The Future of Contract Staffing

Contract staffing, also known as temporary or contingent staffing, has long been a solution for employers to meet short-term or variable staffing needs, while providing candidates with the opportunity to gain seasonal work or work between permanent positions. Temporary employees are no longer viewed as just being lower-level, non-essential and less-committed workers. In fact, the recession of 2008 introduced many companies to the value of having contractors as a significant portion of their workforce.

As the job outlook improves, contract staffing remains as a viable, growing workforce solution for not only satisfying administrative needs, but also engaging senior-level staff, in a cost-effective manner for strategic, leadership expertise. Contract staffing is becoming such an integral part of the workforce that Staffing Industry Analysts predicts 50 percent of the workers at Fortune 100 companies will be contingent hires by 2020. While every employer's need for contract workers will vary, they will increasingly need to think about how to implement an effective recruitment strategy that provides the right mix of contingent and permanent workers to move their organization forward.

According to Staffing Industry Analysts' Temporary Staffing Trends, Development and Forecasts webinar, the U.S. temporary staffing market is projected to experience 5 percent growth in 2014 and 4 percent globally. "Our employment landscape is changing and it's clear that contract staffing is no longer being viewed as just a secondary or backup labor solution," says DD Graf, vice president of contract staffing for MRINetwork. "The focus is moving from using temporary workers to fill in for or replace permanent functions, to more of a strategic approach in which companies contemplate whether key initiatives will require temporary vs. permanent work."

Graf offers the following advice for implementing an effective contract staffing recruitment strategy:

Include discussions around the workforce mix in annual company-wide strategy sessions. Companies should be considering the contingent labor that will be required to drive the organization's strategy instead of waiting until demands become too much, or out of the scope of work performed by permanent staff. Simply put, consider if you have everyone needed on board to accomplish company goals.

Don't disregard contract talent as only short-term workers. While contract talent are frequently hired for project-based work or short-term, mission-critical initiatives, there is a large pool of highly-skilled, contract talent that is increasingly being hired for projects that last several months or even years. Many of these top performers also prefer contract staffing for the same reasons companies do: work flexibility and the ability to demonstrate expertise in a given area. Utilizing contingent workers in this manner, makes it advantageous for employers to solve temporary workforce needs in a more cost-effective and efficient manner.

Consider your industry and the variances in workflow that happen throughout the year. Industries that are highly susceptible to fluctuations in workflow are information technology, electronic patient records implementation, healthcare information technology and pharmaceutical/life sciences. Having variable staffing expenses will allow you to better control your costs.

Partner with a staffing company that has expertise as a single source solution provider for contract and permanent assignments. When bringing in the best talent is the goal, working with a staffing organization that understands your industry, has relationships with top candidates and has your company's best interest in mind, can provide you with the competitive edge to recruit the top performers in your market, whether on a permanent or contract basis. As entities that remain current on constantly changing contract labor regulations and handling payroll and other back offices responsibilities, staffing organizations take much of the risk out of contract staffing, while helping you implement effective recruitment strategies.

As we move towards the 2020 workforce, companies are becoming more quality-focused as opposed to work output-focused. Graf concludes, "This fundamental shift in the workplace is causing companies to dissect and redesign work responsibilities and even roles, creating a growing need for contract staffing."

Dental Associate Agreement and Employment Contract: Is it In line With What I Should Expect, and Is it Reasonable?

This time of year is prime time for employment changes across the dental industry.  May through August is always the busy time.  Dentists are completing residency programs, dental students are graduating, and they are all going to be reviewing employment agreements now or very soon.

Here are a few things to consider:

1)      What is the commitment?  1 year; 3 years; can you give reasonable notice if you are unhappy or dissatisfied in the practice

a.       Most are 1 year

b.      If you receive a sign-on bonus or relocation incentive expect to commit to 2+ years.  Typically, if you leave before your commitment you will need to pay back any bonus money you receive

c.       Notice periods across the nation have grown beyond the normal 2 week courtesy.  Many agreements now require 30, 60, or 90 day of resignation notice

2)      Want to associate in your home town and eventually own a practice in your home town?  Be cautious of non-competes and restrictive covenants that would cause significant headaches in the future.  Especially if your hometown is a small town. 

·         Resource:  You Can’t Compete With Me – The Legality of Non-Compete Agreements

3)      Are you an Employee (W-2) or an Independent Contractor (1099)?  Associate positions throughout the dental industry vary greatly.  W-2 employment is most likely what you truly are. That means the employer takes your tax withholding and takes responsibility of the daily operations of the practice.  1099 contractors are simply paid for services rendered.  If this is your status, you are required to fulfill the entire tax obligation of your income. 

·         Resource: IRS website: Employee versus Independent Contractor

4)      Production versus collections-based compensation:  You need to understand which way you are getting paid, when it is calculated, and what is included and not included

a.       Is it calculated daily, weekly, bi-weekly, monthly, and quarterly? Many dentist don’t know when I ask them

b.      Are x-rays or hygiene exams included? Many times there are not

c.       Lab Expenses:  are you responsible for all, some, or none of the lab expense?

5)      Base compensation questions:

a.       Is it permanent or does it sunset after x number of months?

b.      Is it a draw on future commission or is it a salary?

·         Resources:  Dentist Contract Negotiations - Compensation Considerations

6)      Be Realistic!  Associate offerings on the East Coast are vastly different than those on the West Coast.  Make sure to understand the compensation trends and models that are common in your market.  Don’t compare offers to your friends, especially if you’re only talking % versus %.  That completely depends on the production potential based on a combination of what the practice can provide and the abilities of the associate dentist.

·         Resource: What Can An Associate Dentist Earn in Different Parts of the U.S.

Other articles to explore:

·         Associate Agreements

·         Dentists – What to Know Before You Accept an Associate Position

 Posted by Carl Guthrie, Senior Dentist Recruitment Consultant with ETS Dental. To find out more, call Carl at (540) 491-9104 or email at cguthrie@etsdental.com.

Associate Agreements

Associate Agreements (contracts) can suffocate us at a time we should be reveling in a new opportunity.  However, many dentists don’t understand what is in their contracts, in turn complicating the process and turning this joy of new opportunity into a whirlwind of anxiety and trepidation.

This article is not intended to be legal advice.  ALWAYS consult an attorney or legal expert in your jurisdiction.

Here are a few points to pay attention to when reviewing your Associate Agreement:

1. Employee or Independent Contractor:  Regardless of the debate on what is technically legal or acceptable by the IRS, make sure you know which status you are agreeing to.  If taxes on income are not paid correctly, it could come back to bite both the associate and the practice.   Consult a CPA or Attorney on what is correct for your situation.

2. Compensation: Are you going to be paid on collections or on production?  These two do vary, but don’t get stuck in the mindset that production-based income is the only way you will accept to be paid.  Keep in mind that even if you are paid on production, many practices will adjust your future paycheck if there are any unpaid patient balances or write-offs.  In essence, you are being paid on collections anyway.

3. Notice Period: The length of termination periods are widely becoming 30 or more days long.  We’re seeing more and more asking for 60 to 90 days notice.  Understand what is required of you to terminate your employment with a practice. 

4. Restrictive Covenants and Non-Compete Clauses: Dental practices will protect their interest by requiring you to agree to some sort of restrictions upon the termination of your employment.  They will restrict you from practicing dentistry in any capacity within a certain distance for a specified length of time.  There will be other language that restricts you from soliciting patients or staff for a specified time period.   Distance varies upon geography.  For example, rural areas can have 20 miles or more of a restricted zone, while a metro area will be 2 to 5 miles.

5. Lab Expenses:  Most practices are paying these costs; however, make sure to ask if you will be paying for any lab expenses.  There is no real standard on this in the industry.  Practices will have associates pay for half or an amount equal to the Associate’s percentage of pay.  Also, make sure you understand the formula for calculating your pay with lab expenses.  You want the lab expense to be deducted from the total production prior to calculating your percent of pay.  {Pay = % of production * (Production – Lab expense)}

These are just a few of the “biggies” that develop in contract negotiations.  Again, refer to your attorney for precise legal advice.

Posted by Carl Guthrie, Senior Dentist Recruitment Consultant with ETS Dental. To find out more, call Carl at (540) 491-9104 or email at cguthrie@etsdental.com.

Dentists - What to Know Before You Accept an Associate Position

Finding a new associate position can be a daunting process for both new and experienced dentists. While making a good impression on an interview is important, it is equally important to learn as much as possible about the practice. Here is a compilation of questions from job seekers who I have worked with over the years. I hope that this list will make the decision process less intimidating.

Relationship
-Employee or Independent Contractor?
-Employee at will?
-Is the doctor open to restrictive covenant in case of future ownership?
-Is the doctor going to stay on PT for some time or can he, if needed (After purchase)?

Type of Practice 
-How the practice is set up (family, Pedo, or dentures)? Pedo: what age?
-Age of the practice?
-When/what do you refer out?
-Place or Restore Implants? Which system?
-# of operatories
-# of Hygienists. Hrs of operation?
-# assistants
-Will the associate have their own assistant?
-How much is the practice overhead?
-How long has each employee been there?
-What does the practice do to market itself?
-How many FT and PT staff?

Patients
-What is the patient pool like?
-Have the number of active patient records been reviewed?
-Is the practice growing or declining in number of patients seen, new patients attracted, and young patients?
-Average number of cancellations per week?
-Average number of patients seen by associate per day?
-How far ahead is the doctor book filled?
-How far ahead is the associate book filled?
-How far ahead is the hygienist’s book filled?
-Discounts/Bartering/payment plans?
-PPO type of insurance? Insurances: accept all kinds or just selected ones?
-How much is the discounted price of the PPO compared to the fee schedule?
-Medicare or Medicaid acceptance?
-How much of the practice relies upon capitation programs, PPOs, HMOs, Medicare or Medicaid?
-What percent is FFS, cash and discounted PPO?
-When was the last fee increase?
-Are the fees low, high or average for the immediate area?
-Do you offer patients credit?

Schedule 
-Days, hours, on call, etc.
-How many office hours and days per week is the office open?

Duties
-Job description (separate document) or general description
-Is the associate expected to check hygiene of other doctor’s patients? If yes, will the associate be compensated for it?
-Will the associate be expected to perform hygiene/prophy?
-Does the doctor do any procedures other than regular general dentistry?
-What were the most of the cases being done by the associate?
-Will the associate be placing Implants for the practice?

Facilities
-Supplies, equipment, support. Etc
-What type of PMS (Software) is used?
-Implant surgical set up? Who finances to get that set up if NOT already in place?
-What is the square footage of the office? Can it be expanded?
-Average age of equipment?
-Is the practice left-handed, right-handed, or ambidextrous?
-Do you have a confirmation system for appointments?
-How do you deal with NO Show?
-Digital X-ray?
-Intraoral Digital Camera?

Term of contract 
-How long?
-What is the required notice period should either party wish to terminate the relationship?

Compensation
-Is there a guaranteed salary, draw, daily rate or hourly rate?
-Is commission determined from collections or production?
-If collections, what is the collections rate in the practice?
-What percentage of production/collections is used to calculate income?
-Is there a chance to increase compensation in the future?
-Is the associate responsible for my own lab fees and expenses?
-Taxes withheld?
-How will the associate be paid? (Weekly/bi-weekly/monthly)
-How much on average was the last associate making?
-What was the average associate production per day?
-Does the associate production include hygiene exams and x-rays?
-Can I get a fee schedule of the practice?

Benefits
-Medical Insurance: health and dental?
-Malpractice insurance?
-Disabilities insurance?
-Required CE courses? How much and for how many hours a year? Are they paid for/reimbursed? Is there a stipend?
-Retirement?
-Sick days…….. # allow per yr…..
-Personal days/vacations…..# per yr allow……
-Holidays?
-What benefits are given to the staff?

Expenses
-Define, list, when paid, lab, etc…..
-What Lab do you use? Use different lab for different lab orders?
-Will the practice support the acquisition loan (in case of future ownership), pay the overhead expenses and can afford a reasonable income?

Other Questions and Notes:
-What is your practice Philosophy and Goals? For the Practice and with new pt’s tx?
-% of implant surgeries
-Have you had associate before? How many? How long they stayed? What was the reason for the associate resignation?
-How do you advertise?
-Will most dental insurance dictate pt’s Tx plan??
-Do you deal a lot with EMERGENCY pt? Separate operatories for that?
-Average number of emergencies per week?
-Will I be doing hygiene/prophy when I don’t have pt?
-Who determines how long I have when spending with new pt/initial exam and record?
-Do I have a separate apt to do comprehensive exams and record, or do I perform the TP when pt comes in for cleaning?
-How long does a hygienist spend on their recalls?
-Is there a particular doctor in the area who is your main competitor?
-Who sees the patient first (Doctor, hygienist, associate)?
-Why was the partnership offer turned down by an associate (if applicable)?
-Will I be able to visit the office during regular working hours?
-Does the doctor have a report showing how much treatment is treatment planned?

Partnership/Buy in/Sale
-Discussion/Formula/Price
-What is the time frame for an associate position before we can talk about partnership/buy in/buy out?
-Is there an option for future ownership? Are you considering a move out of state?

Restrictive Covenant
-Define


Posted by Morgan Pace.

Morgan Pace is the Southeastern U.S. Account Executive and Senior Recruiter for ETS Dental. He can be reached at mpace@etsdental.com or 540-491-9102. ETS Dental is a Dental Recruiting firm specializing in finding and placing General Dentists, Dental Specialists, and Dental Staff throughout the United States. www.etsdental.com

From Dental CPAs: Dental Associate has Practice Purchase Questions

Thanks to our friends over at Dental CPAs we bring you this great thread from Dentaltown regarding Associate transitions.

Check them out at www.dentalcpas.com and http://dentalcpas.blogspot.com

I'm going to begin a 1-2 year associateship with the opportunity to buy 50% of the practice after that period.  I've hired a practice sales broker/CPA to provide me with a second opinion on the appraised value of the practice.  

Jason Wood, Dental Attorney:

Is he representing you as a CPA or as a broker?  There is a big difference in fees I would imagine.   

I'm trying to arrange it so everything about the associateship, transition, and purchase of the practice will be arranged in a contract prior to beginning.  

Jason Wood, Dental Attorney:

This is extremely expensive to do.  My recommendation would not be to do this but to have everything addressed in the associate agreement with the particulars of the deal (ie purchase price, ability to acquire 50% of the building, etc.) being built into the contract.  Otherwise to properly do this now will cost you around $15,000.  Wait until you know you can work together before spending this kind of money.  

However, I'd like to receive an appraisal of the building/real estate, but the CPA has informed me that it can become very expensive to have the building appraised.  Although the CPA does not appraise office buildings himself he has recommended an agent he has used in the past.  He has also told me that the building appraisal could cost several thousands of dollars and may not even matter since any bank/lender will want another appraisal to loan me the money.  

Jason Wood, Dental Attorney:

Agree that you can buy in to the building at the appraised value of the building when you acquire the practice, that way you push the appraisal out and the bank that will lend you to money for the acquisition would be happy to lend you more on the real estate since it strengthens their position.

Is there any benefit to having the building appraised this early into the associateship?  With the real estate market as bad as it is I would like to capitalize on the depressed market values. 

Tim Lott, Dental CPA

You should keep in mind having it appraised now won't guarantee you that this value will be the price in the future. Put yourself in the seller’s shoes. Historically, after real estate has declined substantially, would you be willing to lock in a price on an asset that's likely to go up in the future?

What you can do is consult with a commercial real estate agent and see what the comps are for similar space so you can get a range of what to expect in terms of real estate value. See if that range matches what the seller is thinking. I don't see any benefit in paying for the appraisal now.

With respect to the practice, I do see the benefit in trying to establish the price now; however, just know that you can appraise the practice as of say 12/31/2011 in 2013 very easily.

Good luck.

Jason Wood, Dental Attorney:

Sure.  Creating the partnership agreement, the purchase agreement, the lease review, etc. would be very expensive to do right now.  You can:

1.  Agree to the purchase price now
2.  Agree to the closing date
3.  Agree to when the parties need to back out before it becomes binding
4.  Agree on stop gap measures to insure compliance after the back out date
5.  Agree on the structure of the partnership
6.  Agree on the building acquisition

All in the associate agreement without having to draft all of the other documents right now.  That way if the deal doesn't go forward, you don't spend the extra money on the details contained in all of those other documents.

Went ahead and attained an appraisal. I'm meeting with the sales broker/CPA to discuss the appraisal. What are some questions to ask him?

Tim Lott, Dental CPA 

It seems to me your questions will be driven by how that meeting goes and the information that gets presented. I don't know what questions I'm going to ask of a seller\broker re: their valuation or asking price until I've seen what they've done, how they did it, the information they used generate their report.

Once you see this you'll be in a better position to know what questions to ask I would think.

Good luck!

This first appeared on Dentaltown.