Associate dentists leave their current practice for a variety of reasons, and occasionally this can be due to a breakdown in communication and issues surrounding working relationships within the practice. When an associate leaves a practice on bad terms this can be the catalyst for a burst of patient complaints. This scenario can be exacerbated if there is no agreement in place with the practice principal in relation to how to manage remedial treatment.
It is common practice for an agreed sum of money to be withheld by the principal for an agreed period of time when an associate leaves a practice, to allow minor problems to be resolved.
Case Study
The relationship between a principal and an associate had deteriorated to such an extent that the associate had left the practice.
The associate was clinically very competent and experienced, and had completed a number of challenging ‘tooth wear’ cases. One particular patient, Mr L, had been treated with composite build up restorations on numerous teeth to conservatively address his tooth wear and the finished result was satisfactory. Whilst the associate’s clinical records reflected the merits and limitations of composite resin versus porcelain restorations, there was no mention that further charges would apply for the maintenance and/or repair of these restorations. When Mr L required some fairly minimal general polishing of the composite restorations due to surface staining, he said he had not been informed that additional charges would apply and did not expect the owner of the practice to charge him for this treatment.
Mr L became upset when asked to pay for polishing the composites and raised the issue with the principal, who passed the complaint to his former associate. Although the associate had moved more than 70 miles away, he offered to review the patient and provide the necessary treatment at no cost, but the patient was unwilling to travel to see him.
This scenario was not an isolated example; it was a recurring story involving a number of patients who required similar maintenance work. Rather than completing this work as a gesture of goodwill to maintain the reputation of the practice, the principal encouraged every minor concern to develop into a complaint that required a formal response from the associate. The fact that the patients were being charged an over-inflated cost for maintenance treatment by the principal only added to the patients’ dissatisfaction.
The associate contacted Dental Protection and, with the benefit of hindsight, realised that he had not made it clear to Mr L – or to the other patients – that ongoing maintenance would be chargeable. He recognised that there had been no clarity regarding what aspects of the treatment were covered by the original fee and, as a result, patients had unilaterally made some assumptions.
Dental Protection advised the associate to talk to the principal and to try and come to an agreement, to avoid further incidents that could be harmful to both their reputations.
The associate and principal reached an agreement between them to cover the reasonable cost of post-treatment maintenance/polish appointments.
Learning points
- This case study demonstrates the importance of clear records and how beneficial it is to maintain a good relationship with colleagues.
- There should be a signed associate agreement that includes a clause regarding the retention of fees for remedial work when an associate leaves a practice. This avoids disputes and disagreements that may arise after the departure of an associate. These disputes are exaggerated where the working relationship has soured.
- When a dentist leaves a practice, inevitably there has to be a point where any further treatment provided by a subsequent clinician becomes chargeable. When planning treatment that which requires ongoing maintenance, clear explanations should be given to the patient and documented in the record. This should include an explicit statement as to what the initial fee includes and what charges may apply in the future. This should be set out clearly in writing for the patient and a copy retained in the records so everyone knows what to expect. If there are any queries after an associate has left, the principal and the new dentist have the necessary documentation to support future interventions and related charges.
- Financial disputes between the principal and an associate should be resolved between the two parties and not involve the patient. This aspect should be a ‘back office’ function and disputes should not be played out in front of the patient.