Can We Talk Staffing? Desperate Times Call for Desperate Measures.

The two big hot topics in the DSO industry are culture and staffing. The later, I would suggest, is at a critical juncture.

Currently I think most in the dental industry would agree that the hygienist’s position is one of the most difficult to fill and retain. In fact, practices are actually poaching staff from other offices. The lure? More money and possibly better benefits. The data that most employees don’t leave over pay is being challenged – BIG TIME!

I pose the following to those emerging dental group owners who want to ensure that they continue a strong six or seven figure income annually.

We know a healthy hygiene program drives practice revenue.  However, with the loss of a quality hygiene team member, total practice revenue will reflect this loss negatively. We have also seen an increase in wages nationally. However, this increase has not outpaced inflation. Wages grew 4.2% in Q3, 2021, but inflation grew at 4.6% in September 2021. Do we see Amazon and Walmart increasing pay because they each want to add a billion + in labor cost annually? Of course not. Being in dental we have a combination of a tight labor market and hesitancy for some to enter or reenter a healthcare work environment. Desperate times call for desperate measures.

Have you ever done an assessment of what it takes to simply make ends meet where you and your staff live? This information is very easily obtained with quick internet searches. The Living Wage Calculator from MIT is very useful. You don’t need to hire someone to create a demographic profile. Just a few keystrokes will provide very valuable information. That data will give you perspective and may make all the difference to you, your staff and your practice.

Some employees share their struggle to make ends meet with management. Some do not. Your dental staff’s economic and family hardships are not your issue per se, but it should be your concern. Especially now that we are in a very tight labor market.

Consider the following two scenarios.

Scenario 1:

Dr. Smith tells Mary that he needs to talk to her.

Dr. Smith: “Mary, I have been noticing your work and I would like to discuss it with you. I recognize what a valuable asset you are to me, our patients and the entire office. I have decided to increase your pay from $20/hr to $25/hr. You deserve more, but right now that is all the office can afford. I would also like us to meet from time to time to discuss ways we can improve things in the practice, so we have the revenue to support additional increases for you. If you have any suggestions, please let me know. Your input is valued.”

Scenario 2:

Mary tells Dr. Smith she needs to speak with him at day’s end.

Mary: “Dr. Smith, I am very sorry to say I’m giving two-week notice. I love you, the staff, and patients, but I have been offered a position that pays more, and I have to take it. For my family’s sake, I can’t turn it down as much as I want to.”

Dr. Smith: “How much more money is it, Mary? If I match it, will you stay? We really value you as a team member and want to pay you what you’re worth.

Consider these two scenarios and how Mary feels after each conversation.  In the first scenario, Mary is feeling like a highly valued and irreplaceable team member. She is confident in her skills and position and presents this way to her patients. Her loyalty to the practice’s success is solidified. In the second scenario, Mary is conflicted and possibly feels taken advantage of. Mary may consider that if she was so valuable, why did it take leaving to prompt a raise to what she really deserved the entire time? What will Mary’s attitude be the next day in the office if she chooses to stay at the practice in the second scenario? No doubt, if she stays, her relationship to the office has changed forever.

I present these two scenarios as something to think about and reflect on as staffing will most likely remain a critical issue in dentistry for a long time. Many of us only think about “Mary” retroactively when forced to. Perhaps being proactive in a top-down culture will protect your dental group from challenges to production which may be totally avoidable.

Written by Frank Balkum. Frank is managing director of Xprt DSO Advisory Group. He has more than 25 years as an owner of a national dental finance company. He has spent the last 10 primarily in the M&A space for emerging dental groups and DSOs of various sizes. He can be reached at 551-202-9944 or


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