Time is money ... or is it?

April 1, 2003
Doctors who want to keep harmony in the staff "family" need to respect their staff members' time and not impose upon them by expecting them to consistently work over into lunch and at day's end.

By Dianne D. Glasscoe

Dear Dianne,

I began working in my office six months ago, but I am already considering leaving. The problem is that we rarely ever get a full lunch hour, and we never get out on time at the end of the day. It is so frustrating!

The dental assistants and front desk people are paid hourly, so they get extra pay when they work late. I am paid a daily rate, which means I don't get any extra pay for using part of my lunch hour or working past 5 p.m. This seems very unfair to me.

I always come in early to get ready for my patients. All the other staff members fill out a time card, so their pay starts when they walk in the door. My pay starts at 8 a.m., no matter if I come in at 7:40 a.m.

Is there any hope that things could get better, or should I start looking elsewhere for another job?
Feeling Cheated in Chester

Dear Feeling Cheated,

The problem you have presented is the number one staffing issue that I hear as a consultant, that being not getting a full lunch and/or not being able to leave on time at day's end. Even if everything else about the practice is perfect, the inability to finish and leave on time is like a bur under the saddle of staff members. It causes a continuing sense of frustration and irritation that often leads to turnover.

There are three causes for this problem. The first cause is scheduling inefficiency. Patients are not scheduled with the appropriate amount of time, or they are scheduled so tightly that no allowance is made for unexpected (or expected) delays. Patients are sometimes scheduled with insufficient time, so the hygienist uses a little of the following patient's time. The net effect is that by lunchtime or end of day, the time deficit is resolved only by working longer.

Another problem is that some hygienists are not very time-conscious, and they waste time by being too chatty with patients or coworkers. Other hygienists lack good organizational skills and lose time by having to leave chairside to retrieve forgotten items. Disorganization is the enemy of good time management, and hygienists need to be highly organized.

The third cause of this problem is a doctor who either is not time-conscious or disrespects the hygienist's time by causing schedule-busting delays in performing prompt hygiene checks. I would advise summoning the doctor at least 15 minutes before the end of the appointment to give him/her time to conduct a timely check.

Your unhappiness over the manner you are paid is a separate (but related) issue. Many hygienists are paid on a daily rate, which means they are paid to work that day, give or take a few minutes. One thing I would like to point out is that when you are paid a daily rate, you get the same pay no matter how many patients you see. Even when you have down time, your pay is not affected. I do not know how adept the front desk is at keeping your schedule full, but I'd bet money that you do have some down time. Coming in a few minutes early or staying over a few minutes usually balances out over time. You should take this into consideration.

I have heard some unpleasant stories from hygienists who are asked to "clock out" when they have a cancellation. So I wouldn't nickel and dime the doctor over coming in a few minutes early.

However, if you are being scheduled so that it is impossible for you to be thorough and get out of the office in a timely manner, you would probably be better off being paid hourly rather than daily. Daily pay can be easily converted to hourly pay. Just take your daily rate and divide it by the number of hours you were hired to work in a day.

I will also interject that some doctors have a habit of doing extra procedures on patients that were not originally planned for that appointment slot. This causes them to run behind, and generally throws a kink in the whole schedule. Poor treatment planning is usually the culprit.

For every problem, there is a solution. What you need to do is discover exactly why you cannot stay on schedule. This is a scheduling problem, and modifications to the schedule may be indicated to alleviate the problem. One solution that has worked well in some offices is to block 20 minutes flex time before lunch and at day's end. This allows everyone to finish in a timely manner.

Some doctors fail to understand that staff members have a life outside the office. These same doctors expect their staff members to have the same love and zeal for the practice that they have, which is entirely unrealistic. The practice belongs to the doctor. It is his/her baby, and staff members do not have the same affection for the business that the owner has. Doctors who want to keep harmony in the staff "family" need to respect their staff members' time and not impose upon them by expecting them to consistently work over into lunch and at day's end.

Of course, we all know that dentistry is not always exact, and "stuff happens." In those cases where treatment time bleeds over into the staff member's time, the doctor should recognize and show appreciation for any assistance given by staff members. Again, it should be the exception rather than the rule to work over.

I advise you to start keeping records of when you come in, when you leave for lunch, and what time you leave the office in the evening. Record this information on your hard copy schedule. After a couple of months, compile your data and schedule a talk with the doctor. Also, track your down-time in units each day and record that as well to get a clear picture of how much down-time you actually have. This issue also may need to be addressed with the scheduling coordinator.

I sympathize with your frustration, because I have experienced it. All staff members deserve to get a full lunch break and leave on time at the end of the day. Every state has wage and hour laws, and I understand that it is illegal for employers to expect employees to work "off the clock." Depending on the severity of your problem, you may decide to explore this issue further.

Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Lexington, N.C. To contact Glasscoe for speaking or consulting, call (336) 472-3515, fax (336) 472-5567, or email [email protected]. Visit her Web site at www.profession aldentalmgmt.com.