Associates are not employees in the traditional sense, and that can leave a number of HR issues lurking out of sight, Lara Brewood-Green explains.
Few areas of HR create more uncertainty in dental practices than associate relationships.
Associates are not employees in the traditional sense. They operate as self-employed clinicians, often with significant professional autonomy. Yet they are also embedded within the daily life of the practice – sharing facilities, working within practice systems, and interacting closely with the wider team.
This unique position makes the associate relationship one of the most complex aspects of practice management.
Why associates sit in a grey area
In most workplaces, HR frameworks are designed around a clear employer-employee relationship.
Dentistry does not always fit that model.
Associates are typically self-employed contractors, responsible for their own tax arrangements and professional indemnity. At the same time, their work takes place within the structure of a dental practice, under shared governance, and often using practice resources. This creates a natural tension between independence and integration.
Practice owners must respect the associate’s status as a self-employed clinician, while also ensuring the practice operates safely, efficiently and in line with regulatory expectations.
Where confusion most often arises
In many practices, associate agreements are created at the point of recruitment and then left largely untouched for years. As practices evolve, expectations can shift – sometimes subtly. Common areas of misunderstanding include:
- Facilities and equipment expectations
- Responsibility for materials and lab costs
- Working patterns and diary management
- Patient allocation and treatment planning autonomy
- Notice periods and exit arrangements.
When these issues are not clearly defined in agreements or consistently applied, tensions can emerge.
Regulation and responsibility
Associate relationships also exist within a wider regulatory framework.
Practice owners must ensure the practice meets obligations around governance, patient safety and regulatory compliance. Associates, meanwhile, remain individually accountable for the care they provide. Balancing these responsibilities requires clarity, transparency and mutual understanding.
Without that structure, misunderstandings can quickly escalate into disputes that are difficult for both sides to resolve.
Why this matters more today
As dentistry becomes more sophisticated – with growing practices, corporate groups and increasingly complex regulatory oversight – the associate relationship is under greater scrutiny than ever before.
For practice owners, this means the associate agreement is no longer simply a contractual formality. It is a critical framework for how the clinical team functions.
Handled well, it provides clarity, fairness and stability for both parties. But handled poorly, it can become one of the most significant sources of conflict within a practice.
Five rules for managing associates professionally
While associates are not employees, HR principles still play an important role in how practices function day to day. The most effective practices recognise this and put simple frameworks in place that support both autonomy and accountability.
1. Set clear expectations from the start
Professional expectations should never sit in the grey space of ‘assumed behaviour’.
Associates should understand how the practice expects clinicians to work with patients, nurses and reception teams, as well as standards around record keeping, clinical governance and communication.
These expectations are best established during onboarding and reinforced through the culture of the practice.
Clarity early on prevents misunderstandings later.
2. Address concerns early and professionally
Difficult conversations can feel uncomfortable in small teams, particularly where associates are self-employed. But avoiding these conversations rarely solves the problem.
If concerns arise around communication, professionalism or teamwork, they should be raised early and discussed constructively. The focus should remain on shared standards within the practice rather than personal criticism.
Handled well, these conversations reinforce expectations and protect the culture of the team.
3. Recognise and reinforce positive behaviours
HR is not only about managing problems.
Associates who contribute positively to the culture of the practice – supporting colleagues, communicating well with patients or helping improve systems – should be recognised.
Simple acknowledgement can strengthen professional relationships and reinforce the behaviours that help a practice run smoothly.
4. Apply expectations consistently across the team
One of the quickest ways to create tension within a practice is inconsistent expectations.
If some associates follow certain processes while others operate differently, the wider team can quickly feel the imbalance. Consistency helps ensure everyone understands how the practice operates and what is expected of them.
5. Make sure the contract reflects the way the practice actually works
Ultimately, the associate agreement should support the real operating model of the practice.
Over time, however, many agreements drift away from reality as practices evolve. Working patterns change, facilities develop, financial arrangements adapt and team structures shift.
Periodic review of agreements helps ensure they remain aligned with how the practice actually functions.
Clarity of language also matters. Because associates are typically self-employed rather than employees, the terminology used within agreements and day-to-day practice documentation should reflect that status. For example, references to ‘holiday’ or ‘annual leave’ may be more appropriately framed as ‘agreed absence’ or ‘planned leave’.
These distinctions may seem small, but they help maintain clarity around the nature of the relationship.
A well-constructed agreement cannot prevent every disagreement – but it can provide clarity and structure if questions arise.
Structure supports autonomy
Dentistry depends on professional autonomy.
Associates must retain the clinical independence that allows them to make appropriate decisions for their patients. But autonomy works best when supported by clear expectations and well-understood boundaries.
When practices get this balance right, associate relationships become one of the profession’s greatest strengths – combining entrepreneurial flexibility with collaborative team care.
For practice owners, the aim is not to introduce unnecessary bureaucracy. It is simply to ensure that the frameworks guiding these relationships are clear, fair and aligned with the realities of modern dental practice.
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