Dr. Mason Chooses an Associate

Dr. Mason was nervous. He was venturing into an area he had never been in before and he didn't quite know how to handle it. After a serious discussion with his wife, Nellie, and a great deal of soul-searching he had decided that his practice ought to be turned over to a younger man. It was not a huge practice, but a substantial one; and, as a result of the way that Dr. Mason had run his practice for the past 25 years, it provided a substantial income and a good life for himself and his family. Still, referrals had definitely leveled off lately. Dr. Mason didn't know exactly why.

He had placed a classified ad in JCO under "Opportunities":

OHIO--Quality solo orthodontic practice. Looking for associate leading to buyout. Good town of 90,000. Excellent opportunity for right person. Reply Box XX.

As Dr. Mason sat looking at his ad, he thought to himself that this was a quality practice. Good people. Paid their bills. And they got their money's worth. He looked at the phrase "excellent opportunity for right person" and wondered why he had written it just that way. How was he going decide who the right person was?

The number of responses to the ad had been greater than he had expected. Just on the basis of the letters and resumes he had narrowed the field down to three whose replies made a greater impression on him than the rest. The replies were well organized, concise, and generally showed care in preparation. The finalists were all about the same age, well trained--in edgewise, which Dr. Mason practiced--had received excellent grades, and had enclosed recommendations from one or two of their instructors. Today he was going to interview these three prospects.

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He made up a list of questions, just in case he needed them, but he had to ask himself what he wanted most in an associate. First, he wanted a responsible and capable person who would treat the patients properly and become as much a part of the community as Dr. Mason himself had been. It was important for the new doctor to be successful enough to take over the practice, say in five years. Meanwhile, Dr. Mason could share some of his responsibilities and shed some of the tyranny of the appointment schedule. It was a chance to cut down and phase out gradually. Did that mean trying to find a clone of himself? Not likely. Dr. Mason figured that new blood and new ideas were fine, and you'd have to expect that a young fellow would make some changes--for the better, one would hope. At the same time, he wasn't ready to change everything he had done for a lifetime. He'd be the one to decide what needed changing and when.

So there he sat. It was Wednesday--his day off. He looked around. He had been in this office for about 12 years. It was a familiar and comfortable environment for him. Beginning to get a little run down maybe, but still serviceable. Now he began to wonder--for the first time--whether his office and practice would measure up, whether it would be an attractive opportunity. Well, it was a little late for that kind of thought. He'd just have to see what happened.

As Dr. Mason sat pondering all this, his doorbell rang. This would be Mark Randall.

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Dr. Mason (extending his hand after opening the door): Good morning, Mark. Come on into my office. Did you have a good trip?

Mark: Not bad. It only took about an hour.

Dr. Mason: Have a seat, Mark (motioning him to a chair opposite the desk). Now let's get acquainted. I see from your resume that you are working for a dental laboratory.

Mark: Yes. I have worked part-time for a dental lab since my junior year in dental school.

Dr. Mason: That's interesting. Do you like lab work?

Mark: Oh, yes. I've always been good with my hands. That's what attracted me to dentistry in the first place.

Dr. Mason: What made you choose orthodontics?

Mark: My hobby has been miniature machines. Orthodontics looked to me to be that part of dentistry that suited my abilities and interests more than the static lab work I was doing.

Dr. Mason: It's a dynamic field, all right. Have you thought about starting your own practice?

Mark: Oh, yes, often. But it takes so much money to start your own practice. Unless you are rich or willing to go deeply into debt, it can't be done. I figure I will be much better off and get a quicker start if I can find a good practice with a compatible doctor and buy in with money I earn in the practice. I also have been asked to stay on at the school as a part-time clinical instructor. I am going to leave the lab at the end of this month and I may accept the instructorship.

Dr. Mason: That might be a good idea for you, but you don't plan to make a career of it, do you?

Mark: No. Frankly, Dr. Mason, it's an honor to be asked and I like the clinic floor, but it's mostly a way to pick up a little extra money. I really want to get into private practice.

Dr. Mason: What do you think is your main goal in a practice?

Mark: I'm just fascinated with the work. Setting up a dynamic appliance system and seeing it do what I want it to do is what turns me on about orthodontics. When I can see two sets of models side by side, a bad malocclusion in the before models and a perfect alignment and occlusion in the after models, that's what I'll be trying for every time.

Dr. Mason: It doesn't work like that every time, you know.

Mark: Yes, but I'll bet that some orthodontists have it work more often than others, and I want to be one of those.

Dr. Mason: That's an admirable goal. I have always done all the work on patients myself, but I don't expect my associate will work exactly the way I have. How do you feel about delegating the work to assistants?

Mark: I feel that working on patients is what I went into orthodontics for. It's what I am trained for and what I am good at. If anything is delegated, I would rather delegate those things that I am not trained for and am not particularly good at. I feel that if I can produce consistently excellent results I will be happy, my patients will be happy, and my referring dentists will be happy. That's the way to build and keep a good practice.

Dr. Mason: There's no question that excellent results are important and I have always tried to get the best results I could. Suppose we look around the office and look at some of my cases, and you can get an idea about this practice.

There followed a tour of the office and a discussion of cases that went on and on until Dr. Mason noted the time and felt he had to cut it short due to the imminent arrival of the second candidate.

Dr. Mason: Well, Mark, I feel we have had a good meeting. I have to see another young man soon, so we'd better end it here for now. I have been very impressed with you and your attitudes. I will have to go through all three of the interviews I have set up and then make up my mind. It might involve my having you back again. Would that be all right?

Mark: Oh, yes. I know this is an important decision for both of us. At another visit, we would have to talk about what the arrangements would be. I have enjoyed my visit with you and I look forward to hearing from you.

The second interviewee was Carl Gilbert. He was 31 years old and had been employed for two years in a busy metropolitan orthodontic practice.

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Carl: Hello, Dr. Mason. I'm Carl Gilbert.

Dr. Mason: Come in, Carl. I'm glad to see you. Won't you have a seat? (This time they settled down on the reception room settee.)

Carl: How long have you been in this office, Dr. Mason?

Dr. Mason: Twelve years this month.

Carl: Have you thought of moving to a location nearer the center of town?

Dr. Mason: This was the center of town when I moved in.

Carl: The practice I work in almost doubled in size in three years after moving to the center of the city.

Dr. Mason: I'm afraid that there may not be that growth potential in this town.

Carl: You have to figure on some growth or a buyout would probably be impossible.

Dr. Mason: I can see your point. A buyout would have to come from practice income, unless you were rich.

Carl: Which I am not. But to me, the challenge in orthodontics is to build the practice continually with a strong staff, efficient management, and strenuous practice promotion. I am itching to get into a practice I can call my own and make some of my ideas work.

Dr. Mason: Are you doing that in the practice you work in?

Carl: Oh, no. I do all the scut work--bonding, banding, impressions, some lab work. I don't have anything to do with management of the practice or with diagnosis or anything like that.

Dr. Mason: Do you really think big-city ideas will work in a town like this one?

Carl: I am sure they will. I don't know anything about how you manage your practice or promote referrals, but I would be willing to bet that ideas that I have are not just big-city ideas. They would work in any practice.

Dr. Mason: I am very interested in hearing about your ideas.

Carl: Well, first comes a good working team, with enough employees. And they would have to be trained to perform their tasks very well, because there has to be a lot of delegation.

Dr. Mason: That would be a change. I have had just two employees, who have been with me . . . let's see--Emma has been on the desk for 15 years, and Julie has been helping me in the operatory since I moved to this office 12 years ago. I do assign some tasks to Julie, but I do most of the work myself.

Carl: I have seen that you can train girls to do almost anything in the operatory very well. In today's world, the doctor has to be freed to manage and build and plan for more management and building. That's the name of the game today. He can't compete if he is tied to the chair all day. That used to be OK. Not any more. Time has to be set aside for practice management and practice promotion.

Dr. Mason: We try to keep a good relationship with referring dentists and with our patients. You think that more than that is needed?

Carl: Yes. You have to do more than maintain your position these days. You have to reach out to dentists who are not referring by entertaining them, educating them, maybe helping them with simple cases, getting their staff to visit our office, for lunch maybe. You have to let the community know you are there by giving talks to school children, parent groups, and fraternal organizations. I'd like to run contests for patients--with nice prizes--have outings with them, decorate the office for special holidays. I would make the office a fun place to come to.

Dr. Mason: You sure have a lot of ideas, Carl. I'm impressed. What made you choose dentistry as a career?

Carl: To be my own boss. That's the American Dream, isn't it? To captain one's own ship. By the way, do you have a computer?

Dr. Mason: I've thought about it.

Carl: They have a computer in the office I work in. I'm convinced that a computer is a must in an orthodontic office if you are going to manage properly in today's world. There is just too much that's important to know about a practice, and the computer can tell you that just by pressing a button.

Dr. Mason: But somebody has to put the data into the computer, and you have to have a program that converts that to the information you want.

Carl: That's right. As I said, it may take more help to get it done, but when you have the right information about your practice, then you can really manage it and keep it healthy. Otherwise, it is a tremendous amount of work to do it manually, or--if it is not done--the practice just drifts along of its own momentum. I believe in taking charge and running the practice, rather than having the practice run you. With the competition that there is out there today, an orthodontist, like any businessman, needs to find a competitive edge.

Dr. Mason: So you look upon an orthodontic practice as a business?

Carl: It certainly is a business, or at least there is an important business aspect to a professional practice. After all, what is a business but the exchange of money for goods and services?

Dr. Mason: How do you feel about the treatment itself?

Carl: It's basically a management job. You have to manage the treatment part of a practice just as you have to manage the staff or the income and outgo or anything else. Setting up a treatment program, seeing that patients stay on schedule, setting up a daily scheduling system, taking care of broken and canceled appointments--that's all management.

Dr. Mason: Would you like to look around the office, Carl?

Carl: Yes, I would.

The office tour didn't take long; it was not a large office. There was a three-chair operatory; one private operatory with a single chair for adult patients, problem patients, examinations, bonding--a kind of catch-all; an x-ray room; a business office with a window to the reception room; Dr. Mason's private office; a lab; a lavatory--and that was it.

Dr. Mason: Well, Carl, I have certainly been impressed with your ideas. I had one other interview this morning, and I am due for one more this afternoon. After that I might want to have you back again. Would that be OK?

Carl: Oh, yes. I see a lot of potential in this town. I like it. By the way, if you had a door cut through over there, you could have a circular traffic pattern through this part of the office, right around the reception desk.

Dr. Mason: Say, that might be a good idea. Well, goodbye, Carl. I hope to see you again soon.

Carl: Goodbye, Dr. Mason. Same here.

Dr. Mason did not enjoy his lunch at all. He could see that choosing an associate was going to require a difficult decision. He returned to his office, and he was in the middle of making some notes about the first two interviews when his bell rang again. Dr. Mason was a little put out with himself that he hadn't made notes as he went along this morning, but he sighed and guessed he was inexperienced at this. He went to the door to admit the last interviewee. This was Alan Edwards. He was 29 years old, just out of a graduate orthodontic program.

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Dr. Mason: Hello, Alan?

Alan: Yes, sir, I am Alan Edwards.

Dr. Mason: Pleased to meet you, Alan. I'm glad you could make it. Come in. Come in. Have a seat. I have interviewed two other young men this morning, and you are the last of three I selected from among a large number of applicants.

Alan: It's the way of the world, I guess. There have always been many others who wanted what I wanted, whether it was to get into college, or dental school, or the orthodontic program, or a job. I guess I've just been lucky.

Dr. Mason: I don't know about that. They say people make their own luck. What kind of jobs have you had?

Alan: I can't remember when I didn't have a job. My folks were not what you would call poor. They worked hard to provide whatever was needed, but there was no money for any of the extras. I had to work to go to a movie, spend money on a date, buy a car or a cassette player, and later on help with tuition, books, and my room and board at school. In junior high I delivered papers. In high school, I mowed lawns and delivered pizzas. In college, I ran the campus laundry service and did construction work summers. I started working at City Hospital when I entered dental school, and after a while I developed a program to receive child patients, orient them into the hospital routine, and stick with them through their stay as a kind of friend when they needed a friend. It worked so well that I became a kind of ombudsman for all the patients, which was too big a job for a student.

It got to be more than a full-time job, so I enlisted the aid of a number of volunteers. I wound up with a great group of eight volunteers. I'm still doing that and I'm going to miss it when I leave. I especially liked working with the children. I guess that's what got me interested in orthodontics.

Dr. Mason: I am very impressed, but you know we are getting more and more adults in orthodontic practice. It's not just for children any more.

Alan: I understand that, Dr. Mason; it's not that I don't like adults. I do. It's just that children in a health-care situation are more of a challenge in interpersonal relationships. They often don't know why they are coming to the hospital--or to an orthodontic office, I suspect; and they are frightened because they don't know what is going to happen to them. They want to know even the smallest details like what the sign-in is about, where they are going after that, what that will be like, when the doctor will see them, what he will be like, how long they will be in the hospital, what the procedures will be, how they will feel, when they can go home. I've been amazed at how much it helps if a child is told everything that is going to happen and why. And, you know, adults aren't that different. In a new and strange situation, adults also want to know what's going to happen to them and why.

Dr. Mason: Do you visualize being an ombudsman in an orthodontic practice?

Alan: Very much so. I think that the doctor/patient relationship is vitally important to a successful orthodontic practice by promoting cooperation in treatment and referral of new patients, and that the doctor has to find the time to do all the things I think are important for that relationship.

Dr. Mason: What are they?

Alan: Well, of course, the doctor has to do the initial examination and decide whether treatment is going to be needed. He need not be the one to take the diagnostic records, but he is the one to do the diagnosis and treatment plan. He does the case presentation, periodic progress reports, and a post-treatment evaluation and conference.

Dr. Mason: I do most of those things myself. Oh, I don't have a lengthy case presentation, and I don't do progress reports and post-treatment conferences, but I do all the others. I think all doctors do.

Alan: Well, from my work in the hospital I think that patients want to know what their problem is, how it's going to be treated, how they're doing in the process, and--when they are ready to go home--what their prognosis is and what to do after they leave the hospital; and I definitely get the impression that they would like the doctor to do all those things.

Dr. Mason: When would you have the time to do all that?

Alan: That's the beauty part of delegation. I can delegate many of the technical tasks and free up enough time for the personal relationships. By the way, we haven't said anything about time for relationships with dentists. That is important, too, and time has to be found for that.

Dr. Mason: You are heavily committed to people management.

Alan: In spite of the fact that people today are said to have less inclination to take the doctor's word for everything, once they have confidence in the doctor, they do trust him to treat them properly. The element of confidence and trust is still the major part of the doctor/patient relationship. It's what motivates people to accept our treatment and to cooperate in it. In orthodontics, we have a unique treatment management problem. We ask people to do things that cause them discomfort and hurt over a relatively long period of time. To me that takes a lot of explanation, support, understanding, and tender, loving care.

Dr. Mason: Alan, I am impressed with your ideas about practice and your grasp of people's needs. Would you like to look around the office?

Alan: Yes, I would, Doctor.

Once again, the office tour was short and, after some additional discussion of staff management, Alan left with the understanding that Dr. Mason would evaluate the three interviews and try to decide which of the three candidates he should choose as an associate.

It was not going to be easy. Mark liked the work itself and thought that excellence in treatment results was the primary factor in a successful practice. Carl emphasized practice management and promotion, and Alan favored people management. It was obvious to Dr. Mason that all of these were important ingredients in an orthodontic practice. The chances are that any one of these fine young men would be able to carry on the practice, but which one should Dr. Mason choose? Which one would be likely to have the best practice?

As the afternoon light was fading and Dr. Mason sat at his desk in near-darkness, he suddenly placed both hands on the desk and said out loud, "I have it. I know which one I should choose."

The characters in this story are fictitious. Any resemblance to actual people or places is purely coincidental. However, we'd like to know which young orthodontist you think Dr. Mason ought to choose. Admittedly, the information about each one is limited, but on the basis of what has been said, which one reflects most closely your own feelings about the most important factors in orthodontic practice? Please fill out the enclosed business-reply postcard and drop it in the mail today. No postage is necessary, and your reply will be completely anonymous. We will report on the results of the vote in a future issue of JCO.