Clear as mud

April 1, 2006
I am so frustrated with my employer! There seems to be a double standard where some employees are treated differently than others.

Dear Dianne,

I am so frustrated with my employer! There seems to be a double standard where some employees are treated differently than others. For example, the doctor allowed his “favorite” assistant to take off two weeks in a row, but he told me I couldn’t take two weeks in a row. He pays medical insurance for two employees who are single parents, but those of us who have spouses with insurance get nothing. Chairside assistants get their scrubs furnished and hygienists receive a uniform allowance, but business assistants get nothing in the way of a clothing stipend.

We do not have an office policy manual, and it seems to me he makes the rules as he goes along. In my 14 years of experience (I’ve been in this office one year), I have never seen an office so disorganized or a doctor so unwilling to lead. Many of the staff members just do what they want to do because they know he will allow it. Then the doctor wonders out loud what happened!

We need help!

Working in Chaos, CA
(and that’s not a city!)

Dear Working,

What a mess! But I’ve seen plenty of offices like yours.

Let’s start with the first problem: favoritism. When a doctor gives preferential treatment to one staff member over another, it is sure to cause resentment. Favoritism is one of the quickest ways to destroy staff morale. A doctor bestowing preferential treatment to a staff member is as negative as a parent showing favoritism to a child. Staff members should be treated equally, no matter who they are or what they do in the office.

One bit of advice I give doctors is to never hire anyone they can’t fire. This advice is especially apropos for the doctor’s family members. It’s difficult for a doctor to not show favoritism to a family member. (This is not a blanket statement that family members should never work in the practice. Sometimes it works fine if everyone is respected and treated as equals.)

I remember a situation where a doctor hired his business assistant’s daughter for a clinical assistant position. The daughter turned out to be a bad hire, and because of her chronic absenteeism, the doctor terminated her employment. This offended the business assistant, who, by the way, was an exemplary employee, and she quit!

The second problem you identified is inequities in benefits. Again, providing certain staff members with better benefits than others is sure to cause resentment. One thing employers can do to maintain fairness is to offer all full-time employees a benefits package worth a particular dollar amount.

In order to stay competitive with other area employers, most dental offices offer a standard benefits package of six paid holidays, paid vacation based on years of employment, uniform allowance, and continuing education reimbursement. Other fringe benefits can include medical insurance (either paid in full or up to a set amount), retirement plan, free dentistry, and/or childcare allowance.

However, fringe benefits are not mandated by law, so employers can choose exactly what they want to offer. Some dental practices offer a generous benefits package, while others offer virtually no fringe benefits. When considering compensation, staff members often do not know the dollar value of their fringe benefits, which can be as much as 20 percent of their wages. Employers should furnish their staff members (along with their W-2) a document that outlines their fringe benefits and the dollar value. This helps people understand and appreciate what they have. The point is that any benefits package should be fairly and equally distributed to all full time staff members.

One of the most frequent complaints I hear from staff members in my consulting is that the office policies are not clear. It is obvious this is the case in your office. The doctor needs to develop a well-written policies and procedures manual that spells out the office policies and expectations.

Every office manual should include (but is not limited to) these items: staff member responsibilities; personal appearance; behavior; disciplinary procedure; absentee policy; salary and compensation; job performance; patient confidentiality; termination policy; vacation; overtime policy; holidays; sick days/discretionary time off; leave of absence policy; funeral leave; jury duty; group medical insurance; pension plan/retirement; dental care; uniforms; continuing education; and a sign-off sheet stating that the employee has read, understands, and agrees to the policies

Finally, you mentioned the doctor’s lack of leadership. Many doctors find the clinical aspect of dentistry easier than running and managing their practices. Leadership skills do not come naturally for most people, but are learned through experience. Part of being a leader is providing an environment where staff members can learn and grow, feel respected and appreciated, and nurture teamwork through example.

There are two types of leadership styles - dictatorial and participative. Dictatorial types focus on calling all the shots and often lead by intimidation, which usually results in high turnover. Participative leaders value the efforts and input from employees and allow them to actively participate in day-to-day decisions. However, this can go too far, where the doctor turns the leadership over to whoever wants it, such as those with strong personalities. Somebody has to be in charge, and that should be either the doctor or an office administrator with excellent interpersonal skills.

It sounds like your office could benefit from a practice management consultant who could help the doctor with leadership and management skills and assist in developing a policies and procedures manual, among other things. An outside, objective evaluation can be the starting point for bringing a chaotic dental practice out of ambiguity and confusion into clarity and order. Best wishes, Dianne RDH