Onboarding Into an Existing Practice — The First 90 Days

Patients stay with the practice they trust. That trust is built on the team — especially the front desk and the hygienist they've seen for 10 years. Every visible change you make in the first 90 days is a signal that things might be different. 'Different' creates anxiety. Anxious patients leave.

The standard transition playbook:

Seller writes a personal introduction letter — mailed or emailed to the active patient list BEFORE closing, introducing you, affirming the continuity of care, and vouching for your credentials. This letter is the single highest-ROI action in any transition.

The team stays. In most acquisitions, the seller terminates all staff at close (for legal reasons — you don't want to inherit employment liabilities) and you rehire them the same day with identical compensation and benefits. Do not use this moment as a culling. Operational changes come at 90 days, not day one.

The schedule stays. Use the seller's scheduling template for 60–90 days. Changing the schedule immediately disrupts the hygiene flow that drives the entire practice.

Your name goes on the sign, your bio goes on the website, and your photo gets added to the welcome area. That's it for visible changes in month one.

At 90 days: you've earned credibility with the team, you understand the real workflows, and you can change things from a position of trust rather than authority.

Every dental practice must have a current employee handbook. In most states, an outdated handbook (or no handbook) creates legal exposure — implied contracts, discrimination claims, and wage-and-hour violations all find footing in handbook gaps.

An inherited handbook from the prior owner may be years old and non-compliant. Review it immediately. The minimum required sections:

AT-WILL EMPLOYMENT STATEMENT: Clearly states employment is at-will (in states that follow this doctrine) and that the handbook is not a contract. Must appear early and be acknowledged in writing.

ANTI-DISCRIMINATION AND HARASSMENT POLICY: Covers all protected classes under federal and state law. Include a reporting procedure. In California, mandatory harassment prevention training is required for employers with 5+ employees.

WAGE AND HOUR POLICIES: Meal and rest break schedules (California is extremely specific: 30-minute unpaid meal break required if shift exceeds 5 hours; 10-minute paid rest break per 4 hours worked), overtime rules, timekeeping procedures, and pay frequency.

PTO, SICK LEAVE, AND BENEFITS: Detail accrual rates, carryover rules, and payout on termination. Many states (including California) require specific sick leave accrual minimums.

HIPAA AND PATIENT CONFIDENTIALITY: Required for any dental practice. Covers what staff may and may not share, social media restrictions regarding patients, and breach reporting.

SAFETY AND INFECTION CONTROL: OSHA compliance, bloodborne pathogens training, PPE use.

SOCIAL MEDIA POLICY: Explicit rules about posting clinical photos, patient information, or practice-identifying information.

DISCIPLINARY PROCEDURES: A clear, documented progressive discipline process protects you legally when you need to terminate.

HOW TO UPDATE AN INHERITED HANDBOOK: Do not simply edit the old one and re-date it. Have a dental-experienced HR attorney or HR service review and redraft it. Services like Dental HR Inc., PatientHub HR, or general dental consulting firms do this for $500–$2,000. A proper update typically takes 2–4 weeks. Have all employees sign a new acknowledgment on day one of your ownership.

PAYROLL: On closing day, you need payroll running. Do not try to process this manually. Set up your payroll provider 2–3 weeks before closing so the first payroll runs on time. Common options with dental experience: Gusto, ADP, Paychex. Collect all employee W-4s, I-9 documentation, and direct deposit info at your first all-staff meeting.

BENEFITS CONTINUATION: Existing employees may have employer-sponsored health insurance, dental, and vision. If you're changing carriers, COBRA continuation must be offered. Employees should have 60 days of coverage continuity to avoid a lapse. Get your benefits broker on the transition team 30–45 days before close.

WORKERS' COMPENSATION: A workers' comp policy in your name must be active on day one. Bind it 5–7 days before close. Your existing policy (if you had one as an associate) does not transfer to the new entity.

401(k) OR RETIREMENT PLANS: Inherited retirement plan obligations are complex. If the seller had a 401(k), consult with a dental CPA and a benefits attorney about your obligations to existing participants. The cleanest approach: seller terminates the existing plan at close, and you establish a new plan when ready.

DENTAL LICENSE AND NPI: Your existing license covers you, but you'll need to update the practice's enrollment with payers to reflect you as the billing dentist. This triggers the credentialing timeline (see Financing guide for duration warnings).