The dark side of how dentistry treats associates—and how I'm offering something better

I remember being told that getting into dental school was the easiest part of becoming a dentist. But it wasn’t easy for me. My road towards my admission was fraught with a mental breakdown and a psychiatric hospitalization; a too-difficult-to-manage juggling act. And yet, having earned those three letters after my name, I have come to wholeheartedly agree. As hard as getting into dental school was, what came after was still harder.

Dental school education was unrelenting and unforgiving. Almost perpetually in a state of depression, I wobbled my way through, showing up late for all lectures (lucky enough to have had angels gathering notes for me) and skipping out as early as possible, at the dismay of my instructors and colleagues.

The culture of our dental school didn’t help. We were continually broken down, continually berated by our instructions, even, or especially, in front of patients and colleagues. The women’s locker room was filled each day and at each break with one of us staring the into the locker fighting or hiding tears.

Why do we treat our young professionals like this?

I can think of no reason for which creating a compassionate practitioners should have been so traumatic. Although it’s been almost two decades, I still cannot drive the highway half a mile west of the college without feeling like my heart is going to jump out of my chest.

How could this situation be different? I hadn’t really considered this much until I began speaking to younger dentists, mentoring younger women stuck joyless in our field, and until I began interviewing potential associates.

What I learned searching for an associate

Our advertisement for an associate reads unlike many others. We advertise not what we seek but what we are present to give. When was the last time as associate was offered, truly gifted something, rather than being asked to contribute? Below is an excerpt from our advertisement for Happy Tooth as an example of how to approach expanding your practice leveraging what you can give as opposed to what it is you’re there to take.

“At Happy Tooth it’s not about what we get from you or what we want from you; it’s about what we can give you. What we give you as an associate is as important as what we give to our patients, as providers and what we give to our team members.

We pride ourselves on having built a practice that focuses on people, on relationships, but not just with patients; we are a practice built on prioritizing people (our team as much as our patients), as multidimensional humans, with talents and potential. We pride ourselves on culture and mentorship, something that has essentially been stripped from associate positions as fewer and fewer private practice owners are hiring.

We put emphasis on good ethics, personal core values, value efficient and effective (not rushed) workflow, we help set and accomplish goals and set manageable expectations based on quarterly check-ins.

We prioritize respect, integrity, teamwork, transparency, diversity and above all a growth mindset. We are a company that puts people and purpose above product. We foster open communication with a safe space for sharing ideas, thoughts, and opinions.

This is the position that eliminates burn and turn. We are two general dentists who have a combined 42 years in private practice resting on a time-tested partnership of 17-plus years. We are two doctors who understand trust and faith in one another, understand complexity of relationships, and the importance of communication and compromise.

As a practice, we are authentic, empathetic, and accepting. We listen generously to those around us, to all around us, and fight hard to stay in the moment, even with life’s difficult noise. We are offering an atmosphere of camaraderie, support, and laughter to make the hard days go by faster, and help you fulfill your purpose.

We are offering employment as opposed to contract work. Yes, we actually do want you to be a part of our family, and not just a visiting body. You will see that we have a carefully curated team of 14 amazing human beings whom we are proud to serve. Administrators, assistants, and hygienists who are highly trained and perform at their highest capacity to elevate patient experience."

The last few weeks I have had the honor to speak with some exemplary candidates for this position. Young-ish graduates who have all been attracted to the post for one reason, and one reason only. They crave to practice in an environment where patient wellbeing is put ahead of profit.

The horror stories young dentists tell

I have met with horror stories of these associates being pushed to treatment plan indirect restorations in an effort to replace small occlusal amalgams. I am hearing of practices charging out services not performed, of practices sending out claims under providers who have not worked with that patient. I am even met with stories of senior dentists using associate DEA licenses to call in narcotic prescriptions, because the renewal of their own DEA standing was considered too costly.

These may be just stories, but I will tell you as a seasoned provider and practice owner I am not the only one hearing those stories. What supports the claims mentioned above is the disdain with which the associates present to the interview, the vulnerability with which they are willing to share their past, and the lack of hope that can be read on their face and in their body language.

As I hear them recall their past journeys everything in me wants to go and save them all. I want, so badly, and with my entire being, to give them the biggest hug possible and protect them from returning to an environment like that. I want, so badly, to return hope to them, to return faith, and to open their eyes to the possibility that not all is lost.

How can we offer something better?

I’m not arrogant enough to suggest that I am the only one out there to provide a safe haven, opportunity for growth, self-development, self-discovery, and mentorship. It exists and it’s out there; it’s not Bigfoot. Yes, it might take time and effort to find us, because we are settled somewhere between the many DSO ads.

The caveat in finding and working with us is that as private owners, and those of us (especially) who aren’t fee-for-service, we simply can’t match the type of benefits offered by the “big box” dental offices. The complexity of that kind of decision even puts me at unease. The new associates have loans to pay. A lower reimbursement for services can get in the way of that.

But what a practice owner like me can provide is worth far more than money. The handholding that I was never afforded, the training in leadership and communication, the overall interest in my associate’s welldoing, in my option, once again, is worth far more than what money can buy.

A strong mentorship and training at the beginning in the early years post-graduation will shave off five or ten years of reinventing the wheel. And most of all, working with a respectful provider as a “Mr. Miyagi” can significantly eliminate job hopping and burnout. It allows you to be surrounded by like-minded team members, who don’t dread the workday. Working with or for a provider that puts people ahead of profit will lead to better nights of sleep, a deeper sense of purpose, a lighter and more joyful life.

Maggie Augustyn, DDS, FAAIP, FICOI, is a practicing general dentist, owner of Happy Tooth, faculty member at Productive Dentist Academy, author and inspirational speaker. She earned her DDS from the University of Illinois at Chicago. Her personal mission is to ignite people to journey towards a less tainted self-actualization. Dr. Augustyn takes most pride in her role as a columnist of "Mindful Moments" in Dentistry Today. She speaks nationally bringing attention to the importance of authenticity and self discovery.