Paralysis in a practice: Keep the dentist motivated about dentistry

June 12, 2015
My boss sat me down in his office last week and said he hadn't had a paycheck in three months.


Dear Dianne,

My boss sat me down in his office last week and said he hadn't had a paycheck in three months.

The receptionist has spoken with him several times about making changes, but he doesn't seem to want to improve the situation. He is still charging $75 for a cleaning and hasn't raised his fees in that category in many years. Our hygiene department is relatively solid and stable. We work Saturdays every other month with two hygienists. I work Monday through Thursday, and we have another hygienist on Tuesday and Wednesday. We always take annual BWs on our patients and FMXs at least every five years, depending on insurance coverage.


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Our doctor does quadrant scaling, which has kept his schedule full. The hygienists are starting to perform localized SRP on our current patients. However, the doctor's production has been low for quite a while. He refers out first and second molar endodontics. We do have a periodontist/implant specialist and oral surgeon that come in several times a month. We also refer our orthodontic cases and difficult extractions to other offices. He works five days a week and has hired two assistants fresh out of school. He states the salaries of his employees are too much for the production he is currently making. Another one is on maternity leave and will be paid for two weeks.

Now, he wants to cut out toothbrushes for the patients. I know this will make them furious, and I'm considering paying for them myself.

Recently, I took a vacation day and got our part-time hygienist to cover for me. This has been my custom for many years, and it has never been a problem. But this time, he said he'd rather just cancel patients if I'm not going to be there rather than pay the other person plus my vacation day.

The Dentrix computer system is severely outdated and continues to have major issues. The receptionist stated we are number 15 on the Google listing. He refuses to do any other advertisement and social media forums. We are on Angie's List, Yellow Pages, and a monthly local magazine. Our new patients have really dropped, and that seems to be the biggest problem. Plus, he undersells his dentistry or barters to his friends.

He's an excellent dentist who spends more than enough time with his patients to make them feel comfortable and connected, as we all do. Our online reviews are always excellent. However, he has an explosive temper, hates change, and can be a bully. The positive side is he has a heart of gold and truly cares about everyone. It seems that he is lacking in business sense. I have worked there the longest, and he respects me but usually doesn't allow me to share my thoughts. I feel like it's up to me to help get him out of this rut. I'm hoping you might have some good tips to share with me.

Kimberly, RDH

Dear Kimberly,

Wow! There are so many systemic problems here that I don't even know where to begin. With a limited word count for my column, there is no way to adequately address everything. However, one thing seems certain, and that is that the practice is in decline. When the owner of an established practice has to forego paying himself because the overhead is devouring any profit, there are serious problems. Evidently, the doctor is suffering from PMP - practice management paralysis.

Two things immediately jump out at me from your post. First, the practice needs a comprehensive fee evaluation. Why is it that some doctors entertain the delusion that they should keep preventive fees artificially low? Patients think all fees are too high, so the doctor is not doing himself or his practice any favors by not raising his fees appropriately. Second, the doctor needs help with treatment presentation in order to beef up his schedule. The doctor should not be doing any procedure that can be legally delegated to a qualified auxiliary, especially nonsurgical periodontal procedures. Unless the doctor is a periodontist, he should understand that hygienists are far better qualified to perform those procedures.

It is possible that the practice is overstaffed. Staff costs are a dental practice's largest overhead category, so there should be a lean and mean staff group - well-trained, competent, and well-paid.

In my book, the worst thing the doctor can do is cancel a day of hygiene for any reason. Not only are patients inconvenienced and production drops to $0, but also restorative needs go undiagnosed, which affects the doctor's already flagging schedule. What on earth is he thinking?

Without enough new patients, it is nearly impossible for a dental practice to grow and thrive. Practice stagnation develops, and then, practice decline follows. Your boss needs to engage in some effective marketing that is ongoing and shows a good return on investment. Most consultants feel the marketing budget should be anywhere from 3-8% of collections.

It also sounds like the doctor is referring out work that could be productive for him, if he is willing to get the necessary training. My feeling is that when doctors learn new procedures, it keeps their fires stoked about dentistry. It is entirely possible that the doctor is so discouraged with the direction of his practice that he has lost his motivation. Without motivation, we lose the desire to learn. When we rest, we rust.

The practice management software is such an important component of overall business management success. Unfortunately, some practices are struggling to keep pace because they are using outdated software versions. What we used even last year becomes obsolete as technology races forward. When the practice doesn't keep up with updates, system functioning slows down. The practice cannot function properly without up-to-date software.

Your boss needs to step out of the fog and see this situation for what it is. Many of the former practice management systems do not work anymore, like trying to fit a square peg into a round hole. The cheese has been moved.

You say the doctor respects you but doesn't allow you to share your thoughts. In other words, just do your job, and keep quiet. That doesn't sound like respect to me. Most likely, he doesn't want to face the truth that his practice is failing, and it is his fault.

It really sounds like he needs a comprehensive evaluation by a consultant to show him where the practice is failing and devise a plan for improvement. Consultants are like business physicians. We diagnose the practice problems and devise a treatment plan for improvement and restoration. Businesses get systemic illnesses just like people. Some illnesses are easy to treat, while some are complicated and require intensive care. And some illnesses are fatal. If he waits too long, he may not be able to recover.

It's kind and considerate of you to want to help your boss, but there's nothing you can do to right this ship's direction. That has to come from the captain. Help is available. RDH

All the best,

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne's new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email [email protected]. Visit her website at