SUBJECTS AND METHODS

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The target sample consisted of 3,875 general dentists in the United States (250 from Idaho, 500 from Utah, 575 from Ohio and 2,550 from California). We sampled these four states because they represent the home states of the largest percentage of students attending the School of Dental Medicine at Case Western Reserve University, Cleveland. The sampling frame was a list of licensed dentists received from the licensing agency in each state. The number of dentists surveyed from each state represented approximately 10 percent of the general dentists in each state. Owing to the small number of female dentists in Utah (n = 74, 4.7 percent) and Idaho (n = 64, 9.0 percent), we stratified the samples in these states by sex. In Idaho and Utah, we included 100 percent of female dentists in the sample, and we chose the male dentists from these states via random sampling. We drew potential subjects in California and Ohio from a random sample of licensed general dentists (lists obtained from the State of California Department of Consumer Affairs, Sacramento, and the State Dental Board of Ohio).

The survey tool was a questionnaire consisting of 33 multiple-choice and short-answer questions. The authors developed the questionnaire and pilot-tested it with a small number of general practitioners before mailing it. Questions addressed specifics of the dentists’ practice, their preferred strategies for financially incorporating associates into their practices, and the characteristics they found desirable in new associates. Three weeks after mailing the survey, we sent dentists a postcard to encourage them to send in their surveys. We completed data collection after 12 weeks. One of us (M.C.H.) performed the data entry and analysis by using statistical software (Statistical Package for Social Sciences 13.0 for Windows, SPSS, Chicago). The analysis consisted of univariate and bivariate statistics.

	RESULTS

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The response rate was 27.1 percent for Ohio, 24.4 percent for Idaho, 22.2 percent for Utah and 9.6 percent for California, for an overall response rate of 14.8 percent. The low response rate from California was due in part to an outdated list of dentists received from the State of California Department of Consumer Affairs that we found to be faulty only after we had completed data collection. Fourteen percent of respondents (n = 16) from Utah were female, though only 4.7 percent of all dentists in Utah are female. In Idaho, 6.6 percent of respondents (n = 4) were female, though they make up approximately 9 percent of all dentists in the state. Thirteen percent of respondents (n = 20) from Ohio and 24.4 percent of respondents (n = 60) from California were female, and these frequencies reflect the percentage of female dentists in each state.

Respondents’ practices treated an average of 26.6 patients per day, and generally they consisted of one dentist/owner, one dental hygienist, two assistants and two general office staff members. Table 1 provides demographic data about the dentists and practices included in this survey.

Although only 178 respondents (31 percent) reported that they currently were considering hiring an associate, we asked all respondents to answer the entire questionnaire on the basis of their attitudes and opinions. Our item-by-item comparison of responses and demographic data between those currently considering hiring a dental associate and those not currently considering hiring an associate did not reveal any significant differences. In addition, when we compared the responses of dentists who reported that they never had hired an associate with those of dentists who reported that they had hired at least one associate, we found no significant differences. Therefore, we combined the responses for analysis.

As shown in Table 2, respondents varied in the reasons they gave for wanting to hire an associate. Many respondents gave more than one reason for wanting to hire an associate, and the diversity of responses in general suggests that associate dentists may fill a number of roles in a practice depending on the goals of the principal dentist.

Table 2 also shows respondents’ preferences with regard to hiring an associate based on sex. Male dentists were significantly more likely to prefer to hire a male associate, and female dentists were significantly more likely to prefer to hire a female associate (² = 59.98, P < .001). Among male respondents who reported having a preference, 97 (88.2 percent) preferred to hire a man and only 13 (11.8 percent) preferred to hire a woman. Among female respondents who reported having a preference, 26 (81.3 percent) preferred to hire a woman compared with six (18.8 percent) who preferred to hire a man.

The survey results showed a wide variation in the number of years of experience that respondents preferred for associates. These results suggest that opportunities are available for associates with varying levels of experience.

Many respondents preferred to hire an associate with postgraduate training (Table 2). They also indicated a preference for hiring associates with training similar to that of their own. Respondents who had completed a General Practice Residency (GPR) themselves were significantly more likely to report that they preferred an associate who also had completed a GPR than were respondents who had not completed a GPR (² = 63.9, P < .001). Respondents who had completed an Advanced Education in General Dentistry (AEGD) program also were significantly more likely to report that they preferred associates who had completed an AEGD program (² = 26.5, P < .001). Similarly, respondents with military experience were significantly more likely to report that they preferred associates with military experience (² = 75.9, P < .001).

As shown in Table 2, respondents also varied in their expectations regarding supervision of new associates. Though respondents did indicate their preferences with regard to training and experience level of new associates, these characteristics do not appear to be as important as a new associate’s ability to integrate himself or herself into the practice and interact effectively with patients and staff members. To assess the relative importance of a number of factors related to hiring associates, we asked participants to rank 10 factors on the basis of how influential each would be in guiding their choice of associate (1 = most influential). Respondents ranked "personality type" highest (mean rank, 1.6), followed by "years of experience" (3.7), "GPR/AEGD" (4.8), "personal acquaintance" (5.1), "age" (5.4), "dental school attended" (5.8), "sex" (6.5), "military service" (6.5), "religion" (7.6) and "other" (8.8) (Table 3).

	DISCUSSION

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The variation in respondents’ preferences with regard to hiring an associate reflects the variety of roles an associate may serve in a practice. This also suggests that respondents’ expectations with regard to associates’ long-term commitment vary, as some dentists are looking for associates who will remain with the practice over the long term and eventually buy the practice, while others simply are seeking to expand their patient load or lighten their workload. Similarly, dentists’ responses varied considerably regarding the degree of supervision they intended to provide and the years of experience they were looking for in potential associates. For new job-seeking dentists, it seems prudent to clarify these expectations with the principal dentist during the interviewing process, as a misunderstanding could lead to an unhappy working relationship.

Compensation. Although payment packages for new associates vary according to type and amount, the results of our study indicate that the majority of new associates would be offered less than $100,000 annually in salary, or would receive 30 to 40 percent of the practice’s net/gross income as their compensation. Compensation packages also often involved a combination of salary and percentage of net/gross income, but these packages varied widely in type and amount. On the basis of the results of this survey, we believe that new associates should assess compensation packages in terms of both the cost of living in that location and the total value before accepting an offer.

In the job market for associates, it appears that dentists often seek out those whose experiences are similar to their own.

In the job market for associates, it appears that dentists often seek out those whose experiences are similar to their own. Although the majority of dentists in this sample did not report having a hiring preference for a male or female associate, among those who did indicate a preference, male dentists preferred male associates and female dentists preferred female associates. Both job-seeking associates and hiring dentists should keep in mind that federal law prohibits discriminating against potential employees on the basis of sex, and they should educate themselves about these laws.⁹

GPR and AEGD. Though a significant percentage of respondents (41.5 percent) preferred associates with a GPR, they did not represent the majority of respondents. These results suggest that postgraduate training could improve a new dentist’s hiring potential with some dentists, but it is not a prerequisite. However, those dentists who completed a GPR, an AEGD program or military service themselves were significantly more likely to prefer an associate who had their training experience than were those without that experience.

Interpersonal skills. Perhaps the most interesting results of this survey pertain to the respondents’ evaluations of the relative importance of various types of training and demographic and personality characteristics in hiring an associate. While respondents considered new dentists’ practice skills to be important, they were most concerned that a new associate have a pleasant personality and be able to interact well with patients, staff members and the principal dentist (Tables 3 and 4). Considering the small size of many private dental practices and the intimate working relationships involved, it seems logical that effective relationships would be highly important to dentists interested in expanding their staff.

This theme also is expressed in the literature^10,11 advising family practice physicians about strategies for bringing in new partners. Physicians are advised to consider carefully not only the prospective partner’s resume, but also his or her personal compatibility with other physicians and staff members in the practice.^10,11 In general dentistry, this emphasis likely reflects the amount of personal investment many dentists have in their practices and the value they place on running their own business and working independently. The literature advising dentists about ways to manage associates suggests that the relationship between the principal dentist and the associate is not without financial, practical or personal challenges.^2,5 That said, it appears that regardless of an associate’s level of experience or postgraduate training, for new dentists with good technical and interpersonal skills, there are diverse opportunities to work as an associate.

Study limitations. This survey had a number of limitations. These results may not be generalizable to the population of dentists in the United States, because we drew the sample intentionally from only four states and the response rate was low, in part owing to a poor sampling frame from California. These data also are subject to response bias, with dentists who were interested in hiring an associate or who had experience with hiring an associate being more likely to respond. Though this bias is evident in comparison with national data regarding the prevalence of associate positions, two-thirds of our sample reported that they had never hired an associate, and we found no differences between respondents who had and had not employed an associate.

	CONCLUSION

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For new dentists interested in attaining an associate position, it is of utmost importance to identify the characteristics that practices’ principal dentists prefer in a potential associate. Furthermore, by identifying important characteristics of the principal dentist, the new dentist can better predict if he or she will be compatible. With the wide variation in characteristics preferred by dentist/owners, we believe that diverse associate positions are available for new dentists, especially those who exhibit strong interpersonal skills.