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11.14.08 Issue #349 Forward This Newsletter To A Colleague
Practice Stress
Consultant Case Study
Salary Review

All Stressed Out And No Place To BLOW!
by Sally McKenzie CEO
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Dentistry would be great if it weren’t for the ______. Fill in the blank: if it weren’t for the office manager, the patients, the insurance companies, the dumpy building, the schedule or the suffocating accounts receivables. Regardless of the stressors on your list, if you are like many of your colleagues, stress has become accepted as part of the day-to-day routine, and is looked upon as the “necessary evil” of the business. For some it’s practically a badge of honor; for others it’s the number one reason why they would choose any other profession if they were given the opportunity.

Dentistry has a long-standing reputation for being a pressure-cooker profession. After all, doctors are working backwards, upside down and in a cave. Compound that with difficult patients, challenging staff and sometimes brutal schedules and you have all the makings for professional burnout. Consequently, dentistry becomes drudgery for far too many clinicians as stress manifests itself in loss of energy, low self-esteem, poor or no decision-making, costly mistakes, illness, accidents and more.

Ironically, in spite of all of the stressors, dentistry remains one of the very few professions in which the doctor and staff can have almost total control over the issues that cause stress in the practice—if, that is, they choose to control them.

You are your own worst enemy. You know what you do not like about your practice. You know what causes your stress, and many of you will try to implement systems and guidelines that are supposed to eliminate that stress, but then the exceptions begin. We see it in practice after practice. Doctors will say they want one thing, but then their actions give them exactly what they don’t want. For example, a doctor will say, “I have too many patients.” So together we develop a system to produce as much or more dentistry on fewer patients per day, which is exactly what the doctor says he/she wanted. The net income has increased, but then the doctor finds he/she has more time on her/his hands, so she/he tells the staff to schedule more patients, which completely undermines the effort to reduce the stress.

Accounts receivables are another major concern for practices and a source of significant stress for dentists. A doctor will admonish the business employee by saying that she/he wants zero accounts receivables in one breath, only to walk into the operatory and extend a zero-interest loan to a patient/friend in the next. It’s the exceptions, inconsistencies and special cases that cause systems to crumble and stress to build for everyone.

Scheduling and finances are near the top of the list of practice stressors, but one other issue reigns supreme over all others. Conflict. This is a huge concern for many practices. In fact, conflict among team members is rated as the greatest source of stress in the dental workplace.

In many cases, stress among the team is the result of miscommunication. When problems arise, doctors and staff need to go to that person and try to resolve it. Conflict-induced stress may also be the result of a system pitting one person against another, and not necessarily because team members don’t like each other or cannot get along. When systems are not set up well, not administered well or not administered consistently, we see stress. And when a system pits one person against another you’ve got plenty of stress and it’s just a matter of time before things blow.

But it is conflict surrounding a negative employee who is engaging in actions that are dividing and demoralizing the team that absolutely cannot be ignored. Doctors have it in their power to swiftly address and, if necessary, eliminate this significant source of stress. Sadly though, many dentists will go to great lengths to avoid dealing with the person. The problem employee is left to continue to drain the effectiveness of the team and the productivity of the practice. Yet when doctors finally do address it, stress is reduced immediately in almost 100% of cases involving a seriously problematic employee.

Next week, how to turn down the “heat” in your practice.

Interested in speaking to Sally about your practice concerns? Email her at
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Team Building Event of the Year!

Nancy Caudill
Senior Consultant
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Are You Santa Claus Or Scrooge This Year?

Dr. Harry Jessup—Case Study #621

Dr. Jessup was experiencing that anxious feeling he gets every year over the dreaded holiday bonus! Do I or don’t I? What happens if I don’t? If I do, how much should it be? If it’s not enough, will they be disappointed or even mad at me?

For some dentists, it is difficult to say no to their team members. You recall how hard they worked through their cherished lunch hour to help you with an extraction on #32, or the afternoon that Mrs. Smith stopped by on her way to church to ask you to look at a tooth with a “rough spot.” As it turned out, she needed a root canal, build-up and crown!

But what about those days that the entire team left early to celebrate Suzie’s birthday, and you sent along your credit card? It all evens out. Right?

Around this time of year the whispers in the office are beginning… the phrase “holiday bonus” is being heard by Dr. Jessup and his anxiety is increasing. What if someone asks him if they are going to get bonuses this year? What will he say? He knows that he has a tendency to say yes to everything.

Why a Holiday Bonus?
Is the purpose to share the wealth with your team for a great year? If that is the case, it isn’t a great year for Dr. Jessup. Fixed expenses remain the same and collections are down.

Bridge The Gap

Is the purpose to follow a tradition because he has given a bonus every year before this year? This year he is really feeling the financial pinch but dreads that look on their faces when he hands them a check for $50 instead of the usual $500.

In order to help Dr. Jessup with his inner struggle, it was necessary to look at his practice expenses for the past ten months.

Dr. Jessup’s Practice Facts:

  • 15-year-old general family practice
  • 6 team members
  • Collections of $850,000 for the past 10 months
  • Total practice expenses are $646,000
  • Gross wages for the staff are $229,500

The overhead percentage for staff gross wages in a practice like Dr. Jessup’s should be 19–22%. In this case, he’s at 27%! This is at least $42,500 more than it should be, which is a bonus in itself! The practice was not performing as a result of the difficult economy, yet no team members were laid off or required to work fewer hours. It is obvious when looking at his schedule that he did not need two assistants and he could have reduced the number of hours for his hygienists. However, he elected not to.

Clearly Dr. Jessup cannot afford bonuses this year, based on the total practice overhead as well as the staff wage overhead.

Mixed Signals
Because Dr. Jessup wants to be included as part of the team when it comes to discussing personal life experiences, he also shares with his team stories about the lavish vacations that he and his family take, as well as the new cars that they are all driving. These revelations make it impossible for his team to buy into the concept that the practice is not doing as well as it did last year.

Recommendation #1: Always think before blurting out an answer to a question. Say to your employee, “Jane, that is a good question. Let me think about it and I will get back to you.”

Recommendation #2: Do not share information about your personal lifestyle with your staff.

Recommendation #3: Make decisions based on statistical facts.

With a little scripting from his consultant, Dr. Jessup expressed to his team members how much he valued them and that he would like to be able to continue the tradition of annual holiday bonuses. However, based on the information that is reviewed every month, this year the practice cannot pay a holiday bonus.

The doctor and team will celebrate the holidays with a lunch at the office and draw names to exchange gifts with a purchase price of no more than $25.00 each. After all, camaraderie is the most important part of being a team.

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

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Belle DuCharme CDPMA
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So You Think You Deserve A Raise?

It is time for your salary review and you’re thinking, “I deserve a raise.” Some of us have a sense of entitlement because we have been at the job for a year or longer and a raise is expected yearly. Is working in your practice a longevity contest? Has having you there really been a benefit to the practice? You may be thinking any of the following:

  • Living expenses, such as food and gas, are going up. Let’s face it—everything is going up, so why not my income? You should realize that your personal needs are not usually a consideration for running a business in the black. Overall operational costs are going up for your employer, including fuel to transport supplies and precious metals for restorations to name just two.
  • I am a Registered or Certified professional. Your credentials represent your education and licensing, which are requirements to legally perform your job duties. This again does not warrant a raise.
  • Mary Jane, my best friend, works for XYZ Dental and she is making more money than I do. Better to look at the total package before you decide that the grass is greener on the other side of the highway. How about the working environment? Is the team friendly? Does the doctor promote personal and professional growth? It may not be such a good idea to give up those important things in lieu of a dollar an hour raise.
  • I am a team player. This is admirable and it certainly contributes to a positive environment, but it is not a reason for a salary raise. It is expected that the team work together for the betterment of the practice and the patients.

The true reason for anticipating a salary increase rests on your…


To talk to your employer about a raise:

Focus on how you meet—and exceed—your job description.

Talk about people, things, events and deeds of the job. You better have a good attendance record and get your work done on a timely basis every day. Provide evidence that you are willing to take the time to train or direct new employees in their positions. Provide evidence that you love your work and take the time to become better educated and informed in the latest technology and other skills that will improve the practice and communication with patients. Don’t count on the boss keeping score. Think of a situation in which you did something special to improve. For example, you did some research to find a better buy on dental supplies and you are keeping the dental supply budget at 5%, or you are tracking monthly production goals and are working to increase growth by 15% a year. If you find the practice is in decline, then make a note that you are going to see how to turn things around with new ideas to market the practice. If your job description includes calling overdue and unscheduled patients, keep a record of the calls and the results. If your position includes treatment presentations, track the success of the presentations.

Make a list of highlights of your accomplishments during the preceding year. Compare that with your original job description. Have you exceeded your job description? (Without a written job description there isn’t a way to measure your job performance and accountability.)

Is patient flow in the clinical area better and smoother since you joined the practice? In what ways have you grown or improved your job skills? For instance, if you are a Business Coordinator, have you collected overdue monies and reduced AR to less than 10% in the 90 days past due column?

Write down the key points and you will be more prepared and confident.

Dress for success. Wear business attire that says you are a professional, including a nice suit jacket. Make sure your hair is neat and don’t wear any dangly earrings that distract.

Schedule an appointment and make sure your employer has enough time without being rushed. Don’t schedule between patients or at the end of a tiring day.

Consider your body language. Sit up straight, with your feet flat on floor and eyes straight ahead and level with the doctor’s eyes. Don’t slouch, cross your legs or cross your arms in front of your chest. Lean forward toward the doctor and engage in active listening as you make your presentation.

Thank your employer for taking the time to meet with you. If the decision for the raise is not reached at that moment, cordially ask for another appointment and define the actions you must take to prepare for the next meeting. Consider the economic situation of the country and your own community at present. Cost of living increases are not a given right now and if you can hold on until things improve, it would be a wise choice.

For more information about McKenzie Management’s Advanced Training courses, email, call 1-877-777-6151 or visit our website at

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

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