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Why dental associates often fail


Viewing an associate as an apprentice rather than a subordinate can make a world of difference.

When I see a persistent problem in the dental industry, I don’t search for solutions in the same place others ordinarily would. Why? Because others typically look for solutions where there is the least power. Most people look for solutions that are either more, better or different - but the same thing they’re already doing. Although they might spend plenty of time and money working on these solutions, rarely does the effort pay off.

Some people are entrepreneurial and inventive enough to experiment with new solutions. Unfortunately, trying to create new solutions to chronic problems doesn’t have a great success rate.

Why do these efforts fail or under-deliver? The answer is invariably the same: because the context is not right.

Context is the source of the problem, not the solution. If one changes the source of the problem, the problem gets resolved with far less effort, stress and politics. That’s why I look at context first.

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Yes, I understand that context has no form. Yes, I know that context doesn’t exist in time and space. But I also know that context is the master of the content within it.

For most businesses, in the absence of a strategically and consciously created context, managers are often enslaved by their issues and circumstances. Without a strategically and consciously created context, the forces and circumstances imprison the company’s culture, resources and people.

Once a strategically and consciously developed context is produced, a process unfolds in which the content - the forces and the circumstances - reorder and align themselves with the new context. Changing the context alters the way people relate to each other. Shifting the context changes how forces and circumstances are perceived. Disrupting the context breaks employees’ captivity to forces and circumstances and opens new pathways to solutions - ones not able to be recognized in the old context.

Why does changing the context have such power? Because the context is decisive. Context is superior-ordinate. Context is conclusive. Context rules. I have looked into the context of dental associates in group practices, and what follows are my observations.

Up next: The context of an associate...


The context of an associate

My particular method of distinguishing a context starts with language. Language is the construction material of a context. The current definition of an associate is “a person with limited or subordinate membership in an organization.”

Consequently, inherent in the context of associate are the words - and the meanings implied by these words - limited and subordinate. The definition of limited: “Confined within limits; restricted. Limited success characterized by enforceable limitations upon the scope or exercise of powers; lacking breadth and originality.”

The definition of subordinate: “Lower in rank or position; a person under the authority or control of another within the organization; treat or regard as of lesser importance than something else.”

How would an associate feel working inside a context where he or she is held as limited and related to as a subordinate?

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Following this contextual trail, what language is spoken? Again, language is the fabric of culture. What language is consistent with the context of limited and subordinate? The language, in this context, is wholly transactional.

A transaction is “this-for-that”; an exchange of something for something else. Negotiations are required, as are concessions and compromises - giving something up to get something. It’s a win-lose game.

In a transactional language, where it is “this-for-that,” you have contracts, defined compensation percentages, goals, targets, SOPs, KPIs, per-hour production numbers, incentive numbers, performance assessment ratings, and so on. Numbers are impersonal. Numbers don’t care. Numbers are indifferent. The language of transactions is impersonal, detached, measured and emotionless.

Observing the transaction language as the construct of the context dictates that strict management be deployed. How would you like to work in a place where you were limited and subordinate, where you are constantly under strict management, given that it is always and only about the numbers?

If the context is made up of language that is purely transactional - a language that is mechanical and non-caring, with no emotional content, based on win-loss, and “do what you’re told” - is this a place to which an associate would be committed?

And you wonder why associates behave the way they do. Look at the context of your dental enterprise; this might shed a little light on why associates are unhappy and underperform. Why the turnover rate is as high as 20 percent per year. Why associates usually turn over every five years or less. The context of “associate” is suppressive and exploitive.

There needs to be a shift in context.

But how do you shift the context? How do you strategically and consciously create a context that will improve associate recruitment and retention?

My method is to look at other existing contexts with basically the same elements that produce entirely different results.

Up next: The context of an apprentice...


The context of apprentice

The definition of apprentice is someone who works with an expert to develop a particular skill. Note the words “works with,” not “works for.”

There is a big difference between working with someone and working for someone. The language used in an apprentice conversation is representative of a mutual and symbiotic relationship. It has an emotive content and is contributory - giving without getting. It requires an authentic commitment to the apprentice as a person and brings forth a relationship of leadership and coaching.

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In an apprentice context, a personal relationship counts, whereas in an associate context, only performance counts. In an apprentice context, the senior party is committed to the apprentice’s skill mastery as well as his or her personal development. In an associate context, the senior party focuses only on results and not on the person.

Combining these two contexts into a single, unified context would result in a new context that would support successful associateships. I’ve invented a new word to describe this unique context. It’s a combination of associate and apprentice: “approciate.”


It’s become clear to me, as I work with group practices large and small, that associates are one of their biggest dilemmas. When you examine their existing context, the associate context is far more common than the apprentice context. By simply adding the basic elements of the apprentice context to the associate context, and blending the components of each to generate the new context of “approciate,” many of these associate-related problems would disappear.

Yes, you need contracts, goals, performance metrics, agreements, policies, etc., but if that is all there is, then the associate will not stay long - nor will the associate feel a sense of responsibility to the practice and to the team.

The relationships in the associate context cause separation, not unification. The commitments in an associate context are entirely performance-based to produce economic results. The commitments in an apprentice context are achievement-based to guide the apprentice toward mastery of a skill within a nurturing relationship.

An associate operating within an associate-apprentice combined context is provided the kind of culture, relationships, communication and results that empower the associate to work hard and be committed and responsible.

Context is decisive. Generate a context of “approciate” and it will make a profound difference for the practice, the associate and the senior doctor.


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