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11.25.05 Issue #194  
Marshalling the Fire Power

Sally McKenzie, CEO
The McKenzie Company

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You’ve tolerated the problem as long as you can. You’ve given the employee every opportunity imaginable. It’s time for them to go. But unlike Donald Trump and this week’s failed Apprentice, you can’t just call her/him into the conference room, point your finger, and bark, “You’re fired.” First, there must be a paper trail long and wide leading to this point of no return.

The process of terminating an employee begins well before you’re ready to escort her/him out of the building. Every conversation in which you discuss performance with the employee must be documented. You must explain to the employee verbally and in writing the specific issues that are not satisfactory and document what specific activities need to change in the employee’s performance. You and the employee must have an agreement on what she/he needs to do to improve performance. That agreement must be in writing, signed by both doctor and employee and placed in the employee’s file. You monitor the employee’s progress and give regular feedback and document every single step in the process.  We recommend The Employee Warning Form.

Ideally, at the end of this 60-90 day progressive discipline plan, the employee has had the opportunity to see the errors of her/his ways, make the necessary improvements, and everyone lives and works happily ever after. Unfortunately, the fairytale ending seldom occurs. Many dental practices do everything they can to help the employee become an effective member of the team only to be forced into eventually terminating the individual.

Oftentimes, the primary reason is a poor attitude, which manifests itself in a refusal to perform up to the practice’s standards or negativism that drags down the entire team. In other cases, the employee’s skills are weak and could be improved, but they won’t take the necessary steps to become a more effective member of the team. Or they make a half-hearted effort in which they will improve for a while then slip right back into their old ways.  In some situations, the employee’s conduct is so egregious that it requires immediate termination. Regardless of the circumstances, a cool head and careful preparation are a must. Do not let an employee go when you are angry. Take the following approach to marshal the necessary “fire power.”

  • Patients should not be in the office or expected in the office when an employee is being terminated.
  • Meet with the employee in private but have a witness present such as your attorney, office manager or spouse.
  • Tell the employee that the purpose of the meeting is to release them from their position.
  • Don’t rehash the details of the performance problems. Through the progressive discipline procedures, the employee has been provided numerous opportunities over the past 60-90 days to understand and address the performance issues.
  • Give the employee a check on the spot for earned salary and benefits or tell them to expect payment within a certain number of days.
  • The person then should be escorted to collect their personal belongings and hand over the office key.
  • When the employee is gone, call the team together and inform them that the employee is no longer with the practice. Do not get into any details regarding the dismissal. It’s important that the team hear from the doctor as soon as possible to avoid speculation and gossip. 
Although firing an employee is something extraordinarily difficult for most people, except perhaps the Donald Trumps of this world, once the step is taken most dentists find that it was the best thing they could have done for both themselves and the practice, and typically, it was long overdue.

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Planning For Your First Associate

Tom Snyder, DMD, MBA

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Like all business decisions, the choice to recruit your first associate requires thoughtful planning and consideration of factors that will affect your personal and professional financial success.  Here are several important steps that should be taken to ensure the associateship benefits the practice, your patients, and your bottom line.


An adequate patient base is a necessary component of all successful transitions.  The number of active patients can help determine whether your practice can effectively support an associate. Busy practices show signs of “saturation,” a condition which offers opportunity to grow, by transferring the care of “excess” patients to the new associate, as the practice continues to expand. For a typical general practice, saturation equals 1,500 to 1,700 active patients. Active patients are defined as those who utilize a practice’s hygiene program at least once every twelve months. For practices which skew toward a higher proportion of aesthetic and complex restorative services, the saturation point is even less — roughly 1,200 to 1,400 active patients. 


Conducting a chart audit is the only way to identify how many patients actively participate in your practice’s hygiene program.  Once the chart audit is complete, you will know whether your patient base can support a full time or part-time associate.  If you have 400 to 1,000 patients who have not been seen routinely in hygiene, reactivation efforts should pay a good dividend for your associate. Reactivating seventy percent (70%) of these inactive patients can provide a new associate with a base of 280 to 700 patients.

3. Determine Part-time vs. Full-time Feasibility

It’s unrealistic for many practitioners, especially in an urban setting, to need a full-time associate since the dentist to population ratio is usually lower and most patient bases are smaller.  A “rule of thumb” is for every 200 to 250 active patients, you will require one full day per week per year for an associate to meet their needs.


In many instances, “first-time” associates may not have sufficient clinical or private practice experience. To ensure a smooth transition, a structured probationary period of three to six months is appropriate. We suggest using a scheduling template to assure that your associate meets minimum production goals. During this time, initial production may vary between $800 to $1,500 per day, based upon the associate’s skill level.  Additionally, this is a good time to begin an aggressive patient reactivation program and to schedule reactivated hygiene patients (two to four daily) with your new associate.  Chances are likely that these “lost” patients will accept your new associate as their doctor and will continue with routine treatment.  Subsequent hygiene appointments should be regularly scheduled with your hygienist(s).


Although most associates are paid a percentage of collections, new associates should be placed on a mutually agreeable guaranteed salary for 90 to 120 days.  This takes the financial pressure off your associate during the initial period and lets the young doctor focus on clinical skill enhancement and patient management. 
This time frame also allows the associate’s Accounts Receivable to build up since he/she will be paid on collections.  Nationwide, compensation range varies from 30 to 35% of collections.  It’s all about supply and demand as to what percentage prevails in your locale.


To seamlessly integrate your associate into your practice’s routine, we recommend new associates be assigned to the most experienced dental assistant during the initial months. This simple consideration provides new associates with ample opportunity to learn valuable efficiency tips and patient record keeping guidelines and procedures.  Since an experienced assistant most likely will know reactivated patients, it promotes a good opportunity to acquaint the patient with the new doctor.


With a new associate, communication is imperative. Regularly scheduled weekly meetings are a must to discuss patient and clinical matters.  Monthly meetings are also needed to review practice statistics and to provide a new associate with better insight into his/her progress. These scheduled meetings, as well as having an open door policy for matters of concern, provide opportunity to review practice management issues together, and develop solutions as a team.


Although some practitioners never contemplate selling an interest in their practice to their first associate, those who do must develop a comprehensive plan for the transition. If a transition is the objective, Practice Valuation should be completed within the first twelve months of employment to establish a baseline value.  Terms of the buy-in or buy-out should also be fully disclosed.  With adequate forethought, successful associateships can produce great rewards for both you, and your associate, as your practice matures and grows.

Dr. Snyder is a noted lecturer and author.  He is managing partner of The Snyder Group, LLC, a transition and financial management consulting services firm located in Marlton, New Jersey.  Dr. Snyder has assisted dentists throughout the United States in developing long range plans as well as designing associate and partner relationships.  He is a member of the Editorial Advisory Board of Dental Practice Report. Dr. Snyder can be reached at 800-988-5674

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A Retreat - Not to Run Away, but to Regroup, Reorganize, Reflect, and Relax

Belle M. DuCharme
RDA, CDPMA. Director
The Center for
Dental Career Development

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2005 is coming to an end and where did the time go?  In the busy world of the dental practice, it is defined as time spent serving the needs of our patients.  As a New Year rapidly approaches the time worn “New Year Resolutions” becomes part of daily vernacular.  If you have ever considered an annual retreat for your staff, now is the time to plan one.  It is the opportunity to update your goals for the next year, reflect on the positives for the past year and analyze the negatives to prevent recurrence. 

A successful RETREAT takes planning.  The site of the retreat should be secluded enough for privacy with little distraction yet close enough to conveniences and resources.  A meeting room with a large circular shaped or long square table to allow team members to face each other.  Have a written agenda prepared ahead of time that spells out break times, meal times and personal times.  The Retreat agenda will also list the day’s activities and time allowed to accomplish each activity keeping in mind to cover the entire agenda by the end of the RETREAT.   Prior to leaving for the Retreat post an ideas for discussion at annual retreat form in the team lounge area so that team members will have an opportunity to address individual ideas when given their allotted time to speak.  By posting their intended discussion issue they will commit to being prepared to speak positively and have a goal in mind as to how to achieve the success of the issue.

I was speaking to a colleague recently who said to me, “Belle, the team retreat was the best idea I have had this year.  We came away understanding each other’s roles in the practice and how our personalities affect practice success. We have a new energy that I can’t define.  I think the RETREAT put us all on the same page.  We put our heads together and came up with new systems to manage emergency patients, which typically just ruined our day.  Complaining had become the rule of our day, but working with a team coach resolved many of our frustrations.”

To help you focus and accomplish your RETREAT goals, prepare and bring the following items:

  • Office Policy Manual
  • Job Descriptions
  • Areas of Accountability for each Job Description
  • Clinical Procedure Manual
  • Business Procedure Manual
  • Master Planning Calendar for new year-to schedule off vacations, CE days etc
  • Copy of Mission Statement and Team Philosophy for update
  • Ideas for Discussion Sheet
  • Meeting Rules
  • Office Financial Statement
  • Production/Collection Goals
  • Hygiene Department Goals
  • Fees
  • Office Budget
  • Information on new products and or services that may enhance practice
  • Information on new marketing or advertising strategies
  • Stop watch or Timer
  • Laptop with overhead projector-if presenting any Visuals or
  • Flipcharts and markers
  • Calculators
  • Pens and Paper for each Team Member
  • Positive Attitudes

The Team Retreat ultimately provides you and your team the “how to’s” of developing your practice vision and a plan to make it happen.  The retreat should strengthen the teamwork of the practice and shift the atmosphere to a more productive environment providing benefits such as, improved morale, greater efficiency, less miscommunication, less duplication of tasks and reduction in employee turnover.

Okay, you are saying, I would love to do this but I don’t have the time to put all of this together and I don’t have the confidence or the leadership skills to pull it off successfully.  That’s where McKenzie Management and The Center For Dental Career Development come in.  We can make all of the plans for your Retreat here in beautiful La Jolla, California and provide the best meeting room and adjoining facilities to ensure the success of your meeting. Our professional team has many years experience with team motivation and team communication to create the synergism to take your practice to a new level of success.

It’s a New Year coming and a time for renewal.  Let us help you get there.

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Sally's Mail Bag

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Hi Sally,
Our office has three front office and three back office employees.  We have a consistent problem of tardiness of different employees at different times.  It varies from five to ten minutes late.  We keep telling them to be on time.  They do okay for a while, than slip back into their old tardy habits again.  What do you suggest to get them to work on time?  It's difficult to know how hard to come down on everyone in a way that is consistent and fair and enforceable.  I would appreciate any advice you can give.

Dr. Late No More

Dear Dr. Late,
Bring the team together and announce that tardiness by employees has become a consistent unacceptable issue for the practice. This is against the practice policy and expectations to provide good customer care. It is also not fair to the other employees who make the effort to be on time. To reiterate, we expect you to be at work at xxx time. Any infractions of being late will result in a written employee warning which you will receive a copy and a copy will be put in your file which will be part of your performance evaluation. Performance evaluations are used to determine salary increases and continued employment with the practice. This enforcement of the practice policy will start immediately. Does anyone have any questions? For reference you can find this employee warning form on my web-site.

I hope you will find this helpful.

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