Having been a principal dentist for a few years now, I look back at my time as an associate and begin to realise that life was not as bad then as I had thought it was. I was always planning to be an owner of a dental practice, even before I went to dental school. My dream was to own a practice and be in charge of my own destiny at the same time as caring for my patients.
Life as a principal does not come straight after graduation though and the route of vocational trainee to associate normally precedes this. Looking back at life as an associate I remember debating with principals in practice, in seminars, in British Dental Association meetings and online forums about the value of associates and how they were poorly treated. How principals did not appreciate their value in practice and how they had forgotten what life was like as an associate as memories of this experience dim with the passage of time.
Looking back at my time as an associate, I feel that I can appreciate both sides better now. I never understood why one of my principals did not pay very much in wages and let nurses go all too easily. Although I like to think I pay my staff considerably better wages than this principal did, I am more aware of how much of the practice costs are consumed by staff salaries. My former principal ran a multi-surgery, mainly National Health Service, practice with associates who did not gross very large fees so I can now appreciate why he had to be so careful with wages. I used to find it amusing when principals got irritated when radios were left on at lunch time when no one was listening or that lights were left on unnecessarily. While I partially understood their frustration, it is only now that I have to pay the bills myself that I understand where they were coming from.
There may always be an element of tension in the relationship between principals and associates but, on the whole, this symbiotic partnership works well for both parties but will that still be the case in the future, particularly in this still relatively new commissioning environment?
With the pressure on PCTs to reduce costs and achieve greater value for money, this may have a significant impact on the value of new dental contracts offered – with lower contract values, and tough key performance indicators linked to access contracts. Inevitably, this is likely to result in less money for principals with the obvious knock on effect for associates.
As practice owners also have to factor in the rising cost of dental materials as well as costs linked to the tougher regulatory environment in which we have to operate (such as HTM 01-05 and the Care Quality Commission), the pressure is on to reduce costs further by squeezing associates’ fees. In addition, the pressure placed on associates by principals to gross high figures will, I feel, only increase in future to ensure practice profitability. The demands on associates to achieve agreed UDA targets will multiply as claw backs by PCTs due to failure to achieve targets could potentially lead to financial ruin.
It is dispiriting to hear from other dentists that they do not use rotary endodontic files on the NHS as the figures do not stack up. Even worse is when I hear of dentists refusing to do any endodontics on the NHS as low UDA values cannot not sustain such treatments.
The pressure placed on practices to keep their heads above water in these uncertain times is intense. The NHS keeps demanding more for less - in NHS speak they call it ‘value for money’. In my view, their approach will achieve less for less and but not value for money. Until the policy makers realise this, there will be more tussles between associates and principals.