You are listening to the DentalPractice Heroes Podcast, where
we teach dentists how to stepback from the chair, empower
their team, and build a practicethat gives them their life
back.
I'm your host, Dr.
Paul Etchison, dental coach,author of two books on dental
(01:49):
practice management, and ownerof a large four-doctor practice
that runs with ease while I workjust one clinical day a week.
If you're ready for a practicethat supports your life instead
of consuming it, you're in theright place.
My team of legendary dentalcoaches and I are here to guide
you on your path fromoverwhelmed owner to dental
practice hero.
Let's get started.
(02:10):
Hey there, welcome back to theDental Practice Heroes Podcast.
We are so happy that you havedecided 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 inNorth Carolina, practicing just
two days a week.
And Dr.
Steve Markowitz on the EastCoast with six practices
(02:33):
practicing just one day a week.
So docs that have managed largeteams, Steve, a much larger
team than Henry and I, but youknow, large teams with large
teams comes large problems andcomes a lot of experience.
So we are going to dissect anissue 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 leadus in?
Steve Markowitz (02:53):
So we were talking with our coaching group
last week, and a great topiccame up about how we want to
treat our doctors, how we wantto treat our associates in our
practice and how we can makesure that they feel that all of
their needs are met and whatthat looks like.
And I thought it would be agreat topic for us to explore
together.
Now I'm gonna hand it rightback to Paul because this is not
my job.
I'm just the guy who's supposedto talk out of his butt and
(03:16):
gives answers.
And Paul leads us into all ofthe discussion.
So let's go back to the person.
Henry Ernst (03:20):
Paul is our point guard.
We're basically like on thewings here.
Yeah, just let me shoot.
Paul Etchison (03:25):
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 listenersome background of what we're
talking about, is we hadsomebody asking and like kind of
a bigger focus question, likewhat should I do next?
But there were some themesthere.
There were some themes thatsome associates with this person
didn't like doing treatmentthat they didn't diagnose.
I'm trying to think, were theresome other issues as well?
Steve Markowitz (03:46):
Yeah, I think the doctor attention was it was
a challenge.
Henry Ernst (03:49):
Yeah, some doctor turnover and stuff.
Disagreeing on treatment.
Yeah.
Yeah.
Doctor treatment plan, onething, and they didn't want to
have it on their schedulebecause they didn't always agree
with their particular treatmentplan.
Paul Etchison (03:59):
Right.
This person, particular personwas mentioning that there's a
lot of things that he wants toaddress and he wants to do, but
yet I believe he was still fourand a half clinical days a week.
And it was what we were tryingto get to is like, man, look at
all the stuff you could be doingif you had more time.
But he's chained to the chair.
And I think that's a mindsettrap.
You know, it's a systemizationtrap.
(04:19):
It takes time to get yourselfout, but there's a right way to
do it.
But what say you, Henry?
I mean, what are your thoughtson the whole thing?
Like, I mean, it is a verybroad topic on associates, but I
think it's an important one.
I mean, there's a right way todo associates, and there's a
wrong way.
And I'm not saying he waswrong, but I'm saying I have
worked with coaching clientsthat have associates that are
producing not much better than ahygienist.
(04:39):
Yeah.
And they don't know understandwhy there's no profitability.
Henry Ernst (04:42):
It doesn't always work.
Some of these things justalways reign true.
So the first question that Iasked for this particular person
was Are you having cadence, aregular cadence of meetings?
And most of the time whenthere's failures, when there's
things aren't going well, 95% ofthe time, no, no cadence of
meeting.
So again, I know it reins truewith a lot of stuff we talk
about on this podcast, Paul.
Is like we need communication,we need meetings.
(05:04):
With associates, they need tobe calibrated, whether it's one
or two, just have a regularcadence of meetings where you
discuss.
And in the beginnings, it maybe kind of boring.
This is what we're gonnatreatment plan for this case.
Do we agree?
Show x-rays, show photographs.
So you're all as closelycalibrated as possible.
I think the number one thingthat associates, from the
associate point of view, thatassociates will say is they
(05:27):
don't know if they're doingokay.
They just go to work, theystart doing dentistry, and they
leave, and they don't have anyidea.
Is my practice owner happy?
Am I doing okay?
The day just goes.
I think there needs to be somesort of expectations as far as,
and this is a failure too that Ifeel of owner doctors.
Share the numbers with them.
Share the numbers of thepractice reports every month.
(05:48):
Share what your expectations.
We do practice production perhour 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 upthat goal a little bit, you
know, that kind of thing.
So I think expectations,calibration, meetings, and let's
(06:10):
have some regular cadence ofseeing how we're doing.
Don't be that owner doctorwhere your associates just
sitting there going, how's yourwork going?
I don't know.
I show up for work, I leave,people are pissed off here and
there, people are happy, but Ijust go.
And that's not what you want.
You want to have definition.
A little more intentionality onit.
Uh, follow-up question, Henry.
Why calibrate?
Great question.
(06:30):
So, in our practice, I don'tfeel like we don't get what was
mentioned by this doctor that wehad in our mastermind meeting.
I see patients from the otherdoctors, and they treatment plan
a crown, they treatment plan afilling and a crown of root
canal.
And by some reason, theycouldn't come on the day where
the doctor, oh, no problem, putthem in my chair.
And the same thing goes backand forth.
Well, we used to have thisproblem here and there, where,
(06:52):
and it was usually this way,where the associates would
treatment plan a really bigfilling, and somehow or another
they sat in my chair, and then Ihad 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 gonnastop and show a photograph and
say, listen, this tooth reallyneeds a crown and explain why.
And maybe the other doctor wasbeing a little conservative, but
this tooth definitely needs acrown.
(07:12):
So we did have that for awhile, and all of a sudden,
calibrating the other doctorsand teaching them how we all
should be on the same page gotrid of that.
So, as in a doctor's office ofours with five doctors, we
always don't run in, we neversay always or never, but we
hardly ever run into this issuebecause we're all calibrated to
treatment plan prettyefficiently the same way.
Paul Etchison (07:34):
Yeah, it saves you from having these
disagreements where you're gonnawork on someone else's patient
and you're feeling that littlelike that uneasiness in your
stomach.
Like, is this the right thingto do?
This is not what I would do.
I think in our situation withthe the person we were talking
about, it was also a thing oflike passing this person low
production procedures too.
Which is not a nice thing to doto your associates, but I gotta
(07:56):
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 acertain point that this is not
gonna sound good coming out ofmy mouth, but it got to the
point where I cut my scheduledown so much, I couldn't do the
procedures that only I could do,such as molar endo implants in
my practice, because they weregetting sucked up by fillings.
And so I said, I'm not doingrestorations anymore.
(08:17):
And I looked the patient in theeye, I told the patient, hey,
I'm gonna see you back for thiscrown, this implant.
But just so you know, for thisrestoration, this is gonna be
with one of the other doctorsthat are great, give them the
endorsement.
But yeah, I don't know.
Like, what do you what do youthink, Steve?
I mean, I just I don't want todo fillings.
I totally, I totally get that.
Steve Markowitz (08:34):
They're hard, they're tight-monsumic.
You talked about differenttraps when you for Paul, when
you were first talking aboutthis issue.
And I think for me, the biggesttrap is the mindset trap.
Meaning I don't allow the wordassociate in any of my offices.
Because if they're gonna see meor they're gonna see another
doc, we're all doctors.
And if I don't want anyone tothink that my work is superior
to anyone else, in most casesit's not.
(08:55):
So when I have my doctor hat onand I'm being a dentist, I'm a
dentist just like everybodyelse.
We're peers on the clinicfloor.
And when we get outside intoour office and we're having
conversations, then I can be, Ican definitely be a manager or a
boss or whatever the heck I am.
But I think a lot of times weview these associates as people
(09:18):
that work for us and that we'rewe know everything and and
they're to serve us.
And I feel like that's justbackwards.
I think the the doctors thatlast the longest in associates,
I put that in quotes, is theones that are happy, the ones
that feel heard, the ones thatfeel like their manager or boss
knows them.
It's the same rules that applyfor every position in the
(09:39):
office.
Most doctors that I talk towith that with have larger
groups and associate doctors,they treat their team one way
and then they treat theirdoctors another way.
And they think because thedoctors are highly compensated
and they have all these things,they should be kissing the ring,
being so thankful that they gotthe opportunity to work in this
(10:00):
great place while the assistantwho's making 20 something bucks
an hour, they bend overbackwards and go pick up lunch
for.
And I'm like, whoa, whoa, whoa,guys, we can treat the
assistant that way, but we alsoneed to treat our doctors the
same way, or we can't beconfused why the assistant's
been there for 20 years and thedoctor's left after two months.
(10:21):
And I do think that the mindsetshould be we should take care
of them and view them as just asimportant part of the team as
the assistant, the officemanager, the hygienist.
Paul Etchison (10:32):
Yeah, I totally agree.
And I think you got to comefrom a level of service.
And I and I do.
I look at my associates and Isay, Hey, I'm here to serve you,
I'm here to mentor you, I'mhere to help you.
Anything you need, let me know.
And I'm gonna give you all myshitty feelings.
Steve Markowitz (10:46):
It's totally okay, though.
Henry Ernst (10:47):
I mean, I look at it from a point of view of like
opportunity.
I feel like associates staywhen they know they have
opportunity.
Like we have about 170, 180 newpatients every month.
And I don't want any of them,right?
I tell the associates, I wantyou to have, you know, I tell
them ahead of time.
Like, you know, in ourindustry, people say 20 to 40
new patients per month perdoctor is the average.
(11:08):
I want you to get way abovethat.
I want you to have all theopportunity potentially that's
out there.
When the patient comes, I'm nottelling the staff, or if
there's implants, put them withme, do this, you know.
You get to see your all thepatients.
If you're comfortable doing theMolarandos, do them.
If it's an implant case andyou're not comfortable with
that, because my associates arejust starting to scratch the
surface of basic implantdentistry.
(11:28):
I give them all theopportunity.
If they don't want to do it,then they refer it to me.
Which for me, the two days aweek gets plenty filled up with
all of the implants andsedations and stuff like that.
I even give my associates theopportunity.
Hey, listen, if there's asedation case, that doesn't mean
you automatically refer to me.
That means that I'll be happyto be the person who sedates the
(11:49):
patient for you and you can dothe work.
Really?
I think associates appreciatethat they know that they're not
being filtered.
They're not saying, hey, youdude, you just get all the
feelings.
Because I would hate that.
I'd be gone very quickly.
Paul Etchison (12:00):
So Yeah, me too.
Henry Ernst (12:01):
Opportunity.
Again, I should have mentionedthis too.
Every week we have our numbersthat we have on the board.
How many new patients, eachdoctor, how many new patients
did you see last week?
What was your production perhour last week?
How many positive reviews didyou have on this way?
It kind of gives that like alittle bit of competitive juices
flowing.
Like, you know, oh man, I wasthe low man on the totem pole
(12:22):
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 andsays, my production's not what I
really want it to be, hmm, youhad about 65 new patients last
month.
I think that's plenty of fuel,don't you?
Let's look into what are youtreatment planning?
What's your treatment planacceptance and all other stuff
we talk about?
Paul Etchison (12:42):
Yeah, absolutely.
And I have a coaching clientI'm working with right now.
Her restoration to crown ratiois 65 to one, which was never
seen.
I've never seen it that high.
You know, that's a diagnosisthing, you know, and that's
probably comes down to like somedifferent mindset things.
And this is what we're gonnawork through on our next call.
But let's switch gears here alittle bit.
(13:04):
We were talking about like,okay, so we've we've established
we've got to be considerate tothe associate, consider them an
equal peer.
We've got to support them.
What about the angle that wealso need to realize that when
we start bringing in associatesinto our practice, we need to
start thinking of our roledifferently.
What would you say about that,Steve?
Steve Markowitz (13:22):
Yeah, it's it's a big change from going to the
person who's making thedecisions when it comes to
patient care, influencing othersto make decisions for patient
care.
So I would always recommend youhave to schedule, just like
you're scheduling your patienttime, you have to schedule time
to what you can call it mentortime, you can call it coaching
(13:42):
time, you can go whatever theheck you want.
But I would say at least anhour a week, at least spent on
investing in this new doctor inyour practice.
And during that time, I wouldnot see patients, I would listen
to their exams, I would reviewtheir numbers, I would review
cases with them, and I would bethere for them.
(14:03):
And I know for me, when I'mthere for them, that may mean
that I'm doing dentistryalongside them, and I am giving
them the credit.
If it's supposed to be in theircolumn, even if I'm the one
that untorx the implant ortorques it, whatever the heck
I'm doing, I'm gonna put it andgive them the credit.
And I want them to see that I'mthere to serve to serve them
(14:25):
and not take anything away, butalso making sure that I have
scheduled time to invest intheir growth.
Paul Etchison (14:31):
Yeah, love that.
Henry Ernst (14:32):
How about you, Henry?
Yeah, the best, the best andmost efficient thing I've ever
heard was somebody who said,once you have an associate in
your practice, your practicewill never be the same.
And that's 100% true.
When you get to the point whereyou have four associates, it's
even multiple, like 10 timesfour.
It's so true.
I've never been more efficientwhen I took myself down, like
this doctor we're talking aboutthat came to us with the problem
(14:54):
last week.
We specifically told thisdoctor, 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 togo from four days to two.
Yes.
And you're gonna spend thattime being a visionary, you're
gonna be a mentor.
And I'm telling you, you'regonna it's the little time that
you spend in that education andmentorship is gonna pay off not
(15:17):
just this week, but it's gonnapay off for the next six months,
for the next two years.
And I just to jump on top ofthis associate thing, I always
have a chart that I show myassociates, and I've got three
levels a basic associate, amedia, like a semi-experienced
one, and a master.
And it shows what theexpectations are,
(15:38):
procedure-wise, money-wise, whatyou can expect to make.
And nobody should ever beforced, like, oh, you have to do
molar endo, you have to dothis.
You do what you want to.
I've had doctors who just docrown and bridge that make
perfectly fine money, right?
I would get crazy but doingthat because I'm I'd be bored,
but I think the most it's veryimportant to look at it that way
that you have to be a mentor.
(15:59):
And sometimes you don't havethe personality type to do that.
Well, either read some books,get some a life coach that'll
teach you how to be a goodmentor to others, because that's
part of this gig.
Paul Etchison (16:10):
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 typicallymost owner producers are we're
high producers.
And most associate dentists,it's hard for them to get to
that level, at least in myexperience.
We both mentioned we mentioneddollar per hour.
(16:31):
I'll share mine, is $650 perhour adjusted.
That is the bare minimum.
I mean, I have never had a docnot be able to hit that.
You know, I want more thanthat, but that is like the bare
minimum acceptability for me forassociate doctors like what is
it for you guys?
Steve Markowitz (16:45):
My goal is $600 for all of our doctors.
And I think the reason for thatnot only is freedom, but it
also allows us to blockschedule.
Before that, you're notcreating enough value in
dentistry to create a schedulethat is gonna do the type of
dentistry you want to do.
So once that once for us, whatI've seen, once you get that
$600 net an hour, you're able tocreate a schedule that's uh
(17:07):
predictable.
Yeah.
Henry Ernst (17:09):
How about you, Henry?
I want success.
I want like layups.
So we start any new doctor,500.
And and we start seeing weproduce those numbers every
week.
So, oh, you're hitting 110% ofthat.
You're hitting 120% of that.
Once we do that, we're off tothe races.
We go up to six.
I think right now we have threeassociate doctors.
We're about to hire anotherone.
One of them is at 700.
(17:30):
So we kind of raise it up to wehit that bar where they're
maybe hitting it most of thetime, but it's not easy.
So I think we're always ourassociates are anywhere around
700 to 650.
Maybe one's at 750, somewherein there.
Paul Etchison (17:43):
You know what I want to add is I feel like a
high dollar power has a lot ofpeople would think it has to do
more with speed.
And that's part of it.
But I think a lot of it comesdown to case acceptance and do
you have enough demand to createthis template, this block
schedule.
That I mean, we do this for allof our clients.
We create the block schedule sothat we know we can hit our
(18:05):
daily goals.
And this is what we do with ourcoaching clients and in the
programs.
But I find if you start withthe template, if they can't keep
up to it, it's about how do weget you faster so you can keep
up with this rather than let'smake the appointments longer in
the template, because that'sjust two steps backwards.
I mean, if if you want to do$1,000 an hour, you cannot book
(18:27):
an extraction just by itself, nobone graft, anything.
A $200 extraction, you can'tput that in your schedule for an
hour.
The math, it doesn't work, it'snever going to work.
If you need an hour to do a$200 extraction and you can't
get the bone graft with it, youneed to refer that to somebody
else.
It's just, it's not a good useof your time.
Steve Markowitz (18:44):
Paul, you can if you have two crowns in the
hour and a half before it.
So I think I agree with youcompletely.
You got to front weight it,right?
Speed is like maybe third orfourth on the list after
diagnosis, treatment planning,and case acceptance.
Then efficiencies come intoplace.
So that's why for us, not allof our doctors are at 600, but
(19:06):
that's the trigger for us toknow that this there's enough
value creation that we can startto create predictable schedules
long term.
Henry Ernst (19:13):
Yeah.
And I think having having theproduction per hour is a good
barometer for a youngerassociate 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, youjust said it, a $200 extraction
that's in gonna take me an hour,that's not at my wheelhouse.
I'd be better served byreferring it and doing something
else.
I think that's really importantto understand that.
(19:35):
But I think you're exactlyright, Paul, is it's not about
speed.
I think it's most important istreatment plan acceptance.
Yeah, the demands.
Right?
Did somebody walk into my chairand 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 themwhat we call the backup
treatment plan, where weinstruct them just to pick one.
(19:56):
And so this way they pick onetooth and it gives them the
opportunity to say yes, andboom, right?
They're off to the races.
And maybe, maybe this patientdoes, you know, 10 crowns over a
six-year period or somethinglike that.
The people that run out and sayno are the biggest deterrent to
that getting to thoseproduction goals.
Don't you call that the tinytaco and the whole enchilada at
your office?
Very good.
(20:16):
The whole enchilada, becauseagain, for some reason, dentists
are scared to give the patientthe 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 givethem what they need.
So we call that the wholeenchilada.
Give them the whole enchiladatreatment plan.
It may be scary, right?
But our staff is trained forthat.
(20:37):
When the patient says, Oh myGod, $15,000, I've got kids in
college.
You know, you put your hand on,you treat teacher treatment
planners or doctor, most of thetime it's treatment planners,
touch them on the shoulder andsay, listen, we understand.
That's why the doctor has thebackup treatment plan for this
tooth that he is concernedabout.
So treatment plan, I'm I'm abig believer that treatment plan
acceptance is the biggest thingthat will allow you to hit your
(20:58):
goals.
Paul Etchison (20:59):
Yeah, I love that.
And I think it's it's the thingthat creates demand.
A block schedule requiresdemand.
If you've got openings in yourschedule, you're like, should I
start block scheduling?
If you've got openingsconsistently, it makes no
difference.
No sense.
I mean, you've got to beselective.
So, like a lot of people, I'mworking with this one coaching
client, and we finally got herto block schedule and we created
(21:19):
major blocks.
So we're holding space forcrowns.
And her production went up alittle bit, but it's still not
where we want to be.
And I said, you know, you'vegot to not only do you have to
hold space for those bigappointments, but you've got to
limit those little guys becauseshe was having four or for seven
hours, we're just anythinggoes.
You know, we held space for twocrowns and then we're anything
goes.
But I mean, if you get a bunchof single fillings in there,
(21:40):
that's gonna crush yourproductivity too.
You can put like a singleextraction that takes you an
hour, like Steven mentioned, butyou can't do a whole day of
those.
Like you need to make surethere's other stuff to offset
that.
So you got to limit those lowproduction procedures too.
Steve Markowitz (21:53):
Paul, if you're an associate doctor and you're
making more money than you everthought you would, you have the
support of an owner doctor who'sgonna be there for you when
things may not go like youexpected them, and you're
continuing to have doing thedentistry that you want to do.
Why the heck would you everleave?
Yeah.
What a way to to to love workand have longevity in your
(22:16):
office.
Paul Etchison (22:17):
I would leave because I would find some way to
be unhappy with what I have.
That would be me personally.
Steve Markowitz (22:21):
Yeah.
Paul Etchison (22:22):
But then I would go see the grass is not greener.
Steve Markowitz (22:24):
That's why you have a life coach, a therapist,
a second therapist, and you talkto Henry and I every every
week.
Yeah, that's my that's what Iwrite about.
There's so many teardrops on myjournal.
So it's sad.
No, don't worry.
My list of therapists is alsojust as long.
So don't worry, Paul.
You're not alone.
Thanks, man.
You are not the most messed upone on this call.
It's Henry.
Henry Ernst (22:45):
I have, yes, I have four daughters and my wife.
So I'm surrounded by ladies, sothat'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 (22:55):
Nice, nice.
I love it.
All right.
Well, hey, if you're looking totake your practice to the next
level and you say, Man, I needto start thinking about my
practice in a morebusiness-minded way.
What would your practice looklike if you had one of these
guys looking at everything withyou for a full year?
Do you think you might have acompletely different practice
and a completely differentpractice that is going to echo
(23:16):
throughout your life, yourrelationships, and everything
you do?
I guarantee you that you would.
So go todentalpracticeheroes.com, set up
a strategy call with us.
Let's talk about what'spossible.
And thank you so much forlistening today.
We'll talk to you next time.
Every dentist dreams of bringing on an
associate and having it feelseamless, like instant growth,
less stress, and more freedomimmediately.
But the reality usually doesn'tplay out that way.
Associates sometimesunderperform, they disagree on
treatment planning, or they feelunsupported and end up leaving
your practice.
Today, we're going to dive intothe real reasons associates
(01:29):
succeed or fail and how to setthem up to be productive,
profitable, and happy long term.
You are listening to the DentalPractice Heroes Podcast, where
we teach dentists how to stepback from the chair, empower
their team, and build a practicethat gives them their life
back.
I'm your host, Dr.
Paul Etchison, dental coach,author of two books on dental
(01:49):
practice management, and ownerof a large four-doctor practice
that runs with ease while I workjust one clinical day a week.
If you're ready for a practicethat supports your life instead
of consuming it, you're in theright place.
My team of legendary dentalcoaches and I are here to guide
you on your path fromoverwhelmed owner to dental
practice hero.
Let's get started.
(02:10):
Hey there, welcome back to theDental Practice Heroes Podcast.
We are so happy that you havedecided 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 inNorth Carolina, practicing just
two days a week.
And Dr.
Steve Markowitz on the EastCoast with six practices
(02:33):
practicing just one day a week.
So docs that have managed largeteams, Steve, a much larger
team than Henry and I, but youknow, large teams with large
teams comes large problems andcomes a lot of experience.
So we are going to dissect anissue 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 leadus in?
Steve Markowitz (02:53):
So we were talking with our coaching group
last week, and a great topiccame up about how we want to
treat our doctors, how we wantto treat our associates in our
practice and how we can makesure that they feel that all of
their needs are met and whatthat looks like.
And I thought it would be agreat topic for us to explore
together.
Now I'm gonna hand it rightback to Paul because this is not
my job.
I'm just the guy who's supposedto talk out of his butt and
(03:16):
gives answers.
And Paul leads us into all ofthe discussion.
So let's go back to the person.
Henry Ernst (03:20):
Paul is our point guard.
We're basically like on thewings here.
Yeah, just let me shoot.
Paul Etchison (03:25):
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 listenersome background of what we're
talking about, is we hadsomebody asking and like kind of
a bigger focus question, likewhat should I do next?
But there were some themesthere.
There were some themes thatsome associates with this person
didn't like doing treatmentthat they didn't diagnose.
I'm trying to think, were theresome other issues as well?
Steve Markowitz (03:46):
Yeah, I think the doctor attention was it was
a challenge.
Henry Ernst (03:49):
Yeah, some doctor turnover and stuff.
Disagreeing on treatment.
Yeah.
Yeah.
Doctor treatment plan, onething, and they didn't want to
have it on their schedulebecause they didn't always agree
with their particular treatmentplan.
Paul Etchison (03:59):
Right.
This person, particular personwas mentioning that there's a
lot of things that he wants toaddress and he wants to do, but
yet I believe he was still fourand a half clinical days a week.
And it was what we were tryingto get to is like, man, look at
all the stuff you could be doingif you had more time.
But he's chained to the chair.
And I think that's a mindsettrap.
You know, it's a systemizationtrap.
(04:19):
It takes time to get yourselfout, but there's a right way to
do it.
But what say you, Henry?
I mean, what are your thoughtson the whole thing?
Like, I mean, it is a verybroad topic on associates, but I
think it's an important one.
I mean, there's a right way todo associates, and there's a
wrong way.
And I'm not saying he waswrong, but I'm saying I have
worked with coaching clientsthat have associates that are
producing not much better than ahygienist.
(04:39):
Yeah.
And they don't know understandwhy there's no profitability.
Henry Ernst (04:42):
It doesn't always work.
Some of these things justalways reign true.
So the first question that Iasked for this particular person
was Are you having cadence, aregular cadence of meetings?
And most of the time whenthere's failures, when there's
things aren't going well, 95% ofthe time, no, no cadence of
meeting.
So again, I know it reins truewith a lot of stuff we talk
about on this podcast, Paul.
Is like we need communication,we need meetings.
(05:04):
With associates, they need tobe calibrated, whether it's one
or two, just have a regularcadence of meetings where you
discuss.
And in the beginnings, it maybe kind of boring.
This is what we're gonnatreatment plan for this case.
Do we agree?
Show x-rays, show photographs.
So you're all as closelycalibrated as possible.
I think the number one thingthat associates, from the
associate point of view, thatassociates will say is they
(05:27):
don't know if they're doingokay.
They just go to work, theystart doing dentistry, and they
leave, and they don't have anyidea.
Is my practice owner happy?
Am I doing okay?
The day just goes.
I think there needs to be somesort of expectations as far as,
and this is a failure too that Ifeel of owner doctors.
Share the numbers with them.
Share the numbers of thepractice reports every month.
(05:48):
Share what your expectations.
We do practice production perhour 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 upthat goal a little bit, you
know, that kind of thing.
So I think expectations,calibration, meetings, and let's
(06:10):
have some regular cadence ofseeing how we're doing.
Don't be that owner doctorwhere your associates just
sitting there going, how's yourwork going?
I don't know.
I show up for work, I leave,people are pissed off here and
there, people are happy, but Ijust go.
And that's not what you want.
You want to have definition.
A little more intentionality onit.
Uh, follow-up question, Henry.
Why calibrate?
Great question.
(06:30):
So, in our practice, I don'tfeel like we don't get what was
mentioned by this doctor that wehad in our mastermind meeting.
I see patients from the otherdoctors, and they treatment plan
a crown, they treatment plan afilling and a crown of root
canal.
And by some reason, theycouldn't come on the day where
the doctor, oh, no problem, putthem in my chair.
And the same thing goes backand forth.
Well, we used to have thisproblem here and there, where,
(06:52):
and it was usually this way,where the associates would
treatment plan a really bigfilling, and somehow or another
they sat in my chair, and then Ihad 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 gonnastop and show a photograph and
say, listen, this tooth reallyneeds a crown and explain why.
And maybe the other doctor wasbeing a little conservative, but
this tooth definitely needs acrown.
(07:12):
So we did have that for awhile, and all of a sudden,
calibrating the other doctorsand teaching them how we all
should be on the same page gotrid of that.
So, as in a doctor's office ofours with five doctors, we
always don't run in, we neversay always or never, but we
hardly ever run into this issuebecause we're all calibrated to
treatment plan prettyefficiently the same way.
Paul Etchison (07:34):
Yeah, it saves you from having these
disagreements where you're gonnawork on someone else's patient
and you're feeling that littlelike that uneasiness in your
stomach.
Like, is this the right thingto do?
This is not what I would do.
I think in our situation withthe the person we were talking
about, it was also a thing oflike passing this person low
production procedures too.
Which is not a nice thing to doto your associates, but I gotta
(07:56):
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 acertain point that this is not
gonna sound good coming out ofmy mouth, but it got to the
point where I cut my scheduledown so much, I couldn't do the
procedures that only I could do,such as molar endo implants in
my practice, because they weregetting sucked up by fillings.
And so I said, I'm not doingrestorations anymore.
(08:17):
And I looked the patient in theeye, I told the patient, hey,
I'm gonna see you back for thiscrown, this implant.
But just so you know, for thisrestoration, this is gonna be
with one of the other doctorsthat are great, give them the
endorsement.
But yeah, I don't know.
Like, what do you what do youthink, Steve?
I mean, I just I don't want todo fillings.
I totally, I totally get that.
Steve Markowitz (08:34):
They're hard, they're tight-monsumic.
You talked about differenttraps when you for Paul, when
you were first talking aboutthis issue.
And I think for me, the biggesttrap is the mindset trap.
Meaning I don't allow the wordassociate in any of my offices.
Because if they're gonna see meor they're gonna see another
doc, we're all doctors.
And if I don't want anyone tothink that my work is superior
to anyone else, in most casesit's not.
(08:55):
So when I have my doctor hat onand I'm being a dentist, I'm a
dentist just like everybodyelse.
We're peers on the clinicfloor.
And when we get outside intoour office and we're having
conversations, then I can be, Ican definitely be a manager or a
boss or whatever the heck I am.
But I think a lot of times weview these associates as people
(09:18):
that work for us and that we'rewe know everything and and
they're to serve us.
And I feel like that's justbackwards.
I think the the doctors thatlast the longest in associates,
I put that in quotes, is theones that are happy, the ones
that feel heard, the ones thatfeel like their manager or boss
knows them.
It's the same rules that applyfor every position in the
(09:39):
office.
Most doctors that I talk towith that with have larger
groups and associate doctors,they treat their team one way
and then they treat theirdoctors another way.
And they think because thedoctors are highly compensated
and they have all these things,they should be kissing the ring,
being so thankful that they gotthe opportunity to work in this
(10:00):
great place while the assistantwho's making 20 something bucks
an hour, they bend overbackwards and go pick up lunch
for.
And I'm like, whoa, whoa, whoa,guys, we can treat the
assistant that way, but we alsoneed to treat our doctors the
same way, or we can't beconfused why the assistant's
been there for 20 years and thedoctor's left after two months.
(10:21):
And I do think that the mindsetshould be we should take care
of them and view them as just asimportant part of the team as
the assistant, the officemanager, the hygienist.
Paul Etchison (10:32):
Yeah, I totally agree.
And I think you got to comefrom a level of service.
And I and I do.
I look at my associates and Isay, Hey, I'm here to serve you,
I'm here to mentor you, I'mhere to help you.
Anything you need, let me know.
And I'm gonna give you all myshitty feelings.
Steve Markowitz (10:46):
It's totally okay, though.
Henry Ernst (10:47):
I mean, I look at it from a point of view of like
opportunity.
I feel like associates staywhen they know they have
opportunity.
Like we have about 170, 180 newpatients every month.
And I don't want any of them,right?
I tell the associates, I wantyou to have, you know, I tell
them ahead of time.
Like, you know, in ourindustry, people say 20 to 40
new patients per month perdoctor is the average.
(11:08):
I want you to get way abovethat.
I want you to have all theopportunity potentially that's
out there.
When the patient comes, I'm nottelling the staff, or if
there's implants, put them withme, do this, you know.
You get to see your all thepatients.
If you're comfortable doing theMolarandos, do them.
If it's an implant case andyou're not comfortable with
that, because my associates arejust starting to scratch the
surface of basic implantdentistry.
(11:28):
I give them all theopportunity.
If they don't want to do it,then they refer it to me.
Which for me, the two days aweek gets plenty filled up with
all of the implants andsedations and stuff like that.
I even give my associates theopportunity.
Hey, listen, if there's asedation case, that doesn't mean
you automatically refer to me.
That means that I'll be happyto be the person who sedates the
(11:49):
patient for you and you can dothe work.
Really?
I think associates appreciatethat they know that they're not
being filtered.
They're not saying, hey, youdude, you just get all the
feelings.
Because I would hate that.
I'd be gone very quickly.
Paul Etchison (12:00):
So Yeah, me too.
Henry Ernst (12:01):
Opportunity.
Again, I should have mentionedthis too.
Every week we have our numbersthat we have on the board.
How many new patients, eachdoctor, how many new patients
did you see last week?
What was your production perhour last week?
How many positive reviews didyou have on this way?
It kind of gives that like alittle bit of competitive juices
flowing.
Like, you know, oh man, I wasthe low man on the totem pole
(12:22):
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 andsays, my production's not what I
really want it to be, hmm, youhad about 65 new patients last
month.
I think that's plenty of fuel,don't you?
Let's look into what are youtreatment planning?
What's your treatment planacceptance and all other stuff
we talk about?
Paul Etchison (12:42):
Yeah, absolutely.
And I have a coaching clientI'm working with right now.
Her restoration to crown ratiois 65 to one, which was never
seen.
I've never seen it that high.
You know, that's a diagnosisthing, you know, and that's
probably comes down to like somedifferent mindset things.
And this is what we're gonnawork through on our next call.
But let's switch gears here alittle bit.
(13:04):
We were talking about like,okay, so we've we've established
we've got to be considerate tothe associate, consider them an
equal peer.
We've got to support them.
What about the angle that wealso need to realize that when
we start bringing in associatesinto our practice, we need to
start thinking of our roledifferently.
What would you say about that,Steve?
Steve Markowitz (13:22):
Yeah, it's it's a big change from going to the
person who's making thedecisions when it comes to
patient care, influencing othersto make decisions for patient
care.
So I would always recommend youhave to schedule, just like
you're scheduling your patienttime, you have to schedule time
to what you can call it mentortime, you can call it coaching
(13:42):
time, you can go whatever theheck you want.
But I would say at least anhour a week, at least spent on
investing in this new doctor inyour practice.
And during that time, I wouldnot see patients, I would listen
to their exams, I would reviewtheir numbers, I would review
cases with them, and I would bethere for them.
(14:03):
And I know for me, when I'mthere for them, that may mean
that I'm doing dentistryalongside them, and I am giving
them the credit.
If it's supposed to be in theircolumn, even if I'm the one
that untorx the implant ortorques it, whatever the heck
I'm doing, I'm gonna put it andgive them the credit.
And I want them to see that I'mthere to serve to serve them
(14:25):
and not take anything away, butalso making sure that I have
scheduled time to invest intheir growth.
Paul Etchison (14:31):
Yeah, love that.
Henry Ernst (14:32):
How about you, Henry?
Yeah, the best, the best andmost efficient thing I've ever
heard was somebody who said,once you have an associate in
your practice, your practicewill never be the same.
And that's 100% true.
When you get to the point whereyou have four associates, it's
even multiple, like 10 timesfour.
It's so true.
I've never been more efficientwhen I took myself down, like
this doctor we're talking aboutthat came to us with the problem
(14:54):
last week.
We specifically told thisdoctor, 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 togo from four days to two.
Yes.
And you're gonna spend thattime being a visionary, you're
gonna be a mentor.
And I'm telling you, you'regonna it's the little time that
you spend in that education andmentorship is gonna pay off not
(15:17):
just this week, but it's gonnapay off for the next six months,
for the next two years.
And I just to jump on top ofthis associate thing, I always
have a chart that I show myassociates, and I've got three
levels a basic associate, amedia, like a semi-experienced
one, and a master.
And it shows what theexpectations are,
(15:38):
procedure-wise, money-wise, whatyou can expect to make.
And nobody should ever beforced, like, oh, you have to do
molar endo, you have to dothis.
You do what you want to.
I've had doctors who just docrown and bridge that make
perfectly fine money, right?
I would get crazy but doingthat because I'm I'd be bored,
but I think the most it's veryimportant to look at it that way
that you have to be a mentor.
(15:59):
And sometimes you don't havethe personality type to do that.
Well, either read some books,get some a life coach that'll
teach you how to be a goodmentor to others, because that's
part of this gig.
Paul Etchison (16:10):
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 typicallymost owner producers are we're
high producers.
And most associate dentists,it's hard for them to get to
that level, at least in myexperience.
We both mentioned we mentioneddollar per hour.
(16:31):
I'll share mine, is $650 perhour adjusted.
That is the bare minimum.
I mean, I have never had a docnot be able to hit that.
You know, I want more thanthat, but that is like the bare
minimum acceptability for me forassociate doctors like what is
it for you guys?
Steve Markowitz (16:45):
My goal is $600 for all of our doctors.
And I think the reason for thatnot only is freedom, but it
also allows us to blockschedule.
Before that, you're notcreating enough value in
dentistry to create a schedulethat is gonna do the type of
dentistry you want to do.
So once that once for us, whatI've seen, once you get that
$600 net an hour, you're able tocreate a schedule that's uh
(17:07):
predictable.
Yeah.
Henry Ernst (17:09):
How about you, Henry?
I want success.
I want like layups.
So we start any new doctor,500.
And and we start seeing weproduce those numbers every
week.
So, oh, you're hitting 110% ofthat.
You're hitting 120% of that.
Once we do that, we're off tothe races.
We go up to six.
I think right now we have threeassociate doctors.
We're about to hire anotherone.
One of them is at 700.
(17:30):
So we kind of raise it up to wehit that bar where they're
maybe hitting it most of thetime, but it's not easy.
So I think we're always ourassociates are anywhere around
700 to 650.
Maybe one's at 750, somewherein there.
Paul Etchison (17:43):
You know what I want to add is I feel like a
high dollar power has a lot ofpeople would think it has to do
more with speed.
And that's part of it.
But I think a lot of it comesdown to case acceptance and do
you have enough demand to createthis template, this block
schedule.
That I mean, we do this for allof our clients.
We create the block schedule sothat we know we can hit our
(18:05):
daily goals.
And this is what we do with ourcoaching clients and in the
programs.
But I find if you start withthe template, if they can't keep
up to it, it's about how do weget you faster so you can keep
up with this rather than let'smake the appointments longer in
the template, because that'sjust two steps backwards.
I mean, if if you want to do$1,000 an hour, you cannot book
(18:27):
an extraction just by itself, nobone graft, anything.
A $200 extraction, you can'tput that in your schedule for an
hour.
The math, it doesn't work, it'snever going to work.
If you need an hour to do a$200 extraction and you can't
get the bone graft with it, youneed to refer that to somebody
else.
It's just, it's not a good useof your time.
Steve Markowitz (18:44):
Paul, you can if you have two crowns in the
hour and a half before it.
So I think I agree with youcompletely.
You got to front weight it,right?
Speed is like maybe third orfourth on the list after
diagnosis, treatment planning,and case acceptance.
Then efficiencies come intoplace.
So that's why for us, not allof our doctors are at 600, but
(19:06):
that's the trigger for us toknow that this there's enough
value creation that we can startto create predictable schedules
long term.
Henry Ernst (19:13):
Yeah.
And I think having having theproduction per hour is a good
barometer for a youngerassociate 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, youjust said it, a $200 extraction
that's in gonna take me an hour,that's not at my wheelhouse.
I'd be better served byreferring it and doing something
else.
I think that's really importantto understand that.
(19:35):
But I think you're exactlyright, Paul, is it's not about
speed.
I think it's most important istreatment plan acceptance.
Yeah, the demands.
Right?
Did somebody walk into my chairand 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 themwhat we call the backup
treatment plan, where weinstruct them just to pick one.
(19:56):
And so this way they pick onetooth and it gives them the
opportunity to say yes, andboom, right?
They're off to the races.
And maybe, maybe this patientdoes, you know, 10 crowns over a
six-year period or somethinglike that.
The people that run out and sayno are the biggest deterrent to
that getting to thoseproduction goals.
Don't you call that the tinytaco and the whole enchilada at
your office?
Very good.
(20:16):
The whole enchilada, becauseagain, for some reason, dentists
are scared to give the patientthe 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 givethem what they need.
So we call that the wholeenchilada.
Give them the whole enchiladatreatment plan.
It may be scary, right?
But our staff is trained forthat.
(20:37):
When the patient says, Oh myGod, $15,000, I've got kids in
college.
You know, you put your hand on,you treat teacher treatment
planners or doctor, most of thetime it's treatment planners,
touch them on the shoulder andsay, listen, we understand.
That's why the doctor has thebackup treatment plan for this
tooth that he is concernedabout.
So treatment plan, I'm I'm abig believer that treatment plan
acceptance is the biggest thingthat will allow you to hit your
(20:58):
goals.
Paul Etchison (20:59):
Yeah, I love that.
And I think it's it's the thingthat creates demand.
A block schedule requiresdemand.
If you've got openings in yourschedule, you're like, should I
start block scheduling?
If you've got openingsconsistently, it makes no
difference.
No sense.
I mean, you've got to beselective.
So, like a lot of people, I'mworking with this one coaching
client, and we finally got herto block schedule and we created
(21:19):
major blocks.
So we're holding space forcrowns.
And her production went up alittle bit, but it's still not
where we want to be.
And I said, you know, you'vegot to not only do you have to
hold space for those bigappointments, but you've got to
limit those little guys becauseshe was having four or for seven
hours, we're just anythinggoes.
You know, we held space for twocrowns and then we're anything
goes.
But I mean, if you get a bunchof single fillings in there,
(21:40):
that's gonna crush yourproductivity too.
You can put like a singleextraction that takes you an
hour, like Steven mentioned, butyou can't do a whole day of
those.
Like you need to make surethere's other stuff to offset
that.
So you got to limit those lowproduction procedures too.
Steve Markowitz (21:53):
Paul, if you're an associate doctor and you're
making more money than you everthought you would, you have the
support of an owner doctor who'sgonna be there for you when
things may not go like youexpected them, and you're
continuing to have doing thedentistry that you want to do.
Why the heck would you everleave?
Yeah.
What a way to to to love workand have longevity in your
(22:16):
office.
Paul Etchison (22:17):
I would leave because I would find some way to
be unhappy with what I have.
That would be me personally.
Steve Markowitz (22:21):
Yeah.
Paul Etchison (22:22):
But then I would go see the grass is not greener.
Steve Markowitz (22:24):
That's why you have a life coach, a therapist,
a second therapist, and you talkto Henry and I every every
week.
Yeah, that's my that's what Iwrite about.
There's so many teardrops on myjournal.
So it's sad.
No, don't worry.
My list of therapists is alsojust as long.
So don't worry, Paul.
You're not alone.
Thanks, man.
You are not the most messed upone on this call.
It's Henry.
Henry Ernst (22:45):
I have, yes, I have four daughters and my wife.
So I'm surrounded by ladies, sothat'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 (22:55):
Nice, nice.
I love it.
All right.
Well, hey, if you're looking totake your practice to the next
level and you say, Man, I needto start thinking about my
practice in a morebusiness-minded way.
What would your practice looklike if you had one of these
guys looking at everything withyou for a full year?
Do you think you might have acompletely different practice
and a completely differentpractice that is going to echo
(23:16):
throughout your life, yourrelationships, and everything
you do?
I guarantee you that you would.
So go todentalpracticeheroes.com, set up
a strategy call with us.
Let's talk about what'spossible.
And thank you so much forlistening today.
We'll talk to you next time.
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