Visit our web-site at
  02.10.05 Issue #153


Impulsive Decision-Making Ruling the Raises

Sally Mckenzie, CEO
The McKenzie Company

Long ago, that flight or fight impulse was a handy tool. Our ancestors could rely on two simple, straightforward responses to deal with the day's predators and effectively manage just about any adversarial situation. Wouldn't it be nice if things were so simple today? We might still have the urge to exercise those two responses in the face of trouble, but professional decorum isn't particularly accepting of primal behaviors such as running like mad out of the office or physical clobberings.

In our evolution, most of us have developed more politically correct responses to anxiety producing circumstances - increased heart rate, sweating, dizziness, GI distress, and impulsive decision-making. It's that last one that is particularly pronounced in dentists. The impulsive decision-making response to stress is keenly evident when the dentist is cornered by an employee demanding more money.

I could probably conduct a scientific study to backup my observations, but for now, let's look at the anecdotal evidence. Dentists can calmly manage the most difficult cases. They can expertly finesse the most challenging patients. But time and again when dentists are confronted by employees expecting a raise, suddenly, without warning impulse takes over and they whip out the checkbook, make promises they can't keep, and pledge allegiance to high overhead and low profits, all to assuage the employee. In effect, they are calling up those primitive survival instincts, trying to run away from this "aggressor" as fast as possible. What they don't realize is they are heading straight for a much more challenging predator.

I have worked with practices in which employees told the dentist how much they wanted to make each year. I have seen doctors forego paying themselves for months because they had been nickel and dimed into paying employees more and more each year. "All she asked for was an additional $1.50 an hour. How could I say no?"

And I have seen dentists engage in bargaining with employees - "I can't give you a raise this year, but how about I pay your entire health insurance premium instead." - without any comprehension that this would be the equivalent of giving the employee a bonus of $300 per month! When employees ask for more money, most dentists don't know how much to give or even if the practice can afford it. The $1.50 adds up as do the additional benefits - and quickly. Before you know it, that financial predator - high overhead - has your blood running cold.

Don't increase any employee's salary until you conduct a Salary Review. A Salary Review is a mathematical tool that enables practices to quickly and clearly determine how much of a raise your practice can afford while keeping your total salary overhead in line with the industry.

Employee salaries should account for no more than 22% of your total overhead, not including benefits which will run an additional 3%-5%. For example, if your staff salaries for January were $14,300 and your average monthly collections are $65,000 you are within the recommended industry range of 19%-22% of monthly collections. However, you would be at the top of that recommended range. "But my employees are really good, and I'm afraid they will leave if I don't pay them well." Let me be clear, quality employees deserve quality compensation. But rather than making an emotional decision make an informed decision. The monies have to come from somewhere and if you choose to hand more money out you better have a plan for bringing more money in.

Next week, shore up the funds before you dole out the dollars.

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

Interested in having Sally speak to your dental society or study club? Click here.

Team Building Apprentice Style: Lessons Learned from Reality TV

Dr. Nancy Haller
Executive Coach
McKenzie Management

I admit it. I enjoy reality TV. In some ways it's very similar to the coaching work I do. When I am "invited" into the lives of people who otherwise would be "strangers," I hear about how they live their professional they think...decisions they make...actions they take. During team retreats, I watch and listen to how team members interact. I look at the dynamics of the group.

Perhaps because of its business orientation, I find The Apprentice to be one of the most appealing reality shows. Even if you are not a fan of Donald Trump, his success in real estate development is impressive. But he didn't accomplish it alone. He needed a team of trusted staff to complete complex and critical projects. And regardless of the theatrics of the program, The Apprentice offers good lessons in building and leading a team. Here are some of the most valuable ones I've observed:

  1. Earn respect as a leader of your team.
    The best way to earn respect is to create a vision for your practice and communicate it to your team. Be clear and passionate about the goals you intend to achieve. Have conviction about your ideas and plans. It will be reflected in the words you use and the inflection in your voice. Your enthusiasm is a key factor in influencing others.
  2. Live your plan.
    Talk is cheap so remember to practice the very things you say you want, and be accountable for doing what you say you will do. Know your strengths and weaknesses, and understand how you impact others. In particular, be aware of those unhelpful "hot buttons" that sabotage team work. Demonstrate courage by admitting shortcomings and apologizing for mistakes.
  3. Create a congenial, supportive office atmosphere.
    Be a good listener. Be patient. Be open. Encourage the members of your team to express themselves freely. Instill a team spirit by enabling your staff to take pride in their successes, no matter how small. This is the "glue" that pulls individuals together and allows them to work productively to complete team objectives.
  4. Identify the strengths of your team members.
    Undoubtedly you have staff members with different levels of skills and different responsibilities. Acknowledge that each contributes to the team's success. Show that you value the work of every team member by recognizing the importance of each role. Ask employees what tasks they enjoy best and what help they need to complete the things they don't like or don't do as well. Delegate assignments to team members who are best equipped, and most eager, to perform them.
  5. Communicate, communicate, communicate.
    Good teams have a multitude of complementary talents. Each person has strengths to bring to the team effort. But everyone needs to understand what is expected of them and what role they will play. Verbalize your expectations, and do so repeatedly even if you think team members "already know" what is expected of them. As Ken Blanchard says, "catch people doing things right." When you recognize a team member performing their role well, praise them. Reinforce good team behavior.
  6. Learn to resolve conflicts.
    Conflict is inevitable whenever two or more people come together. It is a natural consequence of differing views and opinions. Conflict also signals change and, hopefully, growth. Yet without alignment or agreement, diversity of beliefs can lead to potential problems.

    Be open and accepting of disagreements, but demand that conflicts be handled constructively. Neutralize conflict by helping your employees to talk about their ideas and feelings without any negative consequences. As Steven Covey says, "disagree agreeably." That is, it's ok to disagree with each other but in respectful ways. Keep your team focused on their common goals and on the bottom line.
  7. Build a culture of feedback.
    Feedback is information...about whether team members are "on track" or are veering off course. Learn to give and receive feedback so that the team can improve its performance. Set the example for the team by asking for "progress reports" on your leadership goals. If you hire a new employee, keep in mind that he/she can often see things more clearly than insiders. Even if you disagree with suggestions, let team members know that you appreciate hearing their ideas.

You may not be competing to win a job with The Trump Organization, but if you are reading this, you really mean business! And if you dream of being a stronger team leader, get in the game. Call me. I'll help you take your practice further than you ever imagined.

Email Nancy at

Interested in Building Your Team for 2005?

What Is The "Best" Protocol for Getting Your Recall Patients To Return?

Dr. Allan Monack
Hygiene Clinical Director
McKenzie Management

What are the proper steps in the treatment of the patient at the hygiene visit? How to get your patients to value their hygiene maintenance visits through communication and recall notices?

The Hygiene Visit

A diagnosis-based hygiene department always evaluates the patient's medical and dental history and then asks the patient if there have been any changes or problems since their last visit. The next step is to perform the necessary diagnostic tests which may include all of the following: blood pressure measurements, radiographs, intra-oral photographs, periodontal probing, gingival bleeding index, plaque index, caries detection, translumination, restoration evaluation, cosmetic evaluation, joint sounds, and cancer screening. Once the patient evaluation is complete, a determination of the treatment needs is performed.

If the doctor is to examine the patient, the doctor should be notified at this time that the patient is ready for an examination. This will allow the most time for the doctor to be available to do the examination and enable the hygienist to complete the appointment in the allotted time. If the periodontal condition is stable and it is determined the patient does not need any periodontal treatment, then the hygienist can proceed with the professional cleaning. While there still may be other treatment that needs to be addressed, this can be scheduled at a subsequent visit. It is best if the patient co-discovers any problems during the diagnostic evaluation process.

The Hygiene Return Visit

After the completion of hygiene visit, the hygienist should review the findings with the patient. The patient is informed when it is appropriate to return for the next hygiene visit and why it is important to schedule that appointment when they receive notification. McKenzie Management recommends that the recall notice be placed in an envelope addressed by the patient. While the patient is addressing the envelope, the hygienist is placing a personal note on the recall notice insert. The note should remind the patient of the reason they need to return for the hygiene visit. The office can also market some of the procedures done at the office that may be appropriate for the patient or other family members by inserting a small informational brochure.

A weekly tickler file can be used to store the recall notices. Place the notice in the week the patient is scheduled to return. The notices in that week should be mailed to the patient 3-4 weeks prior to the date the patient is due. If the patient has not responded by one week before their due date, they should be reminded by telephone or e-mail to set up a hygiene visit. Once the due date has past, the patient is automatically placed in the computer as past due. Utilize this report to fill in hygiene open time.

Follow these steps for effective recall return results:

  1. Determine the proper return interval.
  2. Have the patient address their recall notice.
  3. Put a short handwritten note on the recall notice insert to increase a patient's perception of the value of the visit.
  4. The note should be clinically oriented to examine areas noted at the last hygiene visit that need to be monitored.
  5. Establish a 52-week recall tickler file and place the recall notices in the file.
  6. Mail the notices 21-27 days prior to the appointment due date.
  7. Request in the notice that they call promptly to schedule their appointment.
  8. If they are pre-scheduled, call to confirm at least 2 days before their scheduled appointment.
  9. If the patient does not respond within 1-2 weeks from receiving their recall notice, telephone follow-up must begin.
  10. If the patient has not confirmed their pre-scheduled appointment by the day before their scheduled appointment, consider scheduling another patient in that time slot.
  11. Once the due date is past or the patient was a no-show, initiate overdue protocol.

The key to patient retention is communicating the value of the hygiene visit to the patient and contacting patients as soon as possible if they have become overdue for their hygiene visit.

Additional Resource: "Building A Succesful Recall System"

Interested in having Dr. Allan Monack speak to your dental society or study club? Click here.

How Much Of A Raise
Can I Afford?

Employee Salary Review

This form will help you to mathematically determine how much of a raise your practice can afford while keeping your total salary overhead in line with the industry. Instead of making an emotional decision, make an informed decision of how much the practice has to collect in order to give a raise.


Missed Past Issues of Our e-Management Newsletter?

Sally's Mail Bag

Dear Sally,

We are getting around 50% cancellation rate of the new patients that are scheduled. While we try to schedule them with me for a comprehensive exam, they want the "burger and fries" (cleaning and check-up) so we give it to them and then 1/2 of them aren't showing up. We are at a loss of what to do. Any suggestions?

Dr. MacDonalds

Dear Dr.,

My recommendation is to get a recording of what is being said when these new patients call your office. Because you are seeing a negative trend in a "system," the system has to be analyzed. If you have more than one front office person taking these calls then record on both. If you don't feel comfortable informing the new patient that the calls may be recorded for educational purposes then have the front office employees role play the situation.

Based on my experience, there is a strong possibility that something is being said that is turning the patient off. For example the caller asks how much is it going to cost and she says, "Well the examination is $47 and the x-rays are $95 and the prophy is $62 and the diagnostic models will be $71 for a total of $275." "Do you have insurance?" "No I don't." "Well, we do expect payment when you come in and you can pay by check, cash, or credit card." "When did you want to come in?" "Well, I work till 5:00 every day so do you have anything after 5:00?" "No, we take our last patient at 4:00." "I see. Well what is your first available appointment at 4:00?" "My first appointment is 4 weeks from now. Is there any other time you could come?"

The above scenario is quite common. This is a new "customer" who is ready and willing to buy what you have to offer but look at the negatives she has thrown at this patient: "$275 and I have to pay cash when I come in. They can't see me for 4 weeks. I have to take off work." This entire scenario is caused by the philosophy of handling new patients which may not be customer focused but that's the way the practice wants it. It could also be caused by a lack of training to the person answering the phone or not allotting time for new patients or not accepting their insurance or their perception that the fees are too high or x-rays cause cancer...

The bottom line is that you have a trend so you have to start chipping at any potential negatives until you see the trend reverse itself.

Best regards,


Want to Know More About McKenzie Management?

This issue is sponsored
in part by:
The McKenzie Company Upcoming Events
Date Location Sponsor Speaker
Feb. 22 Chicago, IL Bisco International Sally McKenzie
Feb. 24-27 Chicago, IL Chicago Mid-Winter Meeting Sally McKenzie & Exhibit
Mar. 3 Rochester, NY Monroe County Dental Society Sally McKenzie
Mar. 10 La Jolla, CA Southern CA Orthodontic Symposium Sally McKenzie & Exhibit
Mar. 14 Santa Rosa, CA Redwood Empire Dental Society Sally McKenzie
Mar. 17-19 Atlanta, GA Hinman Dental Society Sally McKenzie & Exhibit

For more information, email
or call 1-877-777-6151

The McKenzie Company Newsletter Information:
To unsubscribe:
To discontinue receiving the Sally McKenzie eManagment newsletter,
click on the link at the very bottom of this page for instant removal,
or simply click Reply to this email with the word "Remove" as the only word in the subject line.
To report technical problems with this newsletter or to request technical help,
please send a descriptive email to:
To request services, products or general inquires about The McKenzie Company activities
please send a descriptive email to:
If you would like to have any of your dental practice concerns answered personally by Sally McKenzie,
please send a descriptive email to her at:
Copyrights 1980-Present The McKenzie Company - All Rights Reserved.