Why Most Dental Practice Associateships Fail

dental mold with braces

Of all the dental practice transition options, associateships have the highest failure rate. A natural first thought is to bring on an associate with plans to buy it at a later date out at a later date, but the numbers prove otherwise. When a practice simply brings on an associate with eventual plans to transition the practice at a later date, the results are predictable—a 20% success rate, in fact. So why do dentists continue to go this route? We break down the logic behind selling your dental practice to an associate.

The thinking

Bringing on an associate is about more than creating a plan to sell the practice to them in the future. Instead, a doctor wants to focus on increasing production. One way to get the most out of their space is by bringing an additional doctor in house. Another common reason to add an associate is because the doctor may want to lighten their load if they’re booking out for months. This can help relieve the bottleneck. 

The downside is that, if an associate is at the practice for a while, they begin to have patients on their calendar for weeks — even months — to come. When that happens, the associateship (predictably) doesn’t work and the practice will have an even bigger bottleneck and unhappy patients. 

Like in both of these examples, associateships are rarely successful since not everything is agreed upon from the outset and different expectations not being met by both parties. In a retirement situation, the retiring dentist brings on an associate to pick up managerial responsibilities to help ease the transition, and that’s why developing a transition roadmap is important to make sure it’s a successful transition. 

The roadmap to any dental practice transition can take many forms, but it starts by getting it in writing. By outlining all the details prior to the date of purchase, the process will be painless when it comes time to finally buy in. Conversely, the current owner should also have a writing plan in regard to scaling back their liability and chance the associate leaves because their expectations are being met.

Then, plan your timeline — and take your time. Part of the written outline should include when and how the buy-in will happen. The timeline could require the associate staying at the practice for a certain number of years before buying it or it could be set by predetermined growth benchmarks. Since the associate-to-buy-in plan takes a few years, it also gives all parties time to figure out their compatibility and working relationship. At the end, mapping out your timeline lets all doctors exit gracefully and with little financial impact.

Most importantly, before starting the associate-to-buy-in process, it’s essential to complete a practice valuation so you have a better understanding of the amount of growth the associate is responsible for to ensure the associate isn’t paying for their contribution to the increased value of the practice. A second valuation is also recommended on the day of the transition. The two valuations are averages so the associate doesn’t pay double for the work they’ve done and the seller is compensated for the risk of having a high-priced employee on board.

The numbers

Who better to sell to than someone you’re already working with? Most dentists take on an associate in hopes of potentially selling the practice in the future, so keep that in mind when looking for an associateship, while also taking into account the cost of acquiring a practice and the overhead of running a business. After the cost of acquiring a practice and the overhead of running a business, taking on an associate is typically not an affordable option. If going this route, make sure there’s a contractual “out” should the match not be a good fit so no time or money is wasted.

The timeline

Selling a dental practice to an associate typically takes around three to four years. On paper, taking on an associate is normally the fastest route as there are often a lot of prospects; however, with a one-in-five success rate, timing can be unpredictable in finding the best match for your dental practice. 

The buyer

While taking on an associate is risky from an owner’s perspective, it makes sense at times for a fledgling dentist to get their feet on the ground. With this option, you are working for a person or a DSO as an employee without an ownership benefit or management responsibility. This allows the associate to relocate or move among practices with ease and little stress since there is no real commitment on their end.

Another perspective to keep in mind as an associate is how the buyout price could change over time. Bringing in an associate should make the practice more successful because they’re able to increase production, collections and more. That said, they’ll likely be buying into the practice at a higher rate than they would if they would’ve developed a roadmap when the associateship began.

The truth

Associates typically only last two years at most because of unset expectations in regard to patient assignment, salary, and timeframe for branching out and buy-in related to value, purchase price, and buy-in/buy-out terms. It’s also worth noting associates don’t receive the same type of tax advantages as the practice owner.

The current state

Now more than ever, dentists are in high demand, particularly associates in private practices and dentists in dental service organizations (DSOs), many of whom suffered income reductions or layoffs during the pandemic. Similarly, with increased hours from those who kept their jobs and a high rate of burnout because of the demands brought on by the pandemic, many independent dentists are turning toward DSOs to reduce management stress or pre-retirement associateships to continue earning.

The alternative

Once upon a time, the only options for transitioning out of a dental practice were to sell to another dentist or close its doors. But today, there are a lot of alternatives with higher success rates, such as partnering with a DSO or selling to an individual or a DSO. 

Bottom line

Selling to an associate can be profitable when making an informed decision based on facts. See if bringing in an associate makes the most sense for your practice, your staff and patients or if there’s a better option that will benefit you and your practice in the long run. Contact the professionals at Professional Transition Strategies to figure out which route makes the most sense for your dental practice.

What to Consider Before Selling Your Dental Practice

Deciding to sell your dental practice can arguably be the most challenging step in the transition process. With the right team of advisors in place, it can be a financially and emotionally fulfilling experience. But where do you start, and how is the value of your dental practice determined? Whether you’re ready to begin planning your transition strategy or you want to learn more about your options, it’s important to understand what impacts the sale of your dental practice. Here are the top five considerations before selling your dental practice.

Know the facts

It’s easy to talk in hypotheticals when thinking of selling your dental practice, but there are a lot of considerations to get on your radar sooner rather than later. You’ll want all the information available to make the best decision for your dental practice. 

Before entertaining offers, you’ll need to have a prospectus in place for both an individual buyer and a group to assess the fair market value of your dental practice as this can vary based on a range of factors. A prospectus includes practice and patient demographics, practice location, staff, insurance, facility, equipment, production summary by category, financial analysis, practice valuation and return on investment

This will help determine if your practice is healthy enough to bring on a partner, whether you should consider affiliating with a dental service organization (DSO), or if you need to make some drastic changes so your practice is more appealing to potential buyers. The most common transitions include:

  • Buy-out: Purchasers buy a practice within a relatively short time period. On average, this takes about three to six months and is the quickest transition route.
  • Buy-in: A specific buyer purchases a defined portion of the dental practice. This is a longer-term approach that can expand the value of your practice over time.
  • Affiliation: You sell a percentage of your business to another entity, typically a DSO, with the intent to slowly transition out of the practice and give up clinical control to the group. This is an excellent way to maximize the practice’s value.
  • Associate to buy-in: A group of associates will court a potential buyer to purchase over a period of time. This process ensures compatibility and a smooth transition to map out the future of the practice. Division of power is the biggest decision that needs to be made with this method. While this is the longest approach — taking at least five years — it’s also the most flexible.
  • Associateship: Yes, you can sell to associates while maintaining full control, but in this method, not everything is agreed upon upfront, leading to a mere 20% success rate.  
  • Merger: Two existing dental practices combine into one entity, and owners often stay on as equal partners after merging. Mergers offer great benefits, like the net income remaining constant or even increasing because there is no loss of business.
  • Roll-up: You purchase multiple dental practices and combine them under one entity to maximize economies of scale. This can boost the value of your practice when it’s time to sell. A roll-up transition is the most lucrative if you have the time and capital to dedicate to this plan.

Make a plan

No matter the reason for your transition, starting the process as early as five years out will give you ample time to identify and make changes to your dental practice to improve the valuation. A good broker will make suggestions on how to amplify your marketing efforts, increase production, and streamline costs and efficiency, including dental supplies, lab costs and even payroll in an effort to increase profitability

Starting the transition process early also gives you the flexibility to be more discerning with the offers you receive. If you’re in a pinch to sell your practice, you may be forced to take one of the first offers and leave money on the table. Being in the driver’s seat of the sale affords you the time to evaluate offers and choose the best one for you, your staff, and your practice, as well as making your practice more attractive to DSOs looking for an affiliation.  

Stay the course

Maintaining your production is one of the best things you can do to obtain the highest valuation possible for your practice because the financials from the most recent years will weigh the heaviest when determining the practice’s value. Slowing down your production can have a massive impact on the price you can get for the practice.

The same holds true for your practice’s specialty. Gearing up for a transition is not the time to focus on a new niche specialty or even make the move toward a multispecialty practice. By opening the practice up to a new specialty — like going from a general practice to a periodontics practice — you decrease the potential buyer pool, which can negatively impact your sale options.

Keep an open mind

Thirty years ago, one of the only transition options was taking on an associate who would hopefully buy your dental practice one day, but today, there are so many more possibilities. Working with a qualified broker will only open your eyes to a dental practice transition you might not have otherwise considered. 

Your options are really only limited by your imagination. Do you want to start the process early so you can affiliate with a DSO before you retire? Or are you ready to get out of the business with a buy-out option so you can move into the next phase of your life? Asking yourself these questions and more will help you narrow down your choices so you can better prepare for the next steps. 

What’s next?

Contact the experts at Professional Transition Strategies to get the ball rolling on the sale of your dental practice.

5 Steps to Selling a Dental Practice

dentist office

Are you thinking of selling a dental practice? If so, you’re likely wondering how long it will take. You have put a lot of time, sweat and tears into building a successful practice. The fact that you are considering selling it can take a mental and physical toll. To prepare for your upcoming transition, here are five things you should know.

Start planning your dental practice transition early

One of the best pieces of advice is to start planning early. Planning early allows you more options than if you wait until the year you are ready to move on. These options are not only the type of transition you go with, but also which offers you consider. If you wait until the last minute to transition out of your practice, you may be stuck taking the first offer you receive. By starting early, you can be more discerning about offers that come in and move forward with the one with which you feel most comfortable.

Starting early gives you time to consider different transition styles. If your practice is large enough, you can sell half of your practice to a partner and continue to work for a few more years. When you determine the time is right, you can then sell the other half to either your current partner or someone else.

Getting a head start also allows you to consider affiliating with a dental service organization (DSO), which you most likely wouldn’t be able to if you needed to get out immediately. The reason for this is that DSOs tend to request the current doctor stay on for about two years.

By starting early, you can determine if you are happy with the value of the practice or if you need to get more out of it to clear any debts. This knowledge can help guide you when determining if you need a few more years to build up the value of your practice before taking that next step.

A transition period is a period between two transition periods. – George Stigler

Know the facts

Instead of living in the hypothetical, know your reality. Too many times, one can plan for a transition without knowing the facts. “Ignoring facts does not make them go away,” as businessman and Hall of Fame quarterback Fran Tarkenton once said. (1) It’s important to have a prospectus in place when determining the right transition type for you and your practice. By understanding the fair market value of your practice, you will know if your practice is healthy enough to bring on a partner, whether you should consider affiliating with a DSO or if you need to make some drastic changes so your practice is more appealing to a potential buyer.

To take this deep dive into your practice, look to a professional to create a prospectus. The knowledgeable experts at Professional Transition Strategies (PTS) will create a prospectus for you at no cost or obligation to work with us. We do this because we believe it is important to practice what we preach: Know the facts before you make any decisions.

The prospectus includes but is not limited to:

  • Practice demographics
  • Practice location
  • Patient demographics
  • Staff
  • Insurance
  • Facility
  • Equipment
  • Production summary by category
  • Financial analysis
  • Practice valuation
  • Return on investment

Don’t let the value of your dental practice drop

A common mistake made by dentists and dental specialists throughout the country is to let the value of their practice drop leading up to a transition. This honest mistake happens when doctors decide they are ready to scale back but they aren’t ready to “hang up their hat” just yet. By cutting back their schedules, only taking certain cases, reducing their hygienists’ hours, etc., they inevitably see their production and collections decrease.

Considering a practice’s value heavily depends on the average of the last three years. With the most recent year receiving the most weight, this reduction will result in a significant drop in value. As investor Warren Buffett once said, “Price is what you pay. Value is what you get.” (2) As much as one would like the practice’s value to be based on the “potential,” the truth is that a bank won’t lend on the hypothetical. Therefore, it is imperative to consider your plans before cutting back, because “cutting back” can dramatically cut the value of your practice.

Know your transition options

Without knowing all your options, how can you possibly choose the right one? One size does not fit all when you’re selling a dental practice. You cannot know you made the right decision without knowing the available options. Once upon a time, a dentist’s only options when transitioning a practice was to either sell to another doctor or close the doors. Times have changed. A dentist or dental specialist now has several options.

The most common transition types include:

Speak with a dental transition expert to determine the best plan for you and your practice.

How long will it take to sell my dental practice?

The most common question leading up to a transition is, “How long will it take to sell my dental practice?” Many factors can help gauge how long your practice will be on the market. One that will play a major role is the location of your practice. Is your practice in a metropolitan area? Is it in a rural community? Is your practice in a desirable area of the city? While it can’t be said for all practices, the offices positioned in “hot spots” of the country — such as Austin, San Diego or Denver — will move faster than those based in a smaller, more rural area. Sales can be as short as 22 days from the day your practice goes on the market to the day it closes or as long as two to five years.

Another variable that will play a part in how long it takes to sell your practice is your practice size. Practices valued between $750,000 and $1.2 million tend to be a sweet spot for most buyers. Practices collecting less tend to sit on the market longer. The reason is that smaller practices mean less revenue for the incoming doctor. This is especially true if the buyer is still paying off student debt.

What is a dental practice broker?

A dental practice broker has undergone training that makes them an expert in taking you through a dental practice transition. A factor in how long a practice takes to sell is the experience and knowledge of your broker. To ensure you are in the best hands, you should hire a broker who is familiar with practices like yours. This does not mean practices in your city, town or even state. It is more important that your broker has worked with practices of your size and in the transition capacity you are looking for — affiliating with a DSO, partnerships, straight buy-outs or even partnering with a private equity firm.

It’s also important to make sure your broker “pounds the pavement” on your behalf and be active when it comes to finding the right buyer. All too often, practice transition brokers post a marketing description on a few websites, sit back and wait for calls to come in. Work with someone like PTS that takes a proactive approach to finding the right fit for your practice.

What’s next?

If you are considering the possibility of selling a dental practice, contact the team at PTS. We will answer any questions and help prepare you in this exciting new stage of your life.


How to Roadmap an Associate-to-Buy-In Dental Practice Transition

dentist working on patient

The roadmap to any dental practice transition can take many forms. In the case of an associate-to-buy-in strategy, a potential buyer is courted by a group of associates to buy in over a period of time to ensure compatibility and allow time to figure out the future of the practice rather than deciding from the outset. Here’s how to get the ball rolling.

Get it in writing

If ownership is your goal when starting as an associate within a practice, a written plan or roadmap should be in place from the start of employment to limit the amount of gray area. By having everything outlined and in writing prior to the date of purchase, the process will be seamless and effortless when the time comes to officially buy in. Likewise, the current owner should also have a written plan to limit their liability and chance that the associate leaves because their expectations are not being met.

Take your time

While this transition is the longest approach, lasting at least five years, it is the most flexible as long as the division of power is taken into consideration. This allows time for all parties to figure out their compatibility and working relationships, as well as for both the seller and the potential buyer as all the contracts are agreed upon at the start as is the timeframe for the transition. Many times, the contracts can be signed before as well so that the deal is “essentially done” even though it may be a year or more before the transaction actually consummates.

Plan your timeline

Part of your outline should include when and how the buy-in will occur. With a roadmap, there can be a certain amount of years the doctor will be an associate before buying in or it can depend on predetermined growth benchmarks. Either way, exit strategies should also be included so that all doctors are able to exit gracefully and with little financial impact.

Know your worth

Completing a practice valuation from the start will only provide a better understanding of the amount of growth the associate is responsible for to ensure the associate is not paying for their contribution to the increased value of the practice. A second valuation is often then conducted on the day of the transition, and the two valuations are averaged so that the associate does not “double pay” for the work they have done and the seller is compensated for the risk of having a high-priced employee on board.

What’s next?

Read more about the associate-to-buy-in roadmap in the e-book “Strategies for Transition,” then contact the experts at Professional Transition Strategies to put your steps in place.

6 Perks of Buying a Rural Dental Practice

Colorado landscape

When buying or starting a dental practice, it’s easy to be drawn toward big-city or metropolitan areas. After all, more people equals more money, right? Not necessarily. One in 10 dentists practices outside of a 30-minute radius from a large city, and for good reason. Here are some perks worth considering if you’re in the market.

More complex cases

For better or worse, rural towns tend to have more complex cases. That is, dentists trend toward seeing more restorative work versus preventative treatment, similar dental procedures to that of urban practices, such as dentures, crowns, bridges, onlays, inlays and dental implants.

More patient demand

Statistically, less competition as fewer dentists are gravitating toward major cities and suburban areas means more patient demand, which equates to a better financial outcome in the long run for the practicing dentist.

More economic and buy-in opportunities

Established practices in rural areas offer more economic and buy-in opportunities simply because existing clinicians are doing well financially and, therefore, don’t have to put off retirement. Similarly, while many young graduates are having a harder time finding associate-to-buy-in opportunities, less competition means more economic opportunities.

Accelerated loan forgiveness

In areas with dental shortages, some states offer accelerated loan forgiveness based on the number of years a doctor practices in a shortage area. What’s more, in reducing your debt, you’ll be able to purchase a practice in a less-competitive market at a competitive price, resulting in a better return on your investment.

Lower overhead, higher net profit

Lower cost of labor, lower occupancy costs, lower rent and office costs, lower housing, and comparable dentistry fees to urban areas all contribute to lower overhead costs, which, in turn, results in a higher net profit for the practicing dentist. And, contrary to popular belief, most rural or small-town practices have updated facilities and high-end equipment.

Better goodwill

It’s no surprise that smaller towns come with a slower pace, allowing you to build a stronger connection with your patients that then translates into goodwill for your practice in the community while also significantly increasing your level of job satisfaction.

What’s next?

Read more about the buying process in the e-book “Transitions: Your Next Adventure Awaits,” then contact the experts at Professional Transition Strategies to find a rural dental practice for sale in your area.

7 Types of Dental Practice Transitions

dental mold

By now, you’ve probably already decided that selling your practice is the best option, whether it’s for retirement or managerial purposes. But maybe you don’t know or haven’t started exploring all your options yet. Here, we break down the types of dental practice transitions in an effort to help you figure out which is best for you and your business.


buy-out is exactly what it sounds like: when a purchaser buys your practice for a negotiated price. A relatively short transition period that typically only lasts three months is ideal for a prospective retiree. The seller may agree to stay on part-time to help ease the transition for the buyer, employees and patients.


A buy-in is the opposite of a buy-out in which a specific buyer purchases a defined portion of the practice for a negotiated amount determined at the outset. In this case, a professional dental practice broker will also perform a personality profile to ensure compatibility, in addition to a practice analysis.

Associate to buy-in

Here, a potential buyer is courted by a group of associates to buy-in over a defined period of time, road-mapping the ease of transition. Rather than making decisions about the future of the practice upfront, this allows time to assess compatibility; however, the division of power is the biggest consideration to make.


A good idea in theory because associates are easy to find, and this route allows you to maintain full control over the transition; however, associateships are typically only 20% effective due to not everything being agreed upon from the outset and different expectations not being met by both parties.


Combining two dental practices to become one entity with equal partnership remains a tried-and-true method as long as compatibility is established upfront and responsibilities and income are equally divided and agreed upon.


This option is one that pays off in the future under the economies-of-scale principle: Multiple dental practices are purchased over a period of time to combine into one entity, which will then sell for a higher value at a later date.


The slowest of the transition options, this option hands over the majority of the practice to a larger entity, typically a dental service organization (DSO) or a group, with the purpose of slowly transitioning out of your practice to and giving up clinical control to the buyer.

What’s next?

Read more about your options in our e-book “Strategies for Transition,” then reach out to the experts at Professional Transition Strategies to figure out which makes the most sense for you and the future of your practice.

Should I Sell My Dental Practice?

dental practice chairs

“Should I sell my dental practice?” This is a question most practice owners come across at some point in their careers. Considering selling your practice can be stressful, especially if you don’t have all of the information you need. At Professional Transition Strategies (PTS), we are here to provide you with that information and guide you through your transition. Here are some common questions asked and answered. Continue reading “Should I Sell My Dental Practice?”

What You Need to Know About Dental Practice Transitions

dentist chair

Transitioning a dental practice is an intricate process and can seem overwhelming if you are approaching or going through the process. Not only does transitioning a dental practice include financial challenges, but emotional and relational ones, as well. We at Professional Transition Strategies (PTS) can help you navigate this process because we have been through it before. We realize every situation is unique, but we also recognize there are many steps to go through to successfully transition a practice. Here’s an outline to get you started. Continue reading “What You Need to Know About Dental Practice Transitions”