Anticipate potential challenges within this work environment, including the possibility of not being able to take allotted breaks due to staffing shortages. There might be issues related to fixed schedules, with occurrences of sudden staff absences. The management's attentiveness and clinical knowledge might be lacking. Colleagues might engage in gossip and exhibit a deficiency in collaborative teamwork. The Chief Operating Officer (COO) may display rudeness and a lack of respect for individuals' privacy. Human Resources (HR) functions primarily in the company's interests rather than those of the employees. Unforeseen patient appointments could arise at the last minute, necessitating flexibility. Overtime might be necessary beyond the scheduled hours. Advancement in the organizational hierarchy could entail cultivating favorable relationships. There may be inadequacies in necessary procedural supplies, and speaking out could lead to adverse consequences, as the company has been known to terminate individuals who voice concerns. Prepare for the likelihood of encountering numerous dissatisfied patients who may choose to seek care at alternative facilities and openly express their discontent with their TEND experience. The establishment appears to operate in a manner akin to an elevated Medicaid-focused practice. Distinctive operational approaches at TEND do not seem to substantially deviate from those observed within other Dental Support Organizations (DSOs). It is worth noting that the recurrent turnover of personnel has made a lasting impact, which prospective employers consider when evaluating individuals with prior TEND affiliations.