Lately, I have been writing about the special considerations involved in a practice transition where other dentists are family members. But not all "family" transitions feature relatives as primary parties in the transition.

One of the more common arrangements involves having an owner-doctor's spouse in an office administrator role. They assume duties such as bookkeeping, payroll and staffing, often with influence over things like calendaring and patient allocation.

 

This may not seem to be a big factor in a transition but there can be significant implications. If the senior doctor is exiting, the spouse will be going too, which means that there are two transitions taking place. This adds an extra challenge to the continuity of value since the patients are not only seeing a new doctor; they're also losing another familiar face in the practice.

If the senior doctor is not exiting but bringing aboard a new associate or partner, there are other delicate dynamics in play here. The spouse is naturally going to be protective of their value in the practice and there can be a tendency to dig in with a "that's the way we do things" mindset. For their part, a new dentist can be so concerned with the partisanship issue that they under-appreciate the dedication—the uncompensated discretionary energy—that a spouse often brings to this vital role in the practice.

This is where clarity and accountability come in, and it is up to the senior doctor to take a leadership role in establishing the rules of engagement. The incoming doctor should be given the opportunity to establish the right relationship with the spouse to ensure they are both comfortable with each other in a professional capacity. The new doctor should be satisfied that there is no conflict of interest or lack of trust, and that the spouse's responsibilities and compensation package are in line with market rates and fair to both parties.

This requires establishing clear guidelines around things like staffing support for each doctor, how existing patients will be allocated and which new patients go to which doctor. In some cases, I would even recommend that you allocate (or hire, if necessary) a front desk person who is dedicated to amplifying the new doctor's interests. Of course there will be crossover of duties and both advocates are ultimately concerned with the best interests of the patients and the practice; however, instituting this system of checks and balances can go a long way in alleviating any concerns a new provider might have and in forestalling any claims about partisan politics at the front desk.

Having a spouse in a special position of trust when it comes to the essentials of practice management can be very reassuring. The important thing is to ensure that any new dentist coming aboard feels that same level of trust in them.

The lesson here, as with any transition or any well-functioning team, is that establishing the right expectations up front and following up with regular communication is the key. Every practice will inevitably have interpersonal issues that arise; when spouses are involved those issues have the potential to become even more amplified. When you have relationships that are marked by personal and professional trust and open dialogue, every issue that arises is approached as a problem to be solved collaboratively, rather than nursed as a private grudge. When it comes to respect and personal flourishing among the members of your practice team, everyone is family.

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