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11.7.08 Issue #348 Forward This Newsletter To A Colleague
Pay Raise-Can You Afford It?
Practice Acquisition
Dentist Coach

Pay Raise - They Deserve It. Can You Afford It?
by Sally McKenzie CEO
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Managing the ever-touchy issue of employee compensation is a challenge for virtually every dental team. Reward some people and you seemingly punish the rest. Reward all and you appear to value excellence no more than mediocrity. It’s a management minefield for most dentists who struggle with balancing the financial needs of the practice with the financial desires of the staff. How do you navigate this tricky issue? Manage expectations.

Certainly, it’s imperative that employees understand how their roles fit into the overall success of the practice. And it’s critical that they have a clear understanding of the financial health of the practice. But above all else, effectively handling the matter of money with your staff requires that you manage their expectations from the outset. It starts day one—not six, eight or twelve months after the employee comes to work for you. Spell out the guidelines the first day the employee becomes a member of your team. Explain when raises will be discussed and under what circumstances a raise will be given.

I recommend this approach: Jess, your yearly salary will be reviewed on your one-year anniversary date. At that time, any increase in your salary will be dependent upon your performance and contributions to the practice as well as the financial condition of the business.

This makes it clear that raises are not given merely because the employee stays with the practice for a certain number of months. Rather, raises are a form of recognition for an employee’s commitment and willingness to learn and grow as a team member.

However, in order for the employee to hold up his/her commitment to the practice, the doctor must hold up his/her commitment to the employees. This means that every staff member must be given a specific, results-oriented job description and have regularly scheduled performance reviews.

For example, if Jess is your new dental assistant, her job description should include things like attending beginning of the day meetings, completing case presentations, reinforcing the quality of care delivered, directing the doctor to check hygiene patients, completing post-treatment care calls, converting emergency patients to new patients, turning the treatment room around promptly, etc.

Jess should also know which quantifiable measurements will be used to gauge her performance. For example, she needs to know that you expect her to achieve an 85% case acceptance, that she is to give a daily report on her post-treatment calls, that she should be converting 75% of emergency patients to comprehensive exams and that she should be able to keep the cost of dental supplies at no more than 5% of practice collections. In addition, you should be able to see the distal of the cuspid on every bitewing X-ray, you should never have to reach for an instrument on any set-up and the molds Jess pours should be free of defects.

When you and Jess both know what is expected you can better assess if Jess is just doing her job or truly making a difference in the practice.

So if Jess truly is a key contributor to the team, if she’s working hard and she’s delivering on her job expectations, after a certain amount of time she wants and expects a raise. Understandably, the doctor feels an obligation to reward the employee. But what if the practice cannot afford it? What does the doctor do? Go back and review what I said a few paragraphs back: Enhanced compensation is contingent upon the employee’s performance as well as the financial health of the practice. If you and your team regularly review the numbers in the monthly meetings as I discussed last week, everyone should be well aware of where practice’s monthly collections stand.

If your practice follows industry benchmarks (as it should), the team realizes that wages should be in the 19–22% range of gross collections, not including the doctor’s salary or taxes/benefits.

If your current monthly collections are $48,325 per month and your existing salaries are $9,353, a $2 hourly raise for Jess from $15 to $17 for a 36-hour work week would increase existing salaries to $9,665, which is within the 20% industry benchmark. However, if your current monthly collections are $39,000 and existing salaries are $9,353, that raise would put you at 24% of gross production and well above the standard. You and your team need to focus on strategies for bringing in more money before the practice can afford to hand out any more.

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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Team Building Event of the Year!

Angie Stone RDH, BS
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Practice Acquisition

In a previous newsletter article, the issue of dentists not employing hygienists and the pros and cons of this decision were examined. Let’s take that topic a bit further. What is the impact on an existing practice when the dentist acquires a practice from a dentist who has never employed a hygienist? Thoughts of acquiring another practice probably conjure up thoughts of increased production which could in turn result in increased revenue. Though this would more than likely be the case, there are many other things to consider.

During the preparation phase of acquiring a practice, there is talk of how many active patients will be acquired, what the cost will be and fixing the acquisition date. There should be regard for how the acquired patients will be accommodated by the existing hygiene department. Typically, an increase in patients would mean an increase in production, but this cannot happen if the current hygiene team cannot accommodate the extra patients.

The number of patients being acquired is important, but it is even more important to learn how many patients are on the selling dentist’s active recall. If there are 1,000 patients on the recall system, the buyer needs to determine how many more days of hygiene the office will need to incorporate in order to keep these patients timely with their established recall interval, and then decide if or how the office can do this. If patients need two professional cleanings and periodic exams per year, you will need to add 2,000 more appointments annually. If the hygiene department works 48 weeks per year, the practice will need to see 41 more patients weekly. Seeing 10 patients a day would require four more days of hygiene per week.

The buyer needs to determine if the office has the staff and facilities available to handle this increased patient base and the flow of new patients who will expect to be seen within a week or two. Patients who need to change providers will appreciate being able to get in for an appointment in a reasonable amount of time; otherwise, they will call another office. They have no ties to the buyer’s office so making the decision to seek treatment elsewhere is not a difficult one. The buyer should take this into consideration if they are interested in increasing production/revenue by acquiring another practice.

Bridge The Gap

In addition, the dentist should know if the seller employed a hygienist. If he/she has not, the recall appointment will be a new experience for the patient. It is possible they have not experienced scaling, periodontal charting or much else in the way of oral hygiene instruction from a dental hygienist. If there was a lack of professional cleanings by a hygienist, these patients more than likely will have large amounts of subgingival calculus and active periodontal disease. Scheduling these patients for recall visits must be reconsidered; you might schedule them for comprehensive examinations instead. Scheduling in this fashion will allow time for the hygienist or dentist to assess the needs of the patient thoroughly. If the need for periodontal therapy is determined this poses yet another hurdle. The patient has been seeing a dentist for many years and maybe has never been told anything other than, “Everything looks great!” Now, a new dentist is identifying problems. The patient has not developed trust in the new dentist and may be skeptical about what he/she is saying. If this situation is not thought about and handled properly, this can end up being another reason the patient may not continue to be a patient at the buyer’s office.

Prior to the acquisition, the doctor and team should determine how they will communicate these changes to the patients. Scripted answers to anticipated questions should be developed. Patients will inevitably ask why their other dentist didn’t tell them about this. The response should be along these lines: I cannot answer for your previous dentist, but as you can see from our examination there are pockets present now that are not normal in health. The advancement in periodontal diagnosis and treatment in the last few years enables us to treat this disease earlier and with less surgery. Fortunately, we discovered the gum disease and we may possibly be able to improve your condition.

Another common question is, “How could my gums be this bad? They don’t hurt.” Consider this response: Jane, gum disease is often painless until the final stages. Do you know anyone that has high blood pressure? That condition is often painless and until detected by your doctor may go unnoticed, yet it is certainly a very serious condition. Just as you would be concerned about your blood pressure and getting it under control, the same applies to the health of your gums and supporting bone. If undetected, the first sign of high blood pressure is often a heart attack. I would not want the first sign of gum disease to be the loss of teeth.

The team will need to be well-versed in the answers to questions that patients ask and allow the patient to co-diagnose dental conditions. If patients can see what the clinician is talking about, they will be more likely to understand what is being said. Having literature such as brochures available for patients to read will reinforce the answers given and will also help patients believe what they are being told.

Purchasing a practice requires thinking about more than an increase in production. If you are in this situation, be sure you do your homework to capture the existing patient base.

Need help with implementing new systems in your hygiene department to ensure patient acceptance and compliance? Email

Interested in having Angie speak to your study group or at your next seminar? Contact her here.

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Dr. Nancy Haller
Dentist Coach
McKenzie Management
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Who (Or What) Are You Promoting?

Dr. Jill Sartin—Case Study #424

Mary was hired for the front office job one year ago. Her task-oriented focus was just what Dr. Jones needed for scheduling, recall and insurance billing. Detailed and self-assured with a strong work ethic, she was eager to take on new responsibilities. Although he was the dental leader of the practice, Dr. Jones didn’t have the interest in managing his 11-employee team. So he promoted Mary to the role of Office Manager.

Six months later, the rest of staff is angry at Mary. They have complained to Dr. Jones that she is “critical,” “power-hungry” and “inflexible.” During individual meetings with the doctor, Mary is defensive, uses lots of excuses and ultimately cries. She doesn’t delegate work to other employees as Dr. Jones repeatedly asks. Her emotional reactivity raises questions in his mind—should he terminate Mary?

Not so fast. It’s expensive to bring on more staff. Recruiting, selecting and hiring a new employee take time and money, and the last thing you want is unnecessary turnover. So what’s the solution?

It makes sense to stabilize your workforce as much as you can for stronger profit. Let’s start with Mary’s strengths. She is extremely dependable, conscientious and bright. Those are priceless traits in an employee. In fact, research indicates that these are the MOST important predictors of job success.

Since Mary has demonstrated exceptional commitment and loyalty to her job to date, the solution rests less in WHAT she does (or doesn’t do) and more in HOW she does it—her work preference. In other words, her personality style. Just because she is good at one job doesn’t predict success in another. But how do you know that before you promote?

McKenzie Management has the solution—The Employee Assessment Test. Now you can compare Mary’s personality to existing front office dental personnel who have been identified as peak performers. The Employee Assessment Testing (online) is effective for existing staff as well as new hires. Here’s what happens when Mary takes this 20-minute Web based questionnaire.

Her “Fit to the Job” profile matches 65%. In terms of her behavioral strengths, Mary is similar to the desired dimensions for the job on several of the 12 personality factor scales. Although she seems like a good match, it is important to determine where she is not fitting.

The report shows that Mary scored “above average” on the scales of Dominance, Self-Assuredness and Organization. She is assertive, confident and driven to achieve her goals with precision. She also scored high on the scales of Rule-Consciousness and Self-Reliance. Her tendency is to adhere to established rules and regulations. She also is resourceful in solving problems. Overall the results indicate that Mary has some natural leadership traits—she likes to call the shots. No wonder she was so successful in scheduling to production!

On the other hand, Mary’s scores were low on the scales of Trust, Open-Mindedness and Liveliness. This triad of characteristics reflects a serious individual who values her autonomy. This is a great combination when the work requires quick action and/or individual initiative. However, when it comes to people management, Mary is not collaborative. Furthermore, she can appear controlling because she expresses little need for assistance or reassurance. These last three scales explain why she is struggling as Office Manager.

The Employee Assessment Test indicates that Mary is more tough-minded and self-controlled than peak-performing Office Managers are. In fact, she is rather black-and-white in her perspectives. Her preference is to take care of tasks on her own and to make decisions by herself. Because she has such drive and determination, she bristles when Dr. Smith gives her feedback. She hears it as criticism.

Mary needs to develop a more accommodating style in her interactions with the team. If you were her boss, you could share these personality results with her. First and foremost, acknowledge her strengths and appreciate her talents. (Dr. Smith failed to do this and instead just focused on her deficiencies.) Then, coach her to find solutions that balance her preferences for data, details and practical matters with the importance of creating harmony and goodwill among the team. Meet with Mary briefly on a bi-weekly basis to follow up on her development plan. As she makes progress, taper off to monthly, then quarterly meetings.

It is essential for Mary to develop greater self-awareness of her impact on others, and to adjust her style according to her audience. Dr. Smith can help by modeling flexibility with her, and by identifying for her which issues are ”urgent”—i.e., when strict policies and procedures must prevail. (NOTE: Most office situations are non-urgent.) By demonstrating greater congeniality and cooperation, Mary has the potential to influence the entire team so that everyone performs at her/his best.

It used to be enough to hire the best people for the job and keep promoting them. But that’s no longer enough in today’s business world. Creating peak performance teams is what separates the best from the rest. Leaders need to be coaches to help people gain confidence and experience in meeting new challenges. Let the Employee Assessment Test help you to spark your staff toward successful results.

For a limited time, McKenzie Management is providing complimentary 15-minute individual consultations by Dr. Haller when you purchase an Employee Assessment Test. Contact her at

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

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