I miss the good ol’ days

Feb. 1, 2007
I have worked as an RDH in the same practice for 20 years. Two years ago, our doctor retired and sold the practice to a young doctor fresh out of dental school.

Dear Dianne,

I have worked as an RDH in the same practice for 20 years. Two years ago, our doctor retired and sold the practice to a young doctor fresh out of dental school. The basic philosophy between the two doctors is as different as night and day. Whereas the original doctor was very nonpressuring and appreciative toward his staff and patients, the new doctor seems obsessive about production and collections. The original doctor never mentioned production. But the new doctor seems to never be satisfied and is constantly pushing me to produce more and sell, sell, sell. I don’t mind talking dentistry, but I don’t like his high-pressure tactics. He frets over every broken appointment or no-show patient, even though we have very few. If it were not for the wonderful patients in this practice who feel like family members to me, I would leave in a heartbeat. Do you have any advice for me?
Feeling Pressured

Dear Feeling,

The problem you are describing is more common than you think. When a practice is sold, there are bound to be differences in personality, philosophy, temperament, and management style from one owner to the next. In addition, when the staff loves the selling doctor, it is extremely difficult for them to “let go” of that doctor. Doctors who have been kind, generous, and appreciative toward their staff members typically have staff members with deep-seated loyalty. By accepting the new doctor, some staff members feel they are being disloyal to the retiring doctor. Often the new doctor has some very big shoes to fill.

The transition is more difficult if the new owner comes in and makes sweeping changes to the practice. For many people, change is very hard to accept. It is not unusual for staff members to leave during a difficult transition period when changes seem unreasonable and burdensome.

It is likely that the buying doctor is carrying a great deal of debt from college expenses and the practice purchase. Never has it been more expensive to obtain a dental education. Over the past 10 years, average dental school resident tuition and fees (for all four years) among U.S. dental schools increased 71.9 percent, from $65,067 in 1995-1996 to $111,807 in 2004-2005. During the same period, average nonresident total costs increased 68.1 percent, from $94,625 to $159,025. These are among the findings of the 2004-2005 Survey of Dental Education, Volume 2, Tuition, Admission and Attrition. This does not include four years of undergraduate schooling that can cost anywhere from $30,000 to $100,000. Many graduates come out of school with significant school debt, which grows exponentially with the purchase of a practice. Not only does the practice have to produce enough for the young doctor to service his debt, but he also has to pay operating expenses of the practice (which can be anywhere from 50 to 75 percent of his collections) and make a living wage for himself and his family. Excessive debt can increase anxiety over daily production/collections. This anxiety is invariably passed from the doctor to staff members.

I expect the selling doctor was in a different season of life with little or no debt, so there was no pressure to produce so much each month. The difference in these two realities can definitely affect one’s comfort level regarding production and collections.

Being aware of this reality may help staff members understand the doctor’s anxiety over production and collections. However, the doctor’s indebtedness is not the staff members’ problem. When the doctor’s stress level is too high, it spills over to staff members, and often results in staff turnover.

The core of this problem is you feel challenged ethically. You may feel uncomfortable “selling” dentistry. The very idea can be repugnant if you feel pressured to persuade patients to accept unnecessary dentistry. However, there is certainly nothing wrong with informing patients of dental options available to them that they might not know about. Hygienists are trusted members of the dental profession; we are dental educators. Therefore, we need to talk dentistry.

I expect that if you felt truly appreciated by the new owner, you would feel more inclined to acquiesce to his desires. Doctors benefit when they express their appreciation, both verbally and by their actions, more often to their staff members and work to create a sense of family among the group.

During my many years of clinical hygiene, I worked with many different

personalities. The treatment-planning continuum ranged from ultra-conservative to super-aggressive, and many doctors were between these two extremes. Ultra-conservative doctors seemed to “watch” too many caries or potential caries cases, whereas the super-aggressive wanted to crown every tooth with an existing restoration and even some with very small existing restorations. I wasn’t comfortable with either of these extremes and remember feeling the treatment recommendation from the doctor was either too little or too much.

One thing I have learned is this: when I am the boss, I get to call the shots, and when I am not the boss, I have to either do what the boss says or find another boss. Another life lesson is: It’s better to be a tree that can bend and flex when the storm comes than a tree that is stiff and unyielding and topples over in a storm.

Since you have been in this practice for 20 years, I’m certain you have developed bonds of friendship with many of the patients. Your longevity is commendable. Your roots are planted deep, and it would be painful to leave. But your current situation reminds me of two warring marriage partners that are contemplating divorce and only stay together “for the sake of the children.” When the affection is gone, the children suffer more than if the partners decide to go their separate ways. If you have lost respect for the doctor and are frustrated and unhappy, it is bound to weigh on you and preoccupy your thoughts, which in turn affects your interactions with patients.

Job stress that seems endless and hopeless also affects you physically. It is unwise and unhealthy to stay in a situation like that without any relief or resolution.

You might have to decide which is more painful - to stay in a practice where you are unhappy, or relocate to another practice with a lower stress level. I can tell you from experience that if you decide to leave, it’s not that difficult to bond with a new set of patients.

Take into consideration all of the previous points. If you have a good working relationship with the doctor, it would be wise to convey your feelings to him in a nonconfrontational manner. He may not realize that his practice anxiety is negatively affecting his staff members. Otherwise, I don’t see the situation improving.

You have to weigh the practice positives against the negatives. If it turns out that the negatives outweigh the positives, it may be time to seek alternate employment.
Best wishes, Dianne

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 Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at www.professionaldentalmgmt.com.