Hi Sally,
I am an office manager in a dental office. My bosses and I have a completely different opinion of what an office manager should be. I work at the front desk with multiple duties. I am not allowed to make even the smallest decisions. What I am allowed to do is make notes of all the discrepancies of my fellow coworkers. I have been told I am not their buddy. I think I can effectively manage this office by being both a mentor and a friend. I would very much like to know what your opinion is with the little information that I have given you.
Best regards,
Susan
P. S I am the oldest in the practice, including the Doctors.  I don’t know if this has any bearing or not.

Dear Kathy,
The term “office manager” has no set definition by industry standards. You can have one person at the front office that is not “managing” anything. On the other hand, you can have an office manager that over sees 25+ employees. I think it was probably a mistake to bestow that title on you without a defined job description. I would suggest that you go to your employer(s) and ask for a defined job description. The title is not the job but the job description is the job. From that list of duties and responsibilities, you can then decide if this is a job you want to keep.

On the hand, I would not over looks the “real” reason of why they are not allowing you to make decisions. Bosses….now that is a problem. Multiple partners that have difficulty coming up with majority rule or unanimous decisions is usually a can of worms. One or more can have trust issues which may mean they will never allow you to make decisions.

There is a fine line in managing people and being their friend. I agree with your bosses that employees are not your friends. Look at it this way. If one were to win the lottery tomorrow, they are gone, adios. Employees need to know that you care about them and you trust them but I agree in terms of my definition of being a buddy that you can’t be a CEO, a COO, a manager do social things outside of the office (not that you said that) and then turn around do a performance review on them. This is all part of Human Resource training which generally there is none of in a dental office. A loyal employee with lots of dental experience is granted the title of Office Manager and she/he has had no experience or training on human resources.

Again, I encourage you to have a face to face meeting and insist that they define and provide you with a clear job description so you are able to make an informed decision if this is the job for you.

Hope this helps,
Sally

Hi Sally,
We need scripts/dialogues for patients that need x-rays/panorex and they refuse to have them. We tell them why we need them and then that at their next visit we won’t be able to treat them unless they have the x-rays. What else can we do?
Penny

Hi Penny,
I went to the management library on my web-site because I knew in the past 7 years this subject had been written about in one of my weekly email newsletters.
Below is what I found:
• Mr. Jones, I need to get your x-rays now.
• I am going to get your x-rays now as the doctor requested.
• As the doctor requested, I am going to get your x-rays now.

The hygienist will not want to ask permission. That is just saying to the patient that it is not really a required treatment but optional, and that is why the hygienist is asking permission.

Of course there will always be exceptions to the office protocol and those patients that respond back with some of the following comments:

“Will my insurance cover them?” “Mr. Jones, we cannot be sure that your insurance company will cover them. You have to keep in mind that dental insurance isn’t really insurance at all. It is actually a money benefit provided by your employer to help you pay for routine dental treatment. Most benefit plans are only designed to cover a portion of the total cost. However, many insurance companies do cover x-rays because they are considered preventive treatment. The doctor has determined that for clinical reasons we need to have these x-rays taken. Without them we will not have all of the information we need to be able to make a thorough diagnosis.”

This and many other questions are answered in the pamphlet, “My Insurance Covers This RIGHT?” (You can purchase them on my web-site here: http://www.mckenziemgmt.com/book-practice.htm#b2
Any time a patient questions if insurance will cover something it is best to educate them about why the treatment is needed and about insurance. Handing a pamphlet to them in addition to verbally explaining to the patient is a great way to approach the questioning patient.

Another scenario may be, “Mr. Jones, I am going to get your x-rays now as the doctor requested.” “Why do I need x-rays? I don’t need x-rays. My old dentist never took these x-rays” “Well, Mr. Jones, I cannot answer for your previous dentist, but we want to make sure that your bone levels are healthy, your teeth are cavity free, and that you are dentally healthy. Without these pictures we will not be able to perform as comprehensive or thorough exam.”

Penny, trying to understand why the patient is saying “no” takes on a more personal effect which could be fear of radiation or the cost or simply just not thinking they are necessary. You could just ask, “Mrs. Jones, would you share with me why you don’t want any x-rays taken?” Make sure that you document all conversations in the patient’s records.

Telling the patient that you can’t treat them on the next visit is very black and white and of course you must accept the consequences that you will lose the patient. Perhaps you could say that you’ll forego them this visit but they will be necessary on the next visit. You can also have the patient sign a release that they understand they are refusing x-rays. While the patient can refuse any treatment, the dentist is subject to liability for failing to diagnose or treat existing conditions.

I think you also have to look at your x-ray philosophy. There are 3 that we see in our consulting work, BW’s every 6 months, BW’s 1 time a year, BW’s every 18 to 24 months. Once a year is the most common. We do find those offices that subscribe to every 6 months have lower patient retention.

I hope this has been of help.

Kind regards,

Sally McKenzie

Last week was my first week back from my birthday vacation. I don’t take vacations very often. Not sure why, but after my week in Cabo, I definitely came back relaxed and no muscle knot in the top of my right shoulder. I think I need to get them on the schedule.

So, last week, I didn’t get much posted. I had a former employee who left last April, come back and started last week. She left me because she wanted something closer to home as she does drive quite a distance to my office. She didn’t leave for money. However, when I found out that she was unhappy and stressed months later, I offered her a position different than what she was doing. The point of this ramble is…..that once she told her employer, they offered her a 3% raise to stay.

This reminds me to caution you when hiring a new employee to always ask the question, “If your current employer were to offer you more money, would you stay.”
While this particular situation did not happen to me because she didn’t stay but came back to me, it’s always good to ask that question. You can be sitting there waiting for the 2 weeks notice and for him/her to start and they call and say they decided to stay where they were. That really could aggravate you.

But, my other point is that it was not about money but, about relationships with my former/new employee. As small businesses, we are able to create relationships with our employees. I really like my employees. If I didn’t, they would not be working for me. Life is too short for me to surround myself with people that don’t bring good energy to my space. Of course I, in turn, need to bring positive energy to them too. I care about my employees and I think they know this.

So, I spent last week working with my new employee. You know, that makes me think about dentists who don’t want to train new employees. I understand you don’t know how to train a front office employee but you know how you want things up there and my point is that I went in on Saturday to help train this person. That’s right….you may have to train on Saturday and Sunday because we certainly don’t have time during our work week.

I’ll post later about training. For now, have a happy week. Plenty of smiles and deep breathing!
Sally

Hi Sally-
I get your newsletter and have used your “mystery patient” with one of my new FD staff members. Anyway, I love your newsletter.

To the point: I had a patient come in yesterday and request a reduced fee (this was related top me via the front desk personnel- I was crazy busy and she was not scheduled to see me that day for an exam ) She was scheduled for perio maintenance. She has just retired, lost her Delta dental coverage, and requested that I continue to bill her the lower, discounted Delta fee for her 4910!!! She can afford my FFS fees I am sure, since she travels to Mexico every winter…Her rationale is that she has been a long term patient (I bought this practice 10 yrs ago and she came with it) and has referred a lot of patients to me…I did not fact check that, but she has referred some nice patients who are FFS…I am in the process of writing a “good bye letter” to her, since I want to convey that I can’t discount, but what MORE do you suggest I put in that letter? I just moved into a new facility and have higher overhead, long term staff, etc so my overhead will NEVER go down…. This would be a good topic to do in your newsletter….since I’m sure we are all getting this request!

Look forward to hearing from you
Karen H., DDS

Thanks for reading my newsletter and utilizing my products and services to help your practice.

I would say or add to or instead of trying to justify with your overhead costs ( because frankly she doesn’t care), what I tell dentists who feel they are entitled to “special” pricing of our consulting services and that is…….

“It’s not fair to the patients who came before you and paid the fee and referred patients nor to the patients who will come after you.”

I think I would then continue to say, “We treat all patients with fairness, respect, kindness, courteousness and…the same fee.”
“I understand if your financial situation causes you to seek dentistry elsewhere. We certainly appreciate having you as a patient
and of course your referrals to our practice. We do have financial arrangements in place that perhaps may be of help to your
current financial situation. Please let me know of your interest and I will have XXXX reach out to you. If, on the other hand you
must leave our practice, I of course will send your dental records to the dentist of your choosing.”

Sure hope this helps you!
All my best,
Sally

January 13, 2011

I am truly blessed to have such wonderful friends and fantastic consultant/coaches that work for me. At our last consultant team retreat last year, I casually suggested that I was having a “big” birthday in January and I would like to spend it with them. So, not all but many joined me this week in Cabo San Lucas, Mexico along with my brother Thom and my niece Tara. They came from Canada, Florida, Chicago, South Carolina, California……What a good feeling to be surrounded by “happy” people that give you energy. Some have worked for me as long as 25 years. Loyal friends who would give you the shirt off their back. I just couldn’t think of a better way to turn another year older. Thanks!

Sally