Th 213228

Sink or Swim

June 1, 2006
When dentists graduate from school, they are prepared to treat patients. They are equipped with the skills to perform fillings and root canals, place crowns and bridges, even partial and full dentures.
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When dentists graduate from school, they are prepared to treat patients. They are equipped with the skills to perform fillings and root canals, place crowns and bridges, even partial and full dentures. They are not, however, prepared to provide effective leadership for their employees. Research has shown that in order to be effective leaders, people must be educated and given opportunities to practice the skill. With 20-plus years in the dental profession, this author has witnessed several leadership styles, none of which has been adequate in a solo practice.

Upon graduation from dental school, a dentist might purchase a private practice from his/her hometown dentist who is retiring. Along with the purchase come patients, a building, equipment, and staff members, who are offered the chance to maintain their employment with the purchasing dentist. Much thought is put into what condition the building and equipment are in, how many active patients there are, and what computer software is included, but how much thought is given to the staff members who choose to stay? The answer is, not enough.

Based upon my experience, dentists are not prepared to be effective first-line supervisors and managers. The lack of leadership training of dental students makes it difficult for them to lead their teams, ensure a happy work environment, and deal with staff issues. With proper training, many of the issues that arise in the dental office could be avoided or dealt with in a more effective manner.

According to Schultz,1 the most difficult management position is that of first-line supervisor. This is because supervisors deal directly with employees and often do not have the training or education of higher-level employees. First-line supervisors are often promoted from within a group of employees due to their good job performance, but this is hardly an indicator that a person will be a good supervisor.

In a dental office with only one dentist/owner, he/she often assumes the role of supervisor. Dentists fall into the role of first-line supervisor because they work directly with all employees. Even though dental school graduates receive no formal leadership training, people assume that because they have eight years of postsecondary education, they should be good leaders. Even when there is an office manager, the dentist is still the primary supervisor because the office manager does not perform evaluations, approve time off, or run payroll.

Schultz1 lists the qualities of a good first-line supervisor. (See chart on this page.) Most people do not automatically possess these qualities. They must be worked on if a person wants to be an effective leader.

The Effective Supervisor’s Handbook, by Imundo,2 shares many of the same thoughts about supervisors as Schultz.1 Imundo discusses the difficulties of first-line supervisors, and writes that putting a person in a supervisory position without considering his/her qualities and training is a mistake.

Successfully managing people requires considerable training and skill development. To place people in supervisory positions without training is to invite the problems associated with the inability to manage stress.2 It has been noted that dentists have a high suicide rate. Part of this problem could stem from lack of managerial training.

Back to Basics Management, by Culligan, Deakins, and Young,3 states that effective leaders must be trained. Today’s crisis in business should be viewed in light of the fast-moving changes that have pushed young, tech-savvy minds to the forefront of management without any leadership training. A person can be given a position or title, but cannot be given leadership skills.3

In addition to the need for management training, Culligan, Deakins, and Young discuss communication skills. They write that the ability of a supervisor to communicate skillfully and effectively is a central part of his/her duties. “Most people problems can be traced in part or in full to poor communication, a breakdown in communication, a misunderstanding about what communication is, or no communication at all.” They state that most people are not born good communicators, but must receive training and practice.

In the article, “Leadership Skills: The Overlooked Training,” published in the online edition of South Carolina’s Business Journal, Mitch Mitchiner4 discusses the importance of leadership training, and how it is often overlooked. This article concurs with the information presented in The Effective Supervisor’s Handbook and Back to Basics Management. Some statements include:

Few are born with great leadership skills, but with proper training, all can be developed.

Many companies promote good workers to leadership positions as a result of their performance at their current level with no leadership training for their new position.

Leadership training below senior management level often does not get the attention it deserves.

Good leadership at all levels, from the first-line supervisor to the top executive, makes all companies better.

The major ingredient in effective leadership is communication.

Good leadership training makes effective leaders.4

A review of current dental school curriculums at the University of Iowa, Marquette University, and Ohio State University revealed that these schools do not include leadership or management training. At the University of Iowa, “Practice management courses help students choose where to locate their practices as well as manage the business aspects of a dental office.”5 The business aspects include money management and insurance issues, but not staff management.

Marquette University offers the course Dental Practice Dynamics. The description reads, “The purpose of this course is to provide students with an understanding of the dynamics of patient management and clinical practice systems that will allow them to effectively manage the practice environment. Topics include the psychology of the clinical patient, effective appointment strategies, attracting clinical patients, and creating ideal systems for the private practice.”6 Again, much attention is given to patient management and clinical practice systems, but none to staff management.

The Ohio State School of Dentistry Web site7 describes their managerial class as, “Practice management, financial, and accounting planning as related to dental practice management. Legal issues relate to dental practice management, practice purchase, and associateships.” Once again, there is the issue of practice purchase, but no mention of staff relations.

I polled 25 dentists with questions about leadership training while a dental student. Twenty-four said their education did not include any leadership, managerial, or human resource training. The remaining one said she had “one semester hour of training” in this area. When asked if such training would have helped in their dental office setting:

Sixteen responded yes
Four responded that it was not needed
Two responded that it would not have made much impact at that point in their education
One said he took this type of training as continuing-education classes
One responded no

How to best implement leadership training is an issue. While it seems sensible to attempt to tie this training in to dental school, time is a concern. There are many skills students need to be proficient in, and most of their time is spent perfecting these skills.

Three respondents thought dental school might not be the best place for the training. Two dentists thought age was a factor in dental school, saying that young students wouldn’t take the training seriously or put much effort into it.

The type of practice a dentist works in is also a consideration. A solo practitioner needs leadership training more than a dentist in a large group practice, which usually employs human resource personnel who take some of the managerial burden off the dentists.

The problem with leadership training classes offered through continuing education is that dentists are not required to take the courses. Many may not realize they are not effective leaders. If they looked at their practices objectively, they would see that there is always room for improvement in the supervisory area.

While dental school may not be the best place to provide supervisory training, it is still a good place to plant the seeds of supervisory growth. Educators could address the importance of supervisory skills and encourage students to pursue this education after graduation. If the leaders of the dental profession were effective supervisors and communicators, there would be a lot for dental staff members to smile about!

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1 Schultz D, Schultz SY. Psychology and work today. Upper Saddle River: Pearson Education 2002.

2 Imundo LV. The effective supervisor’s handbook. New York: Amacom 1980.

3 Culligan MJ, Deakins CS, Young AH. Back to basics management. 1983, New York: Facts on File, Inc.

4 Mitchiner M. Leadership skills: the overlooked training. South Carolina Business Journal, Online Edition 2005. Accessed Dec. 1, 2005, at

5 Iowa State School of Dentistry curriculum, (n.d.). Accessed Nov. 20, 2005, at

6 Marquette University School of Dentistry curriculum. (n.d.). Accessed Nov. 20, 2005, at

7 Ohio State University dental school curriculum. (n.d.). Accessed Nov. 20, 2005, at