Nashville, Tenn.-based Tend is setting itself up for success in the coming years by investing in new technology and creating a competitive compensation model for its dentists.
Tend’s new compensation model allows dentists to earn up to 40% commission and equity in the company, representing one of the highest commission structures in the U.S. dental industry. In addition to commission and equity in the company, dentists are also provided mentorship, continuing education and a full benefits package.
Tend, which supports more than 30 locations in the U.S., said the compensation model aims to combat industry-wide challenges and make the field more sustainable for clinicians.
Tend Chief Dental Officer Chris Salierno, DDS, recently spoke with Becker’s to discuss how the company is approaching its next stage of growth after these changes.
Note: Responses were lightly edited for clarity and length.
Question: Was there any specific event or anything that inspired the company to update its compensation model?
Dr. Chris Salierno: No specific event triggered it. We have a constant, never-ending improvement philosophy. We want to innovate in healthcare. We want to innovate in hospitality. We’ve just completed a multi-year process of getting real operational excellence, and we’re ready to hit the gas pedal on real growth in terms of number of locations, but also really making good on our promise to innovate in healthcare and hospitality. Innovation means change. It means new, exciting technologies and investments we’re making, and we need a top team to do that. I think it made so much sense to start with, “Hey, it’s been a little while since we’ve reviewed the compensation structure.” Our retention is good. Our dentists really enjoy the culture we build at our practices. They love playing with the technology we have, but we’re in growth mode. To take on that change and those innovations, we really need to make sure we continue to just always dial up attracting and retaining top talent.
Q: How did you go about adjusting the compensation model?
CS: Our goal, and I think everyone’s goal in the industry, is to attract the best talent. What that looks like and how you do that, depending on your business model and where your locations are, should be different. We always had a competitive compensation structure for our dentists. We always felt really good about it. We heard it was innovative and different, but it’s evolved over time, and the most recent iteration really speaks to what our dentists wanted most.
We didn’t know what it was going to be until we sat down with some of our top dentists and said, “What would the next evolution of compensation look like for you? What are the things that matter to you?” … We literally got them in a room, bought them dinner and a glass of wine, and we were like, “Alright, we’re just gonna throw stuff out here. What do you think?” There were expensive parts of their compensation package, like real investments we were making, that in some cases they were like, “Yeah, we don’t really care about that.” More often than not, there were things they cared about, but they didn’t mind making an adjustment in an area to then get them more of what they were looking for somewhere else. We wanted to have really exciting numbers that would attract and retain top talent. How we got there was this really customized, personalized journey based around what our top performers wanted. That was really insightful for us. That was critical to this. Then, we came back to [the doctors] again and said, “Okay, here’s what this is looking like. What do you think?,” and they had another round of being able to say, “This is great. More, please,” or “I don’t love that trade off. How could we do that differently?” So, it really was a dialog.
Q: What were some of the items doctors were willing to trade off?
CS: One place we were surprised was around our PTO. We had probably one of the most generous paid time off policies out there. We had holidays, of course, but then we were giving them, based on tenure, strong PTO, and that attracted a lot of people who worked hard [and] then used that PTO to play hard. And that’s great. We recognized there was an opportunity to change that PTO amount, still make it one of the most competitive and generous PTO policies out there, but by tweaking the dials a little bit, we were able to get them more wins on things like their commission rates. That was something that mattered to them … As it turns out, that’s also partly what attracts top talent is seeing that we can reward them really well from a percent commission standpoint, but also that we value that they have families, they have friends [and that] they want that work-life balance.
I’d say another thing was with labs. There are many different ways group practices and private practices handle labs — you pay a percentage, you pay 100%, you pay none — I think it’s rare that dentists pay none of their labs, and we were one of those that did that. We didn’t have any of our dentists participate in labs, and now they do. We have wonderful preferred laboratories we work with. We give [dentists] a lot of clinical autonomy on selecting labs to get great outcomes for our patients, but they were willing to pay more of of their lab costs to be able to to drive up their percent commission. That was interesting and surprising. I think [the doctors are] really sharp because they probably saw we’re already rolling [3D printing] out, so as you’re able to manufacture more things in house, you can really drive those lab costs down. That’s them making really smart business decisions. I think that’s an example of just a really good dialog. If we hadn’t consulted with them, we might have tweaked that in a totally different way that didn’t resonate with them.
Q: How is Tend approaching growth now that it has made these changes?
CS: So, we’ve made an investment with VideaHealth, and we’ve rolled that out in all of our locations. We really appreciate the ability to have AI-assisted diagnosis, and all of the exciting things that the company is going to be rolling out beyond just 2D image analysis. We’ve also partnered with Neoss. That’s an implant company that is incredibly innovative. Ivoclar is another strategic partner. These are groups that make huge investments in materials and adopting digital workflows, and we’re so excited to be along for the ride with them. We’re going to be rolling out some other exciting initiatives and service lanes that make a ton of sense for our patients. Clear aligner therapy is a huge one. I always say to our doctors, “You’re going to do far more clear aligners than dentures at Tend.” It’s just our patient population, that young, urban professional. You can kind of get a sense of the aesthetic dentistry needs and efficiencies with digital workflows. This is such an exciting time to be in dentistry and in healthcare in general. We’re in the midst of an industrial revolution in dentistry, and so now that we’ve got a great compensation plan in place, we’re just scratching the surface on being able to really roll out some of these new things.
Q: What else is in the pipeline for Tend in 2026?
CS: Aesthetic, digital workflows. We’re excited to make a splash in sleep apnea. We think that’s a huge market for our patients. Our clinical philosophy is comprehensive and preventive dentistry. We don’t just do urgent care. We want to treat the whole person, the whole mouth, so we think sleep apnea, just like clear aligners, just fits so well. We have a relatively healthy patient population. They have a relatively higher oral health IQ, and they’re very much interested in doing comprehensive, preventive dentistry. They understand an ounce of prevention is worth a pound of cure down the road, especially as it applies to their overall health.
