Wednesday, October 22, 2014

Associate Pay: Collections vs Production

Money Tree

This debate will exist forever. Associates want to be paid on production. Practices want to pay associates on collections. Associates say “Not my responsibility to collect money on production” or “I don’t manage the front office staff.” Practices say “can’t pay what we don’t collect” or “What if associate over-produces in order to make more money?”

It’s simple to understand and agree with either side of the argument. I have this same conversation with prospective associates and practice owners daily.

Collections pay is my preference in most cases involving FFS, PPO, and some Medicaid practices. I prefer to avoid DHMO practices since associates are better off being paid a salary rather than a percentage in those models.

Why Use Collections Based Pay?

  1. It is in the best business interest of the practice to collect all co-pays up front and bill insurance immediately. If the practice doesn’t do this effectively, the associate relationship will fail regardless of compensation method. Practices can’t keep paying bills if they don’t have the cash to do it.
  2. Production pay in most cases is “Adjusted Production.” Adjusted production is pay based on what the practice anticipates it will collect on a procedure based on the patient’s insurance plan. 
    1. UCR may be $1,000 for that crown, but since patient x is an ABC PPO patient, the crown production is actually $800. Production $800. At 30% associate earns $240.
    2. Let’s assume that crown doesn’t get covered, and the practice has to attempt to collect from the patient. After 90 or 120 days the crown fee is written off. A lot of practices will come back and deduct that $240 from a future paycheck.
  3. Based on the above, I would rather know that I am paid with money I keep and don’t have a chance of losing at a future date.
  4. Using a base guaranteed salary or a minimum draw will help with the initial employment period of 3 to 6 months to get the associate started. If the collections are not above the draw in that timeframe, there are problems with the practice systems, and likely not a place an associate will want to work. 

    Side By Side Comparisons
Associate paid when practice is paid Associate is paid at time of completed procedure regardless if practice collects patient/insurance payment
Practice can cash flow collections with payroll Practice likely has a deficit for a period of time between payroll and insurance/patient payment
Adjustments are made before associate is paid therefore greatly limiting future payroll adjustments Associate is paid up front, but the practice will adjust future payroll for uncollected payments ( isn’t this “collections” pay, just delayed for the practice?)
Associate often questions or wants proof that money is being collected by practice Associate feels more secure in knowing he/she is paid for work when it is done
Simple accounting cash in, cash out Accounting more challenging. Adjusted production usually means the practice will want to recoup payroll paid on uncollected procedures at a later date. Lots of tracking involved.
If practice collection percentage drops too low then associate will leave Theoretically, associate should be paid regardless if the practice is paid. If practice can’t collect practice would wind up terminating associate because it couldn’t afford associate
Collections based pay will better prepare associate for future ownership or partnership where he/she will live or die by cash flow Production based pay can build an unrealistic view of associates abilities in actual revenue

Stats and Red Flags
  • In most cases looking for collections percentage above 97%; anything out of the 90’s is no good
  • Practice has to open the books to the associate so he/she can see production/collection numbers. If practice is not willing to do this then the associate should move on
  • As in everything, communication is vital to everyone's success. Without communication all is lost
  • Associate needs to be educated and understand dental insurance, collection policies, timeline of collections, write-offs, etc
  • Practice should been willing to give an initial base minimum to build a mutual commitment
Written by Carl Guthrie, Senior Account Executive/Dental Recruiter at ETS Dental. For more information, contact Carl directly at 540-491-9104 or

Thursday, October 9, 2014

Marketable Clinical Skills - How Do you Compare?

What does it take to stand out from the crowd? What CE should you take to make yourself a more marketable candidate in the dentist job market?

Many factors play a role in a practice owner’s hiring decision. Matching treatment philosophies, goal alignment, communication skills, and personality compatibility all play a role. When an owner is comparing otherwise similar associate candidates, clinical skills will always be a major consideration. So how do you stack up?

Our firm, ETS Dental, is in a unique position to answer that. With over 9,500 general dentist interviews logged into our database, we are able to create a profile of the clinic skills self-reported by the average associate dentist candidate. Here is what we found.

Rotary Trained 84%
Comfortable with 1st Molars (uppers or lowers) 68%
Comfortable with 2nd Molars (uppers or lowers) 45%

Comfortable with Surgical Extractions 79%
Comfortable Extracting Soft Tissue Impactions 46%
Comfortable Extracting Partial Bony Impactions 28%
Comfortable Extracting Full Bony Impactions 8%

Crown and Bridge 95%
Removable 93%
Veneers 65%

Pediatric Dentistry
Will only see adult patients 8%
Would limit their work with children 13%

Places Implants 15%
Restores Implants 73%

Additionally, we found that an associate candidate’s flexibility can increase the number of options available.

Would work some Saturdays 42%

Practice Environment
Would work in a corporate practice 41%
Would work in a Medicaid Clinic 23%
Would work in a Public Health Office 27%
Would work in Medicaid or Public Health 33%

While these results are self-reported and not scientific, they give a good overview of the clinical skills available in the associate dentist job market. It is our hope that this information will be helpful to you as you plan your next career move.

Written by Vice President and Senior Account Executive/Dental Recruiter Morgan Pace. For more information, contact Morgan directly at 540-491-9102 or