An Unusual Case; Being an associate in rural and remote Canada

Running a rural practice can yield some unusual experiences…as with this story about a client. He’s a dentist who owns a practice in rural Canada, and he called me this past October, very upset and frustrated.

A recent graduate joined his practice in June of 2012. Due to a number of mitigating factors, there was a substantial backlog of dentistry to be done, and this recent graduate, who was very young, ambitious and capable, stepped in and produced extremely high production figures in a short period of time.

Essentially, this dentist, in a four-month period from June through September, produced $600,000 in gross income. This did not include the income generated by the hygienist. If we do the math, it’s simple. Based on $600,000 in fees with a commission rate of 50%, this new graduate earned approximately $300,000 in a four-month period.

Now, the story gets really interesting. In October, in more remote, rural Canadian settings, winter is fast approaching. The first snowfall is imminent. The nights are longer and days shorter. Sometimes a dark foreboding of what is to come sets into the minds of those not accustomed to northern climes.

At this time, this recent graduate approached the dentist owner and asked for a raise, from 50% to 60% commission. The owner refused to do so on the basis that they had only been working together for four months. As a result, the associate tendered his/her resignation.

This type of resignation is an extremely rare occurrence. I don’t know of any new graduates in the last three to five years who have generated $600,000 in four months of work because of a backlog of patients needing care—and then resigned.

There was no mistreatment here, no over-treatment—just much work to be done because of the remote location of the practice. The circumstances are clear: good insurance, good people, good industry, no other dentist there for some time, and my client who could not fully attend to the practice.

The result? An associate who basically stepped into a very lucrative work situation. Then, after tapping out four months of work, the associate wanted a raise. When the wner denied it, the associate tendered his/her resignation. Their agreement called for 60-days’ notice; instead, he/she gave two weeks’ notice and left.

My questions are:

• What does this tell us about today’s generation and today’s dental graduates?

• What does this tell us about their ability to enjoy the rural and remote sensibilities of Canada?

• How do we recruit these people?

• How do we retain these people?

Clearly, there was enough financial reward for the associate. There was enough work and the book is still full of many more months of procedures. My client is in a desperate situation; he needs to suddenly recruit again and he’s asked our firm to assist. It’s not an easy task. We anticipate weeks or months where there is no dentist in the office. We’re looking for locum dentists to cover in the interim, but patients will once again go unserved. Staff will go unpaid as no procedures will be performed. Staff will be sent home and the cycle will repeat itself.

To sum up, a new graduate makes $300,000 in 120 days and quits. Given that, how are we going to serve the future needs of the Canadian population if money is not enough of an incentive? I have concerns about the dental profession’s ability to manage the needs of rural and remote Canadians when money is clearly not enough. It’s a serious quandary and yet I seem to have no viable solutions. Do you?