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Dysfunction reigns in office

Jan. 1, 2018
Dianne Watterson, RDH, advises a dental hygienist who is caught in a worsening work environment.
Office Administrators
Dramatic changes lead to toxic work environment


Dear Dianne,

I have been employed for over four years with the same company. We have two offices and usually have two doctors. Since I have been there, the “second doctor” has been five different people. One left for higher education, one was fired, and the last three left.

In the past year, my boss built an extravagant building and hired 50% more staff (most of them have no dental experience). Needless to say, we went from being a small family-oriented office to this big compilation of people and bills. And what happens when money gets tight? You guessed it: The staff pays. Since then, he has brought in his wife, who has no dental experience, to run the offices.

Things have really changed. We have had to fight to get paid for time off, even though we have the time available. Her reasoning is that if it is not beneficial to the office, then they can’t approve time off, which means you can’t be paid. Our previous office manager always lumped all time together, including paid time off and vacation (PTO). Now, without warning, you have to be sick to use your PTO and must provide a doctor’s excuse. She also likes to talk about staff members and is always trying to get people to talk about other people. I feel like rumors have even been started just to see who talks to who.

My biggest problem, besides not being paid for approved time off because I was out of town and not sick, is the scheduling of new patients on the hygiene schedule when there is no doctor in the office. This came up at a meeting, and the doctor agreed that should not happen. The very next day she came in and told the front desk assistants, not the hygienists, that if hygiene didn’t want to see new patients without the doctor here they didn’t need to work when he wasn’t here at all. Now mind you, with one doctor and two offices, we see recall patients on our own. This makes no sense to me.

I feel I am being threatened with my job every time I turn around. I don’t make Florida law, but I have to follow it. Last I heard, so does the doctor. I used to love going to work, but lately work has caused me to be physically ill. He will not discuss anything with us. It is up to his wife, and that is it. She is not flexible, will not answer text messages or phone calls, and is not on a schedule at the office. You never know where to find her. I have been a hygienist for 20 years, and this is the second time this has happened. It is always about the wife and the money. Any advice would be helpful.

Frustrated Florida Hygienist

Dear Frustrated,

From what I can gather, your office is undergoing some rather extensive changes. Change can be both positive and negative, but too much change too quickly is worse than no change at all. The inability to retain a second dentist is a serious problem that needs the most immediate attention if the owner wants to minimize patient attrition. Patients are not stupid, and when they see new faces every time they come in, they know things are not good.

The stress of working under the conditions you describe is enough to make anyone physically ill.

The doctor’s spouse should have a solid working knowledge of the practice, because if the doctor becomes incapacitated, the spouse will have to make important business decisions. However, having the doctor’s wife onboard as a kind of hatchet person/manager who also has a proclivity to gossip is never good.

The situation you describe is about as negative as it gets. In retrospect, I have seen situations where the doctor’s wife was a real asset to the practice. I can only speculate, but does the owner really believe that having a stable and reliable staff group that wants to be there is good for his practice? He sure isn’t acting like it.

The office administrator position is one of the most important and difficult jobs in the practice. The OA stands in the middle as the bridge between management and staff members. This position requires a very high-quality individual, preferably with a business degree, who possesses exceptional people and organizational skills. He or she must be thoroughly proficient with the office practice management software and understand all the office systems, such as scheduling, recare, accounts receivable/payable, and insurance administration. Above all, this individual must be 100% trustworthy and not given to gossip, since the office administrator will be privy to sensitive office information that must be kept confidential.

I had a consulting client some years back where one of the doctor’s wives carried the title of “office administrator.” The office opened at 8 a.m., but she arrived around 9:30. She would leave for a long lunch around 11 to get a manicure, hair appointment, massage, etc., and return around 2 p.m. She always left before everyone else at day’s end, and I have never seen a staff group despise an OA more than her. The tension in that office was palpable! The other doctors were most unhappy with this woman’s job performance and did not feel she deserved her title or impressive salary. Staff turnover was rampant there, and I told the partner in my report that it was my observation that they might not have a practice in the future if they didn’t get her out of the office. Later, the partnership came unraveled, and the Queen Bee and her husband left the practice.

I have a couple of questions. First, does the office have an employee’s manual that spells out office policies? If so, you need to refer to that regarding vacation and PTO. When owners have a policy manual, they must abide by it. They can’t make new rules that suits their purposes when situations change.

Secondly, I understand Florida is a general supervision state with some stipulations. As far as I can tell, you can see a new patient for the purposes of gathering data, such as x-rays, periodontal charting, and determining the periodontal status. But you are not allowed to provide treatment until the doctor examines the patient. So, if the doctor expects you to render care without first having an exam by the doctor, he would be in violation of Florida rules.

It appears the doctor has abdicated the management of his offices to his wife, who, incidentally, is not equipped for such a large undertaking. Unfortunately, there could be catastrophic consequences, and there’s not much you can do but stand back and watch it happen.

If I were you, I’d be looking for another job. Dental hygiene is stressful enough without adding volatile and emotional drama in the work environment and dealing with people who want to make up the rules to suit their purposes. The stress of working under the conditions you describe is enough to make anyone physically ill. Just keep your job radar engaged. Something will turn up.

I wish I had better news,

DIANNE WATTERSON, RDH, BS, MBA, is an award-winning author, speaker, and consultant. She has published hundreds of articles, numerous textbook chapters, and two books. Dianne’s new DVD on instrument sharpening is now available on her website at under the “Products” tab. Visit her website for information about upcoming speaking engagements. Dianne may be contacted at (336) 472-3515 or by e-mail at [email protected].