by Dr. Tamara Jones

“I think I found a job!” I excitedly called my husband to announce the news. After 23 years of school and with graduation from residency around the corner, I was ecstatic about any job possibility. Thanks to amazing faculty, I graduated with the skills to provide my future patients excellent care – but with the inability to evaluate any employment opportunity.

I personally understand the challenges of finding employment opportunities in today’s tough dental economy. Over the last few years, I have developed a list of questions to ask/things to consider prior to working for a DSO, as an associate or as an independent contractor.

Things to Ask about Contracts

  • Did you review the contract?
  • Did you have a lawyer with knowledge of orthodontic practice read your contract?
  • Employee vs. independent contractor: Does your position actually qualify for 1099 independent contractor status (very few do)?
  • Term of contract: Does it auto-renew? How much notice is required to terminate the contract?
  • Is a non-compete part of your contract?
    • Is it realistic? (Length of time and location boundaries depends on the area.)
    • Non-solicitation: How is a referring dentist defined?
    • Does it apply only to offices where you work or to all offices of the DSO/practice?
    • Exclusivity: Can you work at another practice?
  • If there is no contract, is there excellent communication and mutual trust/respect between the two parties? (There should be.)

Important note: Remember that contracts are negotiable. 

Questions to Ask about Compensation
  • Is pay based on adjusted production or collections?
    • How is it calculated?
    • Can you audit it?
    • Is there a daily guarantee?
    • Are there a minimum number of days?
    • What financing charge (as a percentage) is taken out of production?
    • Who is paid: the doctor (personally) or the doctor’s corporation?
    • When/how is payment made?
    • Do you get any input on marketing discounts?
    • What is the practice’s collection rate (if dependent on collections)?
  • Are there expected quotas?
  • What benefits are offered?
    • Who pays AAO dues?
    • Who pays for malpractice insurance?
      • Will tail coverage be needed?
      • Will your malpractice carrier cover you at the job?
      • Does the DSO/owner have settlement rights for a case?
      • Did you verify the contract does not include an indemnification, or “hold harmless”, clause?
    • Are uniforms or uniform allowances provided?
    • Are license fees reimbursed?
    • Is CE (continuing education) offered?
  • Review of practice statistics: Does the practice have enough starts to support your expected salary?
Questions to Ask about the Job
  • What are the hours?
    • What is the policy for handling weekend/holiday emergencies?
    • What holidays are offered?
    • Expected work days/hours: Who can change them?
  • Can you take a leave of absence (maternity leave) if necessary?
    • Is your job held for you?
    • Are you paid during your leave?
    • What if there are complications?
  • How is staff managed?
    • Do you get any input on who is hired/fired as staff?
    • How much training does the staff have?
    • What duties are delegated to staff while you are working? Do you have a say?
    • What is the employee turnover rate?
  • What is the treatment philosophy?
    • What technology is available in the practice?
      • Does equipment function properly?
      • Are treatment philosophies similar (if more than one doctor)?
    • Do you have independent treatment plans/choice on treatment plan/authority on everything clinical?
  • How are patient complaints handled?
  • Are supplies provided?
    • Do you have any choice on supplies?
    • What is the availability of supplies?
  • How are terminations handled?
    • Does the employer pay unpaid collections after termination?
    • Is any payment due for unfinished patients?
    • Who can terminate and how much notice is required?
    • After you give notice, can the employer clear your schedule (so that you work for nothing)?
  • What are the practice’s insurance-related policies?
    • What insurances are contracted with and what are the fee schedules if pay is production-based?
    • Does the practice accept HMOs?
    • Do you have the ability to audit insurance filings under your name?
    • Do you need to complete a credentialing process with the insurance companies prior to seeing patients/starting a job?
  • Other questions to consider:
    • Do you have right-of-first-refusal to purchase the practice?
      • What is the buy-in provision?
    • How is the transition between doctors handled?
    • Who owns the records?
      • Who is responsible for storage?
      • Are you able to lock your records (ensure someone does not change them afterwards)?
    • Who pays Invisalign/lab fees? Who gets credit for the case/rebates?
    • What happens when a patient stops paying?
    • What is the payment status of current patients?
      • How many patients are past due?
      • What is the compensation policy for patients who are paid in full but still in treatment?

This list is not exhaustive and is not a replacement for professional legal or consultant expertise, but I hope it can be a valuable resource for any new orthodontist. As a final thought, I highly recommend getting the opinion of orthodontists you trust to help you evaluate any employment possibility. Every option has positives and negatives, but overall working as an orthodontist is a wonderful career! Good luck!

Dr. Tamara Jones, owner of Willow Bend Orthodontics in Plano, TX, is a Southwest Society of Orthodontists (SWSO) representative to the AAO’s Council on New and Younger Members (CONYM). She can be reached at