Hiring an Associate & Dropping PPOs: Timing and Strategy

You've decided to bring on an associate—a major milestone for any practice. Now comes the critical question: should you drop PPO plans before or after hiring? This decision will shape your practice's profitability, your associate's job satisfaction, and your ability to attract top talent. Learn the strategic approach that maximizes benefits on both fronts.

The Challenge Most Dentists Face

Adding an associate creates a unique scenario. You're simultaneously trying to:

• Generate enough patient flow to keep two doctors busy (or busy enough)
• Reduce or eliminate insurance dependence
• Maintain financial stability during the transition
• Attract quality associate candidates

These goals can feel conflicting. Many dentists assume they should keep PPO plans active "just in case" they don't have enough patients to support an associate. But this reactive approach often backfires.

The Myth of Scarcity

Many practice owners operate from a scarcity mindset: "If I drop PPO plans, I won't have enough patients for my associate." This belief leads them to delay or avoid the transition entirely, keeping themselves trapped in the insurance system.

But consider the abundance mindset instead: "I have 100% confidence that I can attract enough patients interested in their health who would love to be part of this practice." This isn't just positive thinking—it's backed by data from hundreds of successful practices.

Why Drop PPO Plans BEFORE Hiring Your Associate

There are strategic, mathematical, and cultural reasons to make the PPO transition first:

Reason 1: Patient Flow Mathematics

Let's work through the numbers. Say you have 500 Delta patients, and Delta comprises 20% of your patient base. If you drop Delta, research across hundreds of practices shows you'll retain 85-90% of those patients. Using the conservative estimate:

Now, why handle this replacement before hiring an associate? Because you'll solve two problems simultaneously:

• You'll replace the patients you might lose from dropping the plan
• You'll generate the additional patient flow necessary to support your associate's schedule

This is a win-win: your associate arrives to a practice with abundant patient flow, not a struggling schedule.

Reason 2: Strategic Marketing Advantage

Robust digital marketing is essential to replacing patient flow from PPO plans. Rather than running marketing twice (once for the PPO drop, again for the associate arrival), do it once strategically.

Partner with a dental marketing firm that specializes in helping practices attract ideal patients. As this marketing ramps up and produces new patient growth, you're simultaneously preparing the practice to absorb an associate's schedule. By the time your associate starts, the machine is already running.

Reason 3: Making Your Practice Attractive to Associates

Here's a rarely discussed advantage: dropping PPO plans first makes your practice incredibly attractive to associate candidates.

The Unicorn Job Opportunity

When you search job boards for associateships, how many positions do you see offering fee-for-service arrangements? Almost none. Most listings describe PPO-dependent practices where new graduates can expect to:

• Work harder for less pay (PPO discounts of 40-50%)
• See more patients to reach income goals
• Experience lower job satisfaction
• Have limited autonomy in treatment planning

A fee-for-service practice offering an associateship is a "unicorn job"—it barely exists. When you can offer this, you attract the best talent in your region. Young dentists recognize quality practices that prioritize clinical excellence and patient relationships over insurance billing.

The Financial Reality for Associates

Consider this scenario:

On a $1,000 procedure, your associate makes 67% more in a fee-for-service practice than in a PPO network. Multiply that across 10 procedures daily, 5 days weekly, 50 weeks yearly. The income differential is massive—potentially $150,000+ annually.

Reason 4: Avoiding the Delta Premier Trap

There's an administrative nightmare you'll avoid by dropping plans first: the Delta Premier/PPO conflict.

Many established dentists grandfathered into Delta Premier status. But Delta no longer extends Premier status to newer graduates. This creates a mess:

• You: Delta Premier provider (negotiated reasonable fees)
• Your Associate: Delta PPO provider (45-50% discount)
• Result: Conflicting fee schedules, administrative confusion, and situations where you're forced to accept your associate's lower fees

When patient care splits between both of you on the same case, you're locked into the worse fee schedule. This scenario has blown up practices entirely.

By dropping PPO plans before hiring, you eliminate this problem entirely. Your associate enters a fee-for-service environment where such conflicts don't exist.

The Alternative Approach (And Its Complications)

What if you hire the associate first, then drop plans later?

It can work, but you're solving problems sequentially instead of simultaneously. You'll likely face:

• Associate retention challenges if they're unhappy with PPO fees
• Double marketing efforts (one for the associate, another for the PPO drop)
• Potential patient loss affecting your associate's schedule
• Missed opportunity to attract higher-quality candidates

The Fear That Stops Most Dentists

The biggest barrier to dropping PPO plans before hiring is fear: "I'll lose too many patients and won't have enough flow for my associate."

Let's address this directly:

The Data

Across hundreds of practices that have made this transition, patient loss from dropping PPO plans typically falls between 10-15%—not the 40-50% many fear. When practices do proper patient communication and maintain clinical quality, retention is surprisingly high.

The Solution

Patient loss is an "eminently solvable problem" through strategic marketing. When you partner with a dental marketing firm that specializes in practice growth, you shift from a scarcity mindset to an abundance mindset.

As one successful practice owner described it: "I feel like I have my hand on a marketing spigot. I can turn it up to get more new patients or turn it down to slow the flow. Whatever circumstances demand. That's not something I felt historically in my practice."

Creating an Abundant Practice Culture

Beyond the mathematics and strategy, there's a deeper principle at work: mindset.

From Scarcity to Abundance

Scarcity mindset believes: "If I drop PPO plans, I can't find enough patients. I'm stuck with insurance-dependent patients."

Abundance mindset believes: "I have 100% confidence that I can find patients who are interested in their health and would love to be part of our practice. Insurance is irrelevant to them."

Look at your colleagues who've successfully built fee-for-service practices. They didn't stumble into this model—they chose it. And most say, "My only regret is I didn't do it sooner."

The Mastermind Effect

When you connect with other dentists who've made this transition, the proof becomes undeniable. They're saying: "This can be done. Here's how I did it. And I'm thriving."

That's when the abundance mindset takes hold. When you see it working in real practices, not just in theory, resistance melts away.

Implementation Timeline: Dropping PPOs Before Hiring

Months -6 to -3: Preparation Phase

• Engage a dental marketing firm to assess your current position
• Select PPO plans to drop (typically start with lower-fee plans)
• Develop your patient communication strategy
• Train your team on new messaging
• Audit your practice financials and overhead structure

Months -2 to 0: Execution Phase

• Implement marketing campaigns targeting your ideal patient profile
• Officially announce PPO plan changes to existing patients
• Begin transition communications with affected patient groups
• Monitor patient retention and adjust marketing if needed
• Begin associate recruitment

Months 0 to 3: Stabilization Phase

• Hire and onboard your associate
• Continue marketing to ensure abundant patient flow
• Establish associate fee structure (significantly higher than PPO rates)
• Build systems for practice-wide consistency

Months 3+: Growth Phase

• Optimize schedules for both doctors
• Consider additional associates based on patient demand
• Refine your $2.5M practice model (if your goal)

The Bigger Vision: Building Your Thriving Practice

Hiring an associate isn't just about adding a doctor—it's about building a thriving practice with better work-life balance, more profitability, and the ability to serve more patients. Dropping PPO plans before this expansion optimizes every aspect of that vision.

Your associate becomes a partner in abundance, not a solution to scarcity. The practice grows from strength, not desperation. And your entire team—including your associate—works in an environment where patient care comes first and financial pressure from PPO contracts comes never.

This article is based on expert insights from Gary Takacs and Naren Arulrajah, leaders in dental practice transformation. For more strategic guidance, visit the Less Insurance Dependence Podcast.

Reviewed by

Naren Arulrajah

CEO & Founder, Ekwa Marketing

Naren Arulrajah is the CEO and Founder of Ekwa Marketing, a 300-person dental marketing agency that has helped hundreds of practices grow through SEO, reputation management, and digital strategy. A published author of three books on dental marketing, contributor to Dentistry IQ, co-host of the Thriving Dentist Show and the Less Insurance Dependence Podcast, and a member of the Academy of Dental Management Consultants. He has spent 19 years focused exclusively on helping dental practices succeed online.