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4.28.06 Issue #216

The Ultimate Preparedness Plan: Job Descriptions

Sally McKenzie, CEO
The McKenzie Company

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The devastating hurricanes of last summer, the heavy snows and rains of winter, and the hundreds of spring tornadoes that have roared across the country recently forced many small business owners to reevaluate, if not establish, their disaster plans. Nature’s fury might have even prompted some of the more conscientious to make sure they are paid up on their disaster insurance premiums. They can rest at least a little easier knowing that if Mother Nature comes out swinging through their neighborhood any time soon, they’re covered. Batten down the hatches, go to a safe area, and wait out the storm.

Unfortunately, while you may be among those who’ve taken necessary steps to prepare for the “big one” which may or may not occur some day in the near or distant future, too few of you give much, if any, thought to ensuring that you prepare for a far more common calamity. This one may not blow the roof off your practice – at least not all at once- but it will leave you flooded with anxiety and constantly scrambling to pick up the pieces. But no blaming the whims of Mother Nature, the disaster I’m talking about is purely of your own making and completely avoidable. Are you heading into the storm? Let’s check the barometer. 

It usually starts with a fair amount of aggravation precipitated by employees who aren’t carrying out their responsibilities. For example, Carol isn’t scheduling appointments correctly. The temperature rises as the day and stress pile on. Jill’s approach with patients seems to change with the wind. One minute she allows any and all to slip out the front door at the first hint that they may not want to pay today, the next, quick as lightening, she’s pummeling them with the financial policy – absolutely no consistency in her approach and it’s blistering the bottom line. And then there’s Mary Beth who should be one of the rainmakers, yet she almost never reinforces treatment recommendations when she sees patients for their oral hygiene visits. Inefficient, ineffective, unproductive, unfulfilled. Yep, conditions are favorable for a major squall.

Perhaps it’s time you created a better, much more predictable forecast. Start by answering a few questions. What steps have you taken to ensure team members are clear on their responsibilities? Have you told employees what you want and exactly what they are supposed to be doing? If there is a 2 p.m. hole in the schedule, does Carol know definitively that it is her responsibility to fill that opening and to schedule to meet daily production goals?

Oftentimes doctors cannot comprehend why employees don’t carry out their assignments as they expect them to, after all the dentist knows what he/she is supposed to do so she/he assumes the staff understands their duties as well. It seldom occurs to the doctor that they actually have to spell out specific responsibilities in the form of job descriptions for employees. The reaction is typically along these lines, “Well she worked in a dental practice before. I thought she understood these things.” Or, “I’m pretty sure we talked about that stuff in the job interview.” Or, “Don’t you think that should be common sense?” Or, my personal favorite, “I’ve told them what I don’t want.” Meanwhile the team is left to merely drift along.

Employees rely on the doctor for clear, fundamental direction as much as the doctor relies on the staff to keep the practice moving smoothly in the right direction. But too often the most elementary tool for ensuring everyone is on track, the job description, is never utilized. It’s the “preparedness plan” for every position on the team, and if it’s not in place chances are pretty good that those routine clouds that float into any day swirl into far more serious storms with little warning. Next week spell out the duties and plan for sunny days ahead.

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"They All Want Raises!"
A McKenzie Management Case Study

Nancy Caudill
McKenzie Management
Senior Consultant

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This case study is an illustration of a dental practice that may be similar to yours. The names have been change to protect the guilty!

Case Study #66
Dr. Dan Goforth

“Revolt! Revolt!”  Dr. Goforth was in a panic.  It appeared that his staff of four conspired to hold him hostage and demand raises or they were all going to walk out the door.  My first instinctive reaction was to protect the doctor.  “How dare they?  After all you do for them?” I questioned.  But then, experience took over and I reminded myself that there are always two sides to every revolt.

Dr. Goforth Facts:

He has no protocols for annual salary or performance reviews.
He hasn’t given an increase in wages to any employees in two years.
There are no job descriptions or accountability for his staff.
He is unaware of his practice overhead percentages compared to collections.
His practice has experienced steady growth.

My question to Dr. Goforth at this point was:
“Why did you give them a raise two years ago?”

“Because they threatened to leave me at that time too!” he responded defensively.

Okay, we have a pattern now.  Dr. Goforth needs some education on how to avoid his confrontation in the future and tools to put out his immediate fire now.

Immediate Action:

Retrieve and review the Profit & Loss report for the past 12 months to determine what percentage of his collections is going toward salaries and benefits.  A healthy practice guideline is 19-22% for gross salaries and 3-5% for benefits (this includes matching social security, workers compensations, healthcare, retirement etc.)

If the percentages are below the “industry guidelines”, the practice could afford to provide salary increases NOT to exceed the 22% maximum. Dr. Goforth was presented with McKenzie’s Salary Review work form in order to determine how much of a raise he could give.

Use performance measurements that are geared toward each employee’s job description to determine each person’s contributions to the practice.  Not all employees are created equally so it is not necessary to apply an increase to each employee equally.  Base any raise decision on their performance.

Interview each employee individually and express your regret that they brought this to your attention before you did.  They have helped you to recognize that you need to implement an annual review of performance and salary (not to be confused as one of the same).  From “this day forward” these reviews will be conducted on an annual basis and it will not be necessary for them to come to you to seek evaluation and consideration.

Present each employee with their performance review and because of their hard work and dedication, the practice collection number has increased in order to allow you to offer a $_____/hour increase.  

Future Action:

At the next monthly staff meeting, share with your staff the seven overhead categories that you use to determine the health of the practice.  Educate your staff about the practice as a business.  Did you know that your staff thinks that all those deposits that are made each day go directly to your wallet?

Help them to understand that salary increases aren’t automatic – the decision to increase payroll is all predicated on the collections vs. payroll percentage and they can have a direct effect on this statistic.  This will also allow them to accept a possible year without a raise because the collections for the year were not sufficient to warrant the 22-27% total salary and benefit goal.

Good employees are hard to find and can be harder to keep because they are aware of their value to the practice.  Don’t let the good ones get away because you fail to stay on top of timely reviews and potential salary increases. You will gain their respect and appreciation and will continue to work hard.  They now realize that they do have the power to control their financial future with you!

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Your Office Building May Be Lying to You

Scott McDonald

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The practice model of an office cannot be separated from its physical appearance, layout and location. You may WANT an upscale, fee-for-service practice, which emphasizes cutting-edge cosmetic dentistry. But if the location of the office, the demographics of the local population, and access to major transportation arteries are not suitable for such a practice, it makes more sense to put lipstick on a pig and call it the Prom Queen.

So you are faced with a choice: Either you can move the office to a location more suitable to the kind of practice you want OR you can change your dental model to one better suited to the area’s demography. Of course, a significant percentage of dentists choose NOT to choose and continue down the path of practice, blithely ignoring what reality is shouting to them: Open Your Eyes.

Every practice needs a demographic overview to help determine if the practice you want is the practice you can have in your location. Not long ago, a pediatric dentist asked if the lack of success in his practice near a resort town might have something to do with demographics. A quick analysis told us that his problem was simple: nearly all the children likely to go to a pediatric dentist in the region were “seasonal.” The “year-round” residents were much more prone to practice “home-based dentistry” which included significant self-medication and extractions. Our research showed that by moving the practice a fairly short distance “down-the-hill” would give him significant benefits in that he would be closer to a larger referral base AS WELL AS a larger potential patient base.

We don’t expect that every dental practice will have such an obvious answer but we DO believe that a Community Overview Report will help inform the doctor about potential target markets and the reality of how “aligned” a practice area and dental office are to the goals and business model of the doctor.   In the event that the determination should be made to move, this same Report can provide insights into where one can relocate while retaining the best part of the current patient base. It can even take into account “drive-times” and “growth pockets” that may be developing near the site.

Choosing a realistic “target market” is another benefit to this kind of market research because each location is dominated by different “demographic types” or “psychographic groups,” it is possible to include messages and media that are specific to that type or group. In short, targeting makes all marketing more cost-effective because it can help develop a message and deliver it through a medium that matches the preferences, needs, and wants of that specific subset of the population that the practice WANTS as its primary patient base.

The more specific you can be about your goals and expectations when requesting a Community Overview Report, the more accurate the recommendations will be as well as being specific to your needs.

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