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1.18.08 Issue #306 Forward This Newsletter To A Colleague
Associate Dentists
Employee Termination
Marketing Mediums

Will the new Associate Dentist End the Perpetual Pandemonium?
by Sally McKenzie CEO
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Would you buy a car if the salesperson said to you, “It’s really a great vehicle when it works?” Of course not, you would turn and walk away. You’re not going to pour thousands of dollars into something you cannot depend on. Unfortunately, that seems to be how many associate relationships turn out. Lots of money is poured into them, their track record of success is generally weak, but when they work, they’re great.

Why do so many fail? Oftentimes, it boils down to unclear or mismatched needs and expectations. The hiring dentist may feel he/she is so busy that another doctor is warranted and he/she believes the new dentist will stem the tide on the perpetual pandemonium. Or the senior doctor may be nearing retirement, and wants to offload the less pleasant work to the new dentist so she/he can focus on other things. In some cases hiring dentists view associates as extensions of themselves. They assume that the new person will come in, fall in line, produce, and keep their mouth shut.

The associate doctor, meanwhile, is likely entering practice with a huge amount of dental school debt –as much as $250,000 in some cases. The economic realities are such that most new dentists are not in a position in which they can take many risks. They require profitability and security. Therefore, they are looking for an established base of patients. They want to work with a trained staff that functions well as a team. And they’re looking for mentoring from the senior dentist in the management of the practice as well as in the diagnostic and treatment aspects of the dentistry. There’s a lot riding on this opportunity and they want to get the most out of it. And that is often where things start to fall apart. The associate has specific needs while the hiring dentist may have very different wants.

In the “too busy” practice, the hiring dentist convinces him/herself that the new dentist can just step in and help control the chaos. Unfortunately, as I’ve said before, the “too busy” practice is too often an indicator of key management systems run amok rather than too many patients to treat.

The associate, looking for a stable environment in which she/he can grow as a professional, walks into swirling mayhem. The office is operating in a perpetual state of crisis because the senior doctor will not address the problems, refuses to delegate, and wastes valuable production time on tasks that the assistant should be handling, and so on. The senior doctor isn’t too busy; she/he’s too inefficient. Aside from trying to put out fires, there’s not enough real work to keep the junior dentist busy.

In other cases, the senior dentist has been cutting back in preparation for retirement. The doctor might have had a thriving practice that was bringing in $800,000 a year, but whittled it down to $300,000. However, overhead remained unchanged, and the senior doctor mistakenly believed that the associate would boost revenues right away, an expensive and incorrect assumption that neither could afford.

When it comes to determining the need for an associate it has to be the hard data that drives your search for another dentist.  You must know without a doubt that there are enough patients to not only keep doctor and associate busy but support the two of you as well as the practice. You have to know that there are more patients than you can handle – not just think that’s the case.

How much is enough? 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. And practices that are eyeing the resumes of potential associates should be seeing new patient numbers in the area of 30-35 per month before the practice is ready to make the investment in a full-time associate.

The industry’s general indicator is that a solo general practitioner should have a minimum of 2,000 active patients – not 2,000 patient records in the system. And just because the patient has a sticker on their record indicating that they’ve been in during the past year doesn’t necessarily mean that they should be counted in the ranks of “active” patients.

Next week, before you hire an associate make sure you understand who your “active” patients really are.

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 3

We opened this series of articles by explaining how you can reduce the potential for a confrontational and even dangerous termination. The risk reduction starts with you having a solid employment relations policy that each employee reads, understands and signs before hire.

We also provided examples of how a termination poorly planned can result in the employer being hit for false imprisonment, assault, battery and a host of other potential claims. The second in the series provided strategies for controlling the situation and easing anxieties over terminations. We continue on here.

Record the termination meeting?
Employees sometimes ask to record the meeting, if they suspect it will be a termination. Many human resources managers refuse to allow recording the session. This is a real mistake. Think how it will play out in front of a judge/jury that the fired employee asked to record the session and was denied. If the employer tries to contest an employees’ claim as to what happened during the session it will cause the employer to lose credibility.

The best evidence is an audio [or, better yet, video] record. Consider deciding to document it yourself without waiting for the employee to ask.  A microcassette recorder works well and is inexpensive.

Main Steps

  1. Test the recorder to make sure it picks up voices clearly where the participants will be sitting.
  2. Ask the employee at the start if he/she objects to being recorded. If the answer is “yes,” simply turn on the recorder at that point, state your name, date, location, name of the employee, that the employee is present, and that there has been an objection to recording the meeting, and ask for the employee to confirm that, then turn it off.
  3. If no objection, go on the record, identify yourself, everyone present, date, place, get the employee to affirm that he/she knows the meeting is being recorded and agrees to it and be sure to state  the employee will receive a copy.
  4. At the conclusion, confirm that it is over, reaffirm you will supply a copy to the employee, state the time, then turn it off.

Conducting the meeting
Hand the employee the termination documents at the beginning. Be straightforward with your determination to terminate the employee. Offer the opportunity to read the termination letter at that time. Do not elaborate on the issues in the letter. This was covered previously. Answer any questions about the issues by referring back to your policies and the letter. The termination letter should say what you need to say.

Employee threats
Often you are hit by the employee with “I’ve already talked to an attorney, and the attorney says I can sue you!”

Do not take the bait in getting into a Q&A with the employee. If you’ve done your homework and documented what you need to, you have nothing to fear...except fear itself.  Never use as a reason for a termination that the employee has threatened litigation. Depending upon coverage of the anti-discrimination laws, you may be creating a cause of action for retaliation that would not exist absent the express basis for the termination.

Employee entreaties
Do not give in to the employee that breaks down and begs for another chance. Once you reverse the termination, you will never be able to terminate that employee. Don’t say you are sorry. Your words are critical – which is why we counsel to use so few. You may certainly say, “I’m sorry you feel this way.” Say no more than that.

Do not agree to give any reference, or to assist the employee in finding work. Any offer or agreement to do so commits you to action, and you want to end that relationship. Moreover it can be construed in unemployment issues as an admission the employee was not as bad as your letter says.

Finalizing the termination
If the employee has personal items that he/she wants to remove, facilitate that by having a box ready. Do not pack the employee’s things before the meeting – you may be subject to a claim of loss or theft. While recording, you or someone else, should accompany the employee to the work station as they pack and leave. Make sure the employee returns any property of the practice. You may need to change passwords and re-key office.

When you inform the staff of the termination – best the next working day – limit your statement to the fact that he /she has been terminated and make no statements as to why. Assure the staff and maintain that you are open to any questions that anyone may have and will answer in private.

Final actions
Make sure to send a copy of the recording to the employee by certified mail. Keep a copy of the cover letter and certified mail receipt in the confidential file for this employee.

If you receive communication from a lawyer, respond quickly and provide him/ her with everything you have in the file. Holding out only looks like concealment to a plaintiff’s lawyer – and he/ she can always get the documents by suit and subpoena. In a number of states, the employer is required by statute to give up the files. Be confident that you have done all you need to do, and can do.

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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Scott McDonald
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Striking a Happy Medium (or Media) in Dentistry

While almost everyone now accepts that some external marketing is helpful, very few know enough about choosing external marketing media to make an informed decision.  This little primer is not a comprehensive list or media choices nor is it a list of priorities.  McKenzie Management can provide you with a detailed Marketing Report that will suggest specific media outlets, frequency (rate of repetition), and even costs.  The dominant “lifestyle groups” or “demographic/psychographic cluster groups” are described in detail in this Report.

Yellow Pages
When I first started speaking on Dental Marketing for the California Dental Association, yellow page advertising was the first BIG medium of dentistry.  “If a little works well, then a LOT will work better,” went the common wisdom.  Not so!

We have seen dentists snap up the “double truck” positions in the yellow pages (full pages that face each other) with gusto and NO idea how well or poorly these ads will deliver. In fact, full-pages are not as effective as those smaller ads that also have alphabetical phone listings also on the page. The effective size of the ad and its position are a function of several factors including the “lifestyles” of the people who read the ad. Ironically, the poor and less educated are often more influenced by a large ad than are those with money and more education.

Direct Mailers
The traditional direct mail piece for dentistry is a “self-mailer” (no envelope) that offers a free discounted entry-level service like an examination and X-rays. This is effective with some lifestyle groups but it can hurt the practice as well. The biggest slam against this format is that it attracts “shoppers” who want no long-term contact with the practice. 

We have found that inducements that are specific to the target market are advantageous. Want families with children? Value-added offers that include a premium work well. Want older fee-for-service adults? Offer a certificate worth $200 toward any treatment after they have paid for an examination, cleaning, and X-ray. Each lifestyle group will have a mailer format and offer that will work best for that group.  Post cards, envelopes, brochures, and newsletters each work with some groups but can be ineffective with others.

Mailing Lists
There is a theory that the best target for an advertisement is new move-ins. This is a good theory but a bad practice. New residents are often inundated with ads and mailers. They often move from a location not far from their previous home and still retain contact with the previous dentist. As an alternative, we believe that a demographically selected group will be a better target for a mailing than one directed at residents. Don’t send mailers to those you either don’t want or who don’t want you.

Radio can be useful in the right setting with the right audience and a complete waster of money in others. This is a function of population density, lifestyles of listeners, and the marketplace. Every radio station will be strong in one demographic group at one time during the day (defined as a “day-part’ media-speak) and weak in others. Radio stations are selected FIRST upon the format of the station as it relates to the target market and SECOND upon its reach (how far the signal travels) and penetration (the number and percentage of the target market hears the message). THIRD is the issue of budgets. Some very expensive “flame throwers” offer good deals if the right ad-buy is negotiated.

Television and Cable
Closely associated with the means of purchasing Radio time, the specific programs are measured against their proven cost-effectiveness of reaching a particular audience. Ironically, cable television can allow for a more targeted buy because competing cable providers may serve the same community.

The difficulty with Television and Cable is the commitment one must make to create the commercial itself. It is an easy way to let $10,000 slip away.

Newspapers are purchased based upon their circulation AND penetration.  Often the section of the paper in which an ad should appear is determined by the penetration of that section with the market we are considering. Regionalized issues may or may not be a desirable option because our target audience may not read that section.

 Radio, Television, and Newspaper advertising should never be considered a short-term advertising media. They require a commitment of several months.

We have considered many old (billboards) and new (internet banners) technologies for dentistry. All of them work BUT none of them will work for everyone.  That is why some good old-fashioned market research will go a long way toward building your practice.

If you are interested in a Community Overview Report that will help explain what your practice area is like NOW and what it is becoming IN THE FUTURE, go here.  Community Overview Report

If you would like more information on how McKenzie's Practice Enrichment Programs can help you IMPLEMENT proven strategies….. email

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