You can inherit the charts. You can buy the building. You can even keep the name on the sign. But if you don’t reset the culture, the practice will never truly be yours.
Leadership transitions are becoming more common across dentistry. Whether it’s the addition of an associate, the handoff of ownership to a successor, or the sale to a DSO or private buyer, one thing is certain: transitions don’t just test systems—they test culture. And when culture isn’t intentionally prepared, resistance follows.
Long-term team members are often considered the heart of a practice. Their institutional knowledge, patient relationships, and historical insight make them invaluable. But sometimes loyalty turns toxic. A new doctor steps in and quickly realizes they’re not being embraced—they’re being tested.
The resistance isn’t always loud. It often whispers through the halls: passive-aggressive comments, eyerolls during a morning huddle, refusal to implement change. When these actions come from long-standing team members, they’re frequently dismissed with, “That’s just how she is,” or “He’s been here forever.” But this isn’t a harmless tradition. It’s subtle sabotage.
At first glance, this can seem like a personality clash or an isolated incident. But the real issue goes deeper: it’s a culture that wasn’t prepared for change—and is now quietly rejecting it.
New doctors, particularly those stepping into ownership, often feel stuck. They know they’re supposed to lead yet feel dependent on the very team that’s resisting them. The result is hesitation, silence, and walking on eggshells in the very space they’ve been called to lead. And when a team senses that uncertainty, the resistance only grows stronger.
Sometimes, the breakdown begins before the new doctor even arrives. I’ve seen multiple situations where an owner sells the practice and informs the team only after the deal is done. The staff is blindsided, and what could have been a respectful, celebrated transition becomes an emotional ambush. Trust fractures. Morale drops. And the new doctor inherits not just a team—but a simmering resentment they didn’t create but are now responsible for navigating.
I recently mentored a new owner who walked into a beloved, long-standing practice. The retiring doctor gave no notice to the team until after the deal closed. From day one, the new owner was met with smiles up front—and silence behind the scenes. Treatment plans were questioned. Staff “forgot” to schedule follow-ups. Patients whispered, “We miss Dr. S.” After six months of pushing through, she confided, “I’m doing everything right, but it still feels like I don’t belong here.”
She wasn’t imagining things; she was leading in a culture that had never been reset.
I’ve also seen transitions where everything on paper was done right. Two founding owners planned their retirements within two years of one another. Two associates were hand-selected, mentored, and groomed for ownership. Transparency with the team and patients was above board. But underneath the structure and planning, a deeper issue was never addressed. The founders had long accepted, if not unintentionally nurtured, a culture of gossip, backtalk, and subtle undermining—even directed toward themselves. They tolerated it because they knew how to manage it. But when they retired, that same behavior turned more aggressive and it had new targets. The associates, now owners, found themselves facing the same culture, but magnified. What was once tolerated became weaponized. The team had been informed of the leadership change, but the room had never truly been reset.
And these experiences aren’t isolated. According to a 2022 report by the American Dental Education Association (ADEA), poor team dynamics and lack of internal support were among the top reasons early-career dentists left their first associateship within just two years. Not because they weren’t clinically prepared—but because the culture resisted them from day one.
Culture doesn’t reset itself. It must be led, built, and—when necessary—rebuilt. And that begins with courageous, intentional leadership.
If you’re planning a transition, whether bringing on a partner, hiring an associate, or preparing for retirement—ask yourself:
Have I communicated early and clearly with my team?
Does the incoming doctor have full authority to lead and be respected as such?
Have we reset expectations, language, and team norms to reflect this change?
Have I created space for open, honest dialogue with the team before emotions turn into resistance?
Resetting the room means moving beyond a warm welcome lunch. It means reshaping the culture to support leadership transitions with clarity, accountability, and mutual respect. It means unlearning outdated hierarchies where tenure equals power and replacing them with shared values that uplift everyone.
It also means watching language. If the team still refers to the new doctor as “the kid,” “the temp,” or “the new girl,” then the room hasn’t been reset—it’s been reinforced with invisible walls. Culture is built through the words we choose and the behaviors we tolerate.
For owners preparing to step away, the greatest gift you can give your successor isn’t the patient list—it’s a team prepared to follow them. That starts with transparency, inclusion, and communicated expectations. Don’t leave your legacy in a locked drawer.
For new doctors stepping in: don’t confuse diplomacy with submission. Lead with clarity. Speak privately and professionally when boundaries are crossed. Seek alignment with leadership. Respect is not a perk—it’s a prerequisite.
Ultimately, leadership transitions shouldn’t feel like battlegrounds. They should feel like handoffs where history meets new energy, and the future is co-created. But that only happens when legacy isn’t used as leverage and when new leaders are empowered to lead.
Because the true test of a practice’s legacy isn’t how well it holds onto the past, it’s how powerfully it prepares for what comes next.
Reference:
American Dental Education Association. Survey of Dental Practice Transitions and Early-Career Dentist Satisfaction. 2022. https://www.adea.org
