Many dental practice owners hire associates to add capacity, but few ever consider an associate running the clinical day in their own practice while they keep ownership. Dr. MaryJane Hanlon never considered it for her own practice, even after building one that could run without her, yet she has also served as clinical director across six Tennessee practices owned by a single entity, where associates led the clinical day and their teams under shared protocols. This article explains why owners overlook the option, drawing on the status-quo trap described in Harvard Business Review and John Warrillow's test of whether work is teachable; what makes the associate model work, including protocols and an owner's mindset in the chair; and how to use the Ready question of The Succession Filter™ to judge whether your practice could run with someone else in your chair.
Introduction
When I sold my practice, I never once considered keeping it and putting an associate in my chair. It was not that I weighed the idea and turned it down. It never came up.
That is striking to me now, because I have seen the model work. As clinical director across six practices in Tennessee, all owned by a single entity, I worked with associates who ran the clinical day and led their teams every day. The owner was not in the chair, and the practices ran.
So this week's dental question is a personal one for me. Why do so few owners put an associate in their own chair, and what would it take to do it well?
Key Takeaways
• In my experience, many owners hire associates for extra capacity, but few consider an associate running the clinical day while they keep ownership.
• The status-quo trap makes the owner-in-the-chair model feel like the only one, even when the practice could support another.
• The associate model works when there are clear protocols and associates are expected to lead, not just treat.
• The single most important quality in the chair is an owner's mindset, whoever owns the practice.
• The Ready question of The Succession Filter™ tells you whether the option is open to you.
The Option That Rarely Makes the List
Most owners picture two futures for their practice: they keep working in it, or they sell it. Associates appear in that picture as extra hands, someone to take overflow, cover a day, or eventually buy in. Very few owners picture an associate leading the clinical day in their own practice while they step back and keep owning it.
Part of the reason is identity. For many of us, being the dentist and being the owner were the same thing from the first day. The name on the door was the person in the chair.
Part of it is what decision researchers call the status-quo trap. John Hammond, Ralph Keeney, and Howard Raiffa described it in Harvard Business Review as a bias toward keeping the current situation even when better alternatives exist. If the owner has always been in the chair, the owner in the chair feels like the natural order, and every other arrangement feels like a risk.
And part of it is a fair worry about quality. If your patients chose you, will they accept someone else? If your standards are high, will an associate meet them?
What I Saw in Tennessee
The six practices I directed in Tennessee were all owned by one entity. The associates in those practices acted on behalf of that entity. Everyone was expected to follow the day-to-day protocols, and every associate was expected to lead their team to be as efficient and effective as they could be.
Not every associate led equally well. Efficiency and leadership strength were individual, and experience made a difference. Some practices needed more guidance from me than others. But the model held, because the protocols gave everyone the same standard to work to, and the expectations made leadership part of the job.
That is the part owners tend to miss. The model works when the practice has a standard that any capable clinician can be trained to, and an expectation that the person in the chair leads. Finding one perfect clinician was never the plan.
The Quality That Matters Most in the Chair
To this day, I have never worked in a practice where I did not treat it as if I owned it. I believe that is the single most important quality in whoever sits in the chair, whether they own the practice or not. Why? Because when you work like an owner, you are treating the patient at the highest level. Isn’t that the point?
The alternative is easy to fall into. Without an owner's mindset, it is easy to get comfortable, then lazy, then inefficient, and that affects both the health of the financial health of the practice and the care patients receive.
Here is the kind of thing I mean. I have worked alongside dentists who would only complete one filling per visit. Think about what that means for a patient with four restorations needed in the same quadrant: four separate appointments, four rounds of anesthetic in the same area, four trips to the office. Not to mention, four rounds of supplies and cost when there only needed to be one at the most, two. For the practice, it means four times the chair time, scheduling, and setup for work that could often be done in one visit. Nobody would design a practice to work that way. It happens when the person in the chair is not thinking like an owner.
So if you are considering an associate in your own chair, the first question is about mindset more than technique: will this person treat your practice as their own?
Is Your Clinical Day Teachable?
John Warrillow's Built to Sell offers a useful test for any business that wants to run without its owner. The work has to be teachable: written down clearly enough that someone else can learn it and deliver it consistently.
For a practice, that means asking honest questions about your own clinical day.
• Are your treatment standards written down, or do they live in your hands and your habits?
• Does your team know how you want the schedule built, how emergencies are handled, and how treatment is presented?
• Would a capable associate know what "the way we do things here" means by the end of their first week?
• Do your patients know your team as well as they know you?
• When a new team member joins, do they learn from a written standard or by shadowing you?
If most of those answers are no, an associate in your chair would be guessing, and you would be right to worry. The good news is that every one of those gaps can be closed while you are still in the chair, and closing them makes your own days easier long before anyone else sits there. If most are yes, the option is real, even if you never choose it.
What It Would Take
Putting an associate in your own chair comes at the end of the work that makes a practice ready for it.
1. Write down the clinical and operational protocols that make your practice what it is.
2. Make leadership part of the associate role, with clear expectations for leading the team.
3. Look for an owner's mindset as carefully as you look for clinical skill.
4. Expect to give more guidance to less experienced associates, as I did in Tennessee.
5. Change your own role from producer to director: setting the standard, developing the people, and watching the results.
Get advice from your attorney and accountant on the structure and agreements before you make any change. The arrangements for compensation, supervision, and patient records vary, and you want them right from the start.
Where the Ready Question Comes In
The first question of The Succession Filter™ is: Ready. Could this operate without me, and have I ever tested it? For a dental practice, the sharpest version of that question is whether the practice could run with someone else in your chair.
You may decide you never want that. Many owners love clinical dentistry and want to practice until the day they leave. Just make it a decision you actually make. I learned too late that it was an option I had never considered.
Final Thoughts
I built a practice that could have run without me, and I have directed practices where associates ran the day. Those two experiences never met when it came to my own practice.
Ask yourself this week: if a capable associate sat in your chair on Monday, would they know how your practice works and lead it the way you would? If the answer is no, you know what to build next.
Book Your Free Practice Efficiency Call
If you would like help seeing whether your practice could run with someone else in your chair, start with a free 30-minute Practice Efficiency Call. We will look at where the practice depends on you and where it is losing time or money. https://calendly.com/drmjhanlon/the-hanlon-group-consultation
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Yes, if the practice has clear protocols, leadership expectations for the associate and an owner who has moved into a directing role. Get legal and financial advice on the structure first, because requirements vary.
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Identity, habit and worry about quality. Many owners have always been both the dentist and the owner, and the status-quo trap described in Harvard Business Review makes the current arrangement feel like the only one.
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Clinical skill, leadership ability, and, above all, an owner's mindset, meaning someone who will treat the practice as their own.
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Its first question, Ready, asks whether your practice could operate without you. For a dental practice, that often means asking whether it could run with an associate in your chair.