Does Clinical Philosophy Drive Turnover? (How to run a dental practice)

How bad is your turnover? Many dental practice team members talk about how terrible their turnover is and point to the list of names they scroll through in their timeclock software. Each person on the team thinks they know the real reason other team members left the group but no matter the reason, it causes stress. Stress from the increased workload that falls on the shoulders of the staff that stay and from the gossip taking over the staff lounge and the parking lot. Even worse is the prospect of having to interview, hire and train new team members. No one has time to meet the candidates, much less train them.

On the flip side, when you are hiring, why are the candidates looking for a new opportunity? Often, it’s related to location and hours. Who doesn’t want a shorter commute? And, if the doctor takes several weeks’ vacation or the staff person was initially hired with part time hours but now desires full time, this is a common motivation to look for a new position. From the dentist and manager perspective, you cannot change your location and you may not be able to adjust hours, so some turnover is expected.

Clinical care philosophy can drive turnover

One driver of turnover dentists may want to consider is how clinical care philosophy affects whether your staff continues working with you or decides to pursue other opportunities. As I review resumes and talk with dental staff who are job hunting, a common motivator is the desire to find a dentist who provides reasonable clinical care for patients. “Reasonable” is obviously in the eye of the staff person and there is no one clinical approach to fit all dentists, much less all dental team members. However, this reason for starting a job search seems to be appearing more and more frequently.

For both clinical team and administrative staff, overtreatment can make them feel uncomfortable. Assistants know how to read x-rays and they understand treatment options, so they know when a small filling will do as opposed to the more profitable crown. Administrative staff can feel guilty when they present treatment and make financial arrangements for patients who can’t afford the premium option but aren’t offered a less expensive choice. Even if these clinical decisions are not money-driven, staff that are expected to keep their mouth shut can wonder about treatment plans and start to become suspect of a dentist’s motives.

Making the matter worse, dental practice software only shows the income side of the equation. When dental team members look at the production and collection generated day in and day out for a busy practice, they can start to wonder about the “luxurious” lifestyle of the dentist whose bank account receives all the deposits. For practices that do not operate on open book management principles and therefore do not share the expenses in the office, this exacerbates the problem. The team has no idea how much the rent, marketing, staff compensation, etc. runs and doesn’t consider any total overhead number against the day sheet or daily production goal.

Talk with your team

Thinking about the twin challenges of clinical care philosophy and financial management, dentists may want to consider having two conversations with their staff. The first focused on clinical care. Under the guise of education, dentists can bring a few cases to the staff meeting to talk through the diagnosis and how the treatment plan was selected. In this safe environment, a dentist can encourage staff to ask questions about why certain treatment was selected, especially when patient finances were a concern. Talking through options and the thought process the dentist uses when evaluating decay and patient compliance will help staff have an appreciation for the challenges of matching the right treatment to the right patient, and create an acknowledgement that this is not a perfect science. The purpose of these meetings and discussions is not only to increase support for the dentist by the team, but also to reduce turnover. If a team member begins to feel uncomfortable with the clinical care philosophy of the practice, a discussion like this gives the perfect opportunity for that person to get her questions answered and concerns addressed.

The dentist may never know that their primary assistant was starting to consider looking for a new opportunity due to clinical care philosophy, but taking time for this meeting even a couple times a year could dramatically reduce staff turnover. And, anything we can do to reduce the number of times we lose well-trained team members may be worth it!

A second meeting or discussion that can help to reduce turnover is open book management. Talking with your team about the expenses side of the practice so they understand the business of dentistry treats them like professionals. Most staff would like to understand how the economics of a practice work, even if they say they wouldn’t want the responsibility of financial management. Beginning this conversation with a clarification on insurance withholds and how the different plans reimburse at different amounts is a great start. Your insurance manager is the best person to bring a few EOB’s to the staff meeting to help everyone understand this part of the finances.

Next, print the total expenses from your income statement and review that with your team. If you can set your income statement to automatically calculate the percentage of income beside each expense so the team can see the raw number and the percentage, this is the easiest to communicate. I can almost guarantee your team will be blown away at how much you are spending. This is a great way to encourage teams to look for opportunities to reduce expense and waste throughout the office. And, when they see the expenses involved with the practice this gives them a fresh perspective on the challenges of running a successful practice. Hopefully, this results in a clearer understanding of where all that income goes and more empathy for the dentist.

If you hate staff turnover and want to do everything in your power to stop good people from leaving you, then you may want to put these staff meetings into your schedule. Think of these meetings like flossing, not super fun to do, but an incredibly valuable measure of prevention.

Tracking your marketing programs is just one way to run a successful dental practice. One of the biggest challenges to managing a dental practice is managing dental insurance. With dental insurance handled, then dental marketing for new patients becomes a primary focus.