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1.4.08 Issue #304 Forward This Newsletter To A Colleague
A Bigger Office
Hiring More Staff
Budget Targets

Donít Expand Until You Do This!
by Sally McKenzie CEO
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That’s it! You’ve had enough. You have been running from dawn until dark for more days, weeks, and months than you care to think about. It’s time to take action. The insanity is too much. You need help whether it’s more staff, a bigger office, possibly an associate; the time to expand is now. You can’t keep doing what you’ve been doing, and what could be more convincing proof that you need a plan for expansion than the insane schedule, the fact that patients cannot get an appointment, and the sheer stress of it all.

Ah yes, another emotional reaction to the rigors of running a dental practice. Now don’t get me wrong, I’m not minimizing your struggle. Believe me, I understand. I’ve been working with dentists in your predicament for years. But here’s the point: The stress, the packed schedule, and craziness of it all are not proof that you need more help or that you need to expand your space.

I hear from doctors all the time who say they can’t keep up with demand, patients are booked out weeks, and hygiene doesn’t have an opening for at least another season and probably two. So what are you supposed to do? You’re bursting at the seams. If you had more space, you could hire more help and this would all be so much more manageable, right? Wrong.

The obvious solution is not always the right solution. In this case, dentists routinely convince themselves that they can afford to move into a larger space with just a smidge more production. They give zero consideration to the fact that they are going to shoot their facility costs well beyond the 5% budget target. Look at what happens to this doctor’s expenses:

Dr Elizabeth produces $25,000 per month. She collects $21,000 per month and she wants to move into a new facility with a total rent of $2,500 per month, which would be a $1,450 increase over what she is paying now. She justifies the increase by telling herself that a couple more crowns per month will take care of it – nada problem. If it could only be that simple we'd be in great shape. With a $2,500 per month rent bill, Dr. Elizabeth will have to collect a mere $50,000 – yes that would be Fifty G’s each month to stay within the 5% guideline. Therefore, she will have to increase collections by a whopping 29 grand to cover that itty-bitty, little $1,450 per month rent hike. That’s a pretty big smidge in production, wouldn’t you say?

Dr. Elizabeth’s stress has just gone through the roof. She now has a huge mortgage, wasted space, and she’s still running from dawn till dark. Worse yet, she’s hired more staff and her overhead is so high NASA is considering classifying it as a separate constellation.

The problem: Well, there are several. First of all, the bigger space didn’t attract more patients. In fact, in the move Dr. Elizabeth lost patients, but she now has more people to pay and significantly greater facility costs. Before she ever signed her profits away for the next 30 years, she needed to consider a number of factors, chief among them, the illusion of the overcrowded schedule, starting with hygiene.

The hygiene department tends to be where the greatest disconnect occurs between illusion and reality.  Although the days look completely booked, too often not a soul is paying any real attention to the multitude of cancellations and no shows.

Worse yet, just because it’s jam-packed doesn’t mean it’s profitable or could support another hygienist. Instead of more hygiene hours, what the department does need are production targets and a designated Patient Coordinator to help it achieve specific goals.

And Goal #1 for every hygiene department is that the hygienist must be booked to produce three times her/his salary. For example, a hygienist paid $350 per day must be scheduled to produce $1050 in practice income. Goal #2: The hygiene department should be producing 33% of total practice production. But the hygienist can’t achieve those goals without the Patient Coordinator. This person is responsible for scheduling the hygienist to achieve financial goals and fill unscheduled time units daily. It’s her/his responsibility to ensure that there is no more than half an opening a day in hygiene.

Next week, you may not need more space, just a better understanding of supply and demand.

Interested in speaking to Sally about your practice concerns? Email her at
Interested in having Sally speak to your dental society or study club? Click Here.

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Michael Moore, Esq.
Director McKenzie
HR Solutions
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Separating Yourself from a Bad Employee Part 2

In the first part of this series, we talked about how the good employee can go bad and how a solid policy can dramatically reduce the possibility of that employee leading you into a crisis, and what the potential legal liabilities can be for a termination gone wrong. It cost CinCom Systems well over $200,000 in damages and attorney fees to learn the lessons we are about to go into here.

Why counseling and discipline don’t work with this person.
Trying to correct behaviors in these individuals is useless by the point that serious disruption and confrontation is occurring. Whether because of a heretofore hidden personality disorder, continuing dislocations in personal life, or just meanness, you cannot help this person get back to productivity and team spirit. The decision to terminate must be made, and quickly, for both business reasons and the doctors’ peace of mind.

Setting up the termination.
As I counsel on all terminations, you must prepare a termination letter. If there are previous counseling documents that were given to the employee, those must be copied again and must be attached to the termination letter.

The termination letter is a critical document. Many employers are under the misapprehension that they will be better off if they put nothing in writing, and, in fact, do not give the employee specific reasons for termination. Although addressing that issue is the subject of another article, do not give in to the wish to avoid the letter.

The letter should be short, but direct, summarizing the past issues, past counseling [whether or not you gave any documents to the employee confirming that], and behavior and performance concerns. If you have specific data that shows loss of patients or revenue, make sure to include that in the letter. If there have been patient complaints, make sure those were documented and identify them.

Hopefully, you have an employee relations policy, and the employee has received that policy. Your termination letter should refer to the specific provisions in the policy that the employee has violated. For example, the McKenzieHR policy handbook has a non-exhaustive list of behaviors that justify termination. If the employee has, for example, threatened another employee, reference the specific provision, and any others that apply.

Your letter should include information on the employee’s pension or profit-sharing, if any, outstanding sick leave or vacation [if you have a cash-out sick or vacation policy], conversion of health insurance, or any other benefits issues.

Finally, if you feel that it is necessary to re-key the premises, or make other changes, if your employee policy provides that the employee may be charged with the cost of such actions, if the circumstances warrant, you may be able to deduct that cost from the employee’s last check.

There must be a meeting. You should not, and cannot, avoid sitting down face-to-face with the employee unless circumstances absolutely do not allow it. If the employee, for example, has walked off the job, hasn’t shown up for work, and you are not sure if they are returning, it would be permissible to have the letter delivered to their home by courier, making sure to follow up with letters sent both by regular and certified mail.

The dangerous employee
If, before the meeting, you have reason to suspect that the employee may become abusive or even violent, prepare. This does not mean hiring a security guard to stand outside the room. The presence of a large man in a uniform might cow some individuals, but only inflame others.

We recommend that you (1) hold the meeting after patients and co-workers have left the facility, (2) have someone else in the room with you, and (3) notify the police in your area of the possibility of some disruption, and have the number on speed dial.

An additional consideration is the employee whose spouse or significant other is the potentially violent actor. If the other person comes to the office, of course they must be politely told that they will have to wait outside the office.

In the last part of this series, we will address some specific issues in terminations that can go a long way to reducing the confrontation, and documenting for your protection.

Mike Moore is ranked among the best in employment law and named one of the top 10 lawyers in Ohio.  As Director of McKenzie’s HRSolutions, Mike is the creator of The Employment Policy and Handbook geared to provide dentists who are unsophisticated in the legal arena with a step-by-step policy manual.
For more information  Click Here.

Interested in having Mike speak to your dental society or study club? Click Here.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
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Goals for 2008
Plan Your Work and Work Your Plan

The hustle and bustle of December is behind us. Another 365 days lies ahead.  There’s renewed hope and optimism about possibilities in the year before us. Thoughts turn to resolutions and goals.

What do you want to accomplish in 2008?
What is your practice vision over the next 12 months?

As both the dentist and the practice leader, your job comes with many challenges and responsibilities. If you do the job right it can be very rewarding. To prosper, you and your team must accomplish big things this year. Getting those things done takes effective leadership.  

Start with your mission.
Your mission should be summarized in a sentence or two. Using basic language describe the purpose of the work you do and the values you espouse. If you aren’t sure, answer this question: What gets you up each morning and out the door? Set aside some time to think about what’s most important to you. Schedule a staff meeting and ask your team to participate in writing the practice mission statement. 

Once you have established the essence of what you do, break your mission into manageable, ‘bite-size’ sub goals. Your employees need to participate in this process too. After all, your ability to achieve your goals largely depends on having your staff’s ‘buy-in’. Research shows that by involving your team in setting the goals, they will be more motivated to achieve them.

Establish priorities by answering the following questions:

  • What needs to be accomplished?
  • Why does it need to be done?
  • When does it need to be accomplished?
  • Where am I/are we now in relation to this goal?
  • Who will be involved in accomplishing this?
  • How will it be accomplished?

Think through your plan carefully but avoid the ‘paralysis-by-analysis’ that happens for those who are perfectionists. It is far better to get going fast and make mid-course corrections as necessary.

Once the goals are identified, move into the planning phase.
Plans provide the direction, focus and organization you need to stay on task. It is important for you and your team to evaluate yourselves periodically. A good span of time tends to be 30 days, or once a month. By monitoring and measuring your actions along the way, you will know if you are on track. This kind of feedback allows you to adjust and stay aligned with your goals.

Having systems and structure in place is crucial for practice success. If growth is a goal, you need to know the number of new patient visits. Being informed about your financial status will enable you to make decisions about marketing and advertising. Another essential source of practice feedback is your staff. Meet with each employee individually and regularly. Schedule frequent team progress checks as part of the planning process. If you are making a decision that impacts your staff, ask for and listen to their input. Be sure to tell them how their functions, actions and contributions are vital to your practice.

Work your plan
Periodically answer the following questions, individually and as a group:

  • Is each goal still valid and doable?
  • Are we where we should be in terms of attaining each goal?
  • Have any conditions or circumstances changed since we originally set our goal?
  • Do we need to make any changes to our goals, our action plans or our performance levels?

Maximize the resources available to you.
Be mindful of the ways you use your time, money and employees. Make the most of your time by prioritizing your tasks. Start and end meetings promptly. Post agendas in advance so that employees will be prepared to discuss issues. Make the most of your money by buying in discount bulk whenever possible. Comparison shopping will net the best price on materials, supplies, and services. Be proactive on preventative maintenance for your equipment. Make the most of employee talent and expertise. Identify each person’s skills and interests. Determine if they need training to handle their respective responsibilities. Encourage your staff to cross-train one another whenever this is feasible.

As the old saying goes, if you fail to plan, you plan to fail. Get 2008 off to a great start and set the year in motion. Happy New Year to you!

Dr. Haller is available for consultation and coaching. Let her help you with your 2008 goals. She can be reached at

Would you like to elevate your practice? Invest in yourself and become a more effective leader.  Inquire about Dr. Haller’s Leadership Training Course  1.877.777.6151 Ext. 21.

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