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  10.08.04 Issue #135

Time for an Associate?
Base the Decision on Reality not Illusion.

Sally Mckenzie, CEO
McKenzie Management

       Contrary to popular perception, it’s not the long days, missed lunches, or rapid-fire schedules that dictate the need for an associate. Those may be good indicators that staff and systems aren’t functioning properly, but they aren’t the signal to throw another doctor into the mix. When it comes to determining the need for an associate it’s the hard data that spells out the black and white, the yes or no, the stop or go in the search for an associate. Inefficient systems can create the illusion of a busy practice, but the actual number of patients may tell a very different story.

Before another doctor is brought into any practice, there must be enough patients to not only keep doctor and associate busy but support the two. How much is enough? The industry dictates that a solo general practitioner must have a minimum of 2,000 active patients – not 2,000 patient records in the system. That number should be projected to double within two years if an associate is brought in.

Generally speaking, industry data recommends that for a solo practice to remain healthy it should have a monthly new patient flow of 16-25, and 85% of those new patients should be accepting treatment. Although there is more flexibility for practices that have a 20 year history in a community and a solid recall, every practice needs new patients knocking on the door. And practices that are eyeing the resumes of potential associates should be seeing at the minimum, new patient numbers in the area of 40-45 per month before the practice is ready to make the investment in a full-time associate.

In addition, the practice must carefully consider a host of other critical details. McKenzie Management works with practices in developing a 40-point needs assessment in which numerous specific considerations are evaluated, including:

Is your present method of scheduling patients maximized?
Are you delegating procedures to an assistant?
Are you as efficient as you could be?
What days and times would an associate be needed?
What level of experience does the senior doctor expect the associate to have?
What types of procedures will the associate be expected to perform?
How much compensation is the doctor planning to offer?
Will the compensation be on a salary or commission basis?
If the associate’s compensation is based on a percentage will that percentage be dictated by collections or production?
What, if any, practice expenses will the associate be expected to pay for, such as lab expenses?
Will the associate have management responsibilities?
And many more.

When it comes to bringing on an associate, don’t skimp on the details. The impact of this decision will reverberate with the doctors, the team, the patients, and the bottom line for a very, very long time. And the reality of a poor choice will snuff out the illusion of that happy partnership quicker than the ink can dry on your agreement.

If you have any questions or comments, please email Sally McKenzie at

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Responding to Employees with Personal Problems

Dr. Nancy Haller
Executive Coach
McKenzie Management

Dear Coach,
A top-notch hygienist in my practice just called in sick for the coming week. She told me that her doctor diagnosed her with OCD (Obsessive Compulsive Disorder) and prescribed Zoloft. I know she’s had some personal problems but I’m not sure how much to get involved. What’s your advise?

Balancing your interest in employees without

getting too deeply into their lives requires good judgment and tact. It’s important to care about employees. People who are cared about in turn show caring to others. They work more efficiently and are more congenial. Effective leaders have empathy…the ability to understand and respond to others, to see the world from someone else’s perspective, to step into their shoes.

Perhaps you believe that work and personal life should be separate. You may have been told to keep a healthy distance from employees. Be careful.

The work environment has changed. Work is more than a job and a paycheck. It is a place where people spend 30, 40, 50, 60 or more hours together a week. Good leaders know more about their employees than just the work they do. And employees expect some compassion from bosses and co-workers. They need personal validation. Being impersonal signals disinterest and a lack of caring, and is as risky as being overly involved.

In his book, Primal Leadership, Daniel Goleman describes empathy as the key to retaining talent. Although a positive relationship with a boss is not enough to produce worker productivity, it can significantly contribute to it. And the absence of sensitivity can lead an employee out the door. At the same time, you need to strike the right note in your interpersonal relations with your staff. It is important to be approachable and friendly, yet fair and firm.

It may be that you are worried about saying the ‘wrong thing’:

  • You shouldn’t take it so hard.
  • You’re overreacting.
  • It could be a lot worse.
  • You’ll get over it.
  • Just pull yourself together.

Those statements minimize a person’s pain and convey a lack of interest on your part. The impact is negative and potentially damaging to your relationship.

So how should you handle the situation?

  1. Be understanding.
    An emotional problem is really no different that a physical problem.
    Although we live in the 21st century, it often amazes me how little we have advanced from the Salem witch-hunts when it comes to our acceptance of psychological disorders. Think about how you would respond if your employee had a broken ankle, or a surgical procedure.
  2. Welcome your hygienist to the office when she returns.
    It’s good to have you back.
  3. Ask how she is doing.
    How are you feeling? Are things okay?
  4. Pay attention.
    Step two in showing empathy is longer listening. Be patient. Refrain from interrupting. Nod appropriately. Maintain good eye contact and display interest in your facial expression and posture.
  5. Be concerned without becoming a therapist.
    She already has a treating professional. Don’t get into the counselor role. Avoid giving advice or probing for details. Most people work through problems and issues very well on their own. Simply expressing concern is greatly appreciated and often enough.
  6. Be objective. Redirect if necessary.
    The office is a place of business. Keep personal disclosures to a minimum. If your employee becomes too self-revealing or rambles, manage the time by gently redirecting the conversation to a close. Sounds like you have a lot on your mind. I’m glad you are seeing a good doctor. Let me know if you need time off for appointments. You’re an important member of our dental team and I want you to continue to feel better. Welcome back. (Pause). I’ll let you get back to your patients now.
  7. If performance is being affected, meet informally with the employee.
    You indicated that your hygienist was ‘top-notch’, but if productivity and/or office behavior declines, it’s important to follow-up. Show genuine concern and not ‘gossip’ style interest.
  8. Respect confidentiality.
    Some subjects are not matters of public discussion in the workplace. These include situations such as your hygienist’s emotional problems. Keep quiet about personal problems employees bring to you. The exception is when problems involve breaking the law or office policy.

In today’s increasingly complex world, even rock-solid workers are likely to have times when their lives are affected by a personal crisis. At some point, you probably will be faced with an employee's family, financial, legal or health crisis. The skill and humanness exhibited by you, the leader, will be important in the final outcome.

Dr. Haller is available to speak to your dental society or study club on subjects such as interpersonal communication, conflict management, and team building. If you would like information about any of her practice-building seminars, contact her at or 1-877-777-6151 Ext. 33

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Tongue Lashing

From the Patient’s Perspective

         Jewelry has been a means of self expression, a symbol of individuality, an indication of wealth or social status, a token of affection and appreciation for tens of thousands of years. Even cavemen sought to decorate themselves with bones in their hair and ears. In Victorian times, men wore more jewelry and more

elaborate jewelry than women, a trend that eventually reversed.

By the 1960s, everyone was wearing jewelry and piercing became a means of making a statement. Men were joining women in piercing their ears. Sexual preferences were announced by wearing earrings in a specific ear. Today, young men and women have taken body piercing to a whole new level. Earrings track from one end of the ear to the other. Jewels adorn noses, eyebrows, lips, bellybuttons, and tongues.

As dentists are well aware, tongue piercing causes chipped teeth, recessed gums and nerve damage, but as more dental and medical journals are reporting, this fad could be fatal. Most patients don’t even consider the harmful ramifications of imbedding jewelry in their mouths. Yet that new decorative hole in the tongue now provides the ideal pathway for bacteria and organisms in the oral cavity to find their way to other parts of the body including the brain and the heart.

According to Karen Murphy R.N. of Morton Plant Hospital in Florida, “surgeons have recently seen patients in their teens and twenties needing open heart surgery to replace a diseased valve.” This means younger people are having major surgery and will have to take blood thinners for the rest of their lives. It also means that they may have to have a prosthetic valve replaced every fifteen or twenty years.

In 2002 the Yale School of Medicine reported that an abscess detected in the brain of a young woman was probably caused by an infection resulting from having her tongue pierced one month earlier. In addition, piercing has been identified by the National Institutes of Health as a possible vehicle for transmission of hepatitis B, C, D and G, and HIV. What’s more, young people who have their tongues pierced are more likely to engage in other high risk behaviors such as smoking and using drugs.

There are plenty of good reasons why young people should avoid tongue piercing, yet too often the sense of invincibility is far more convincing than the sense of reason. But dentists can influence their young patients and one of the most persuasive tools is pictures. Telling patients that their “sexy” studs are hazardous is one thing, showing the danger in living color is another. However, like any potentially sensitive discussion between doctor and patient it requires a careful approach.

Assure the patient that you are not judging their looks or style. However, you have genuine concern for the life and wellbeing of the patient and his/her family. This puts the discussion on a personal level –it’s not just facts and statistics. The approach should be oriented toward a discussion regarding dental hygiene and health. Let the patient give you the reasons for the jewelry ornament or ornaments and listen closely. Listening builds confidence between you and the patient. It makes the patient feel that you care. If you listen to the patient, there is a good chance that the patient will listen to you.

What if the patient still will not remove the tongue jewelry and allow the hole to close? You could continue to provide care and take your chances with the patient’s health. Or you could follow the lead of a New Jersey dentist who has made a strong statement. He refuses to work on any patient that has tongue studs or an open hole in the tongue. He has not lost one family because of his decision. The parents at the next visit thank him for taking the time to explain to their child the dangers of tongue jewelry. Most of the young adults do come back to him after the hole has closed up and never have another hole put in their tongue again.

Jewelry has provided physical ornamentation for tens of thousands of years, its purpose, however, is to enhance beauty, not destroy it.



Changes In Staff
Lack Of Training
Patient Flow
New Techniques
Staff Or Doctor
Personal Life

QuickBooks 2004 In Your Practice

By Susan Gunn
Before you invest time, money, and energy taking a QuickBooks class from your community college, check out the QuickBooks In Your Practice workbook. Written by Susan Gunn, this workbook is the result of frustrated clinicians wanting a workbook designed specifically for their professional practices. A mandatory reference for any practice, this workbook allows practices to care for patients, not figure out their accounting software.
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Sally's Mail Bag

I feel that you have a true understanding of the numerous situations (that are mainly negative) with bringing on an associate dentist.
I have a special request--many of us have children that become dentist--this happened to me and his coming into my practice was a disaster. We had been so very close before he came into the practice, and things happened that were just crazy!!!!!!!
Do you have any insight on this part of a situation?
Dr. Pennsylvania

Dear Dr.
Thank you for your email. Yes, I have observed, first hand, your situation many times over the 25 years I've had this company. Just because you're the father doesn't mean that it is your obligation to provide an opportunity for your son. Sometimes the opportunity isn’t even there, i.e., patient base to support another dentist. Just because you are biologically from the same gene pool doesn’t mean that your philosophy of dentistry will mix or your personality types will be the same and then there is the issue of “you’re the father” who protects the son, controls and makes all the decisions. If your son is still in the practice, my recommendation would be to have us in the practice, as an outside objective expert that would "level" out the playing field for both of you and make recommendations to provide one path to a common vision.
Let me know if I can be of help.
Best regards,


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