Starting Your Career as a Dental Associate in Canada: Small Practice vs. Corporate Practice

When Dr. Dan Hwang graduated from the University of Toronto’s Faculty of Dentistry in 2002, he felt pressured to pay off his student debt. Pursuing an associateship was an attractive option as he was guaranteed an income, didn’t have to pay any upfront costs, and had the opportunity to sharpen the administrative and operational business skills required to open his own practice one day.

After working seven days a week at associateships in small and large practices and urban and rural settings, Dr. Hwang became a practice owner briefly before moving back to his native Ottawa to build Station Dental from scratch in 2009. Reflecting back on his journey, he says the most important criterion for dentists to consider when choosing an associateship is if it will help them grow.

“Young dentists need guidance to gain confidence in their decision-making and improve their systems for dental procedures,” says Dr. Hwang. “Having the right mentor is indispensable.”

Whether you choose an associateship at a small or corporate practice, both carry unique benefits. It’s important to consider the work environment of each practice and your long-term career goals before making a decision. Here’s a closer look to help you decide.

Benefits of small practice associateships

Consider the following benefits of joining a small practice associateship.

• No upfront costs: Joining a small practice usually doesn’t require any upfront costs, which is great news if you still carry student debts.

“Dental students today potentially graduate with over $300,000 in debt. This number is much higher if they pursue studies in another country,” says Dr. Hwang. “This is also two to three times higher than what it cost when I graduated.”

• Stable income: Small practices often already have an existing patient base, helping to ensure income and financial stability during the early stages of your career. And because their overhead costs are lower than those of larger corporate practices, they may also provide better compensation.
• Focus on clinical skills: Working in a small practice allows you to hone your clinical skills without worrying about managing the practice.
• Experienced staff support: Small practices usually have a team of well-trained and experienced staff who can support you and contribute to your professional development.
• Future opportunities: Joining a small practice as an associate can open doors for future opportunities. If that aligns with your long-term goals, you might become a partner or buy the practice someday.
• Community evaluation: You could be better positioned to evaluate the community in which you’ll practice, including patient demographics and the overall demand for dental services in that area.

Potential drawbacks of small practice associateships

Before signing an associateship agreement, make sure to read it carefully and negotiate any restrictive covenants that limit your ability to practice in the same area if you leave the practice. Here are some other potential drawbacks to consider:

• Location limitations: The location of a small practice may not always align with your desired lifestyle.
• Limited or non-flexible hours: Limited control over your working hours can affect your work-life balance. Consider whether the practice’s schedule aligns with your personal needs.
• Clinical limitations: Associates have limited control over a small practice’s overall management and decision-making processes. The principal dentist may impose clinical limitations, which might restrict your ability to practice in accordance with your preferred treatment philosophy.

Corporate practices

If you’re considering corporate practices, it’s important to know they can take many forms. Some individual dentists incorporate their practices for tax purposes, while larger dental corporations own multiple practices across a wide geographic area. Corporate dentistry may also involve centralizing management services through a dental management or dental service organization.

“With corporate practices, there is always that third party investor who has provided funding through private equity or shares acquisition and whose sole concern is their return on investment,” cautions Dr. Hwang. “So there may be more pressure on decision-making favouring improving the bottom line.”

Benefits of joining a corporate practice

Consider the following benefits of an associateship at a corporate practice.

• Structured environment: Corporate practices can offer more structured environments and working hours. They may also have centralized back-office functions such as human resources, supply ordering, and payroll that take care of your administrative tasks.
• Collaboration and support: You could have the opportunity to collaborate with colleagues, discuss treatment plans, and seek support from a network of professionals within the organization. This can foster camaraderie and provide a supportive environment for early-career dentists.
• Immediate income and benefits: Working in a corporate practice may come with a guaranteed income and benefits right from the start.
• Continuing education opportunities: Many corporate practices offer access to continuing education programs and resources, allowing you to expand your knowledge and skills.

Potential drawbacks of joining a corporate practice

Consider the following challenges to decide if a corporate practice is the right environment for you:

• Potential misalignment with patient care priorities: The corporation’s metrics (e.g., billings, number of patients treated, etc.) might differ from your personal philosophy of dental care.
• Potential conflicts: Corporate dentistry models may involve fee splitting or equity support with individuals not part of the regulated health professions.
• Regulatory challenges: Investors in the practice may not be healthcare professionals, potentially leading to a lack of familiarity with regulatory requirements, for example, compliance with the Health Information Act.

Whichever type of practice you choose, it’s important to understand its model and ensure it aligns with your lifestyle, values and goals.

“One corporate practice where I interviewed was only concerned with maximizing billings. I did not take that position,” says Dr. Hwang. “If I had to do it all over again, I would go with an office where the practice owner was present and who could mentor me to help me gain that valuable experience.”