The Dentist's Network #70


	Sally McKenzie Dr. Tom Snyder Mike Moore, Attorney

Sally McKenzie, CEO
McKenzie Management
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Is it A Guessing Game in Your Practice?

“I think.” “I guess.” “I believe.” “I presume.” Do you ever find yourself starting a sentence with those phrases. For example, I think someone explained to Nicole how to properly answer the phone. Or I would guess Ann has been trained how to collect from patients and handle insurance claims. Or I presume Katie understands how to use the scheduling system.

Well, I don’t have to guess, nor do I need to presume, in fact I know that in virtually every case in which dentists think staff is prepared to handle day-to-day tasks and challenges, they are losing both money and patients with every assumption.

Oftentimes, dentists don’t comprehend the impact that lack of training or poor training has on the practice. They don’t realize that the daily scheduling problems occur because the appointment coordinator doesn’t know more than the basics about the scheduling system. Dentists don’t see the link between their astronomical accounts receivables and the business employee who routinely asks patients if they would “like to be billed for today’s services.” They don’t see the connection between multiple cancellations in the schedule and the patient coordinator who confirms appointments by asking patients if they would “like to keep their appointment on such and such a date.”

Meanwhile, the employees, most of whom genuinely want to perform well, are frustrated. We talk to dental team members almost daily who genuinely want to do a good job. They want to know how to better manage collections, how to schedule to meet production objectives, how to present treatment plans and financial arrangements that will benefit both the practice and the patient. They want a strategy for monitoring and improving patient retention. In every case, the employees are craving the opportunity to learn how they can help the practice and the doctor reach their goals. But they haven’t been given the number one tool to succeed - training.

It’s not that dentists don’t recognize the value of training. But they often talk themselves out of sending employees to professional training for fear that it will cost too much in both time and money. So, they rely on staff to learn on their own or train each other, which is costing practices a fortune in lost productivity. Yet, multiple affordable and convenient options in the dental marketplace are readily available to dentists and teams.

Meanwhile, employees are working at the front desk running the entire business, dealing with hundreds of thousands of dollars. They are handling virtually every aspect of the cash flow. But they have not had one, single day of professional training. And there are no systems. There’s no accountability. There’s lack of information and communication. And this is a huge factor in why practices are not as profitable and as productive as they could be.

The scheduling coordinator, Liz, may know the doctor wants to do as many crown and bridge cases as possible, but she needs training in how to make this happen without turning away other bread and butter patients. The dentist is only going to produce what Liz schedules. And if Liz does not know how to schedule to meet production goals or if she’s blocked the schedule to maximize crown and bridge appointments to the exclusion of other more routine cases, it’s going to hurt the practice. No matter how hard Liz tries, if she doesn’t have the training or understanding of how to interpret production data and what to do with it, she and the practice will fall short. The doctor thinks that because Liz is a “good employee and a hard worker” that can substitute for real training. Sadly, it’s as much a frustrating guessing game for her as it is for the doctor.

Take unscheduled treatment as another example. The doctor and staff in most practices have no idea how to determine how many patients never schedule recommended treatment. I can’t tell you how many dentists’ offices we go into and the dentist has never seen an unscheduled treatment plan report. Talk about an epiphany when we hand the doctor the report that spells out the hundreds of thousands of dollars in treatment recommended but not pursued. The doctor assumed that most patients eventually scheduled recommended treatment. However, if his staff had been trained, they would have been monitoring this and following up with patients according to a carefully developed plan and strategy. And the team would be discussing this and other key systems regularly in staff meetings.

Perhaps it’s time to stop the “I think” “I guess,” “I believe,” “I presume” routine and find out what you and your team really know.

Sally McKenzie is CEO of McKenzie Management, a nationwide dental management, practice development and educational consulting firm. Working on-site with dentists since 1980, McKenzie Management provides knowledge, guidance and personalized solutions that have propelled thousands of general and specialty practices to realize their potential.

Interested in speaking to Sally about your practice concerns? Email her at sally@thedentistsnetwork.net or call 1.877.777.6151.

Interested in having Sally speak to your dental society or study club? Click here.

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Thomas L. Snyder, DMD, MBA
Managing Partner
The Snyder Group, LLC
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Conducting an Associate Interview

For many of you, 2009 will mark the year that you will hire your first associate. There are many variables that can affect the success of your associateship relationship. A well-structured interview can help you determine what qualities stand out in your candidates. Here are a few points to consider:

Qualifications of the Candidate
Based on the number of years the associate has graduated from dental school, this line of questioning can become quite important. If you are considering a recent grad, ask about clinical likes and dislikes. Was the candidate involved in extracurricular activities and if so, have them describe their experiences. If the candidate completed a residency program, explore the clinical services the candidate provided. If the candidate has private practice experience, have them describe their experience(s). It is highly unlikely that most associates can provide you with his or her production reports, but if they are available ask to see them to give you an idea on his or her capabilities.

Marketing Capabilities
Many associates fail to contribute to a practice’s growth. You should make it clear to the associate that even though you may have an abundance of patients, your expectation is for them to help grow your practice, just as you did when you began your career. Ask what they plan to do to attract patients. Is there an interest in participating in community activities? Are they willing to join organizations that will benefit the practice? Setting the bar for marketing performance is essential for a healthy and productive associate relationship.

Personality
Sometimes doctors will engage the services of a testing firm or consultant to assure compatibility between the candidate and the owner. This is particularly true if you are considering an associate for a transition, most notably a partnership. There are various personality tests available that can assist this activity for example, McKenzie Management has an on-line assessment test for dentists.

Philosophy of Dentistry
If it’s a recent grad, having a meaningful dialogue on clinical philosophy may be difficult, but, certainly, questions should be asked about how the candidate feels about their profession, about patient care, and ethical issues. If the candidate has experience in private practice, it’s fair game to ask questions about their philosophy and how it may have changed since dental school.

Management Experience and Knowledge
Does the candidate have any interest or experience in business management matters? If your candidate is going to be your potential partner, clearly, you should want someone who is willing and able to become engaged in business activities. Has the candidate taken any business or practice management courses since dental school? Did they take any business courses in their undergraduate program? Do they show any interest in managing a small business?

Expectations of Both Parties
Often associateships fail because both parties have not clearly expressed their goals and objectives. Ask the associate candidates what their one, three and five year plan may be to see if they have been thinking, critically, about their future. Has the maturity you’ve been looking for been demonstrated, or do you get the impression that the candidate is just looking for a job. Conversely, it’s important for you to be prepared for the associate candidate to ask you questions about your expectations of the relationship.

Compensation
Ask the candidate if they have prepared a personal budget. Since most young dentists have high debt, student loans are a big part of their financial needs. As we discussed in prior columns, we normally recommend that fulltime associates be paid a guaranteed salary for the first three to six months of their employment. Are the income requests realistic or so far fetched that you cannot meet their demands? Let them know how much they would have to produce if the salary requirements appear unrealistic.

Other Factors
Throughout the associate interview, be attentive to the candidate’s ability to answer questions, succinctly. Does he/she make eye contact with you when speaking to you? Are they prepared and organized in their thought process?

References
If you’ve interviewed several candidates and have narrowed it down to one or two individuals, it’s imperative that you check references to learn about his or her overall abilities, clinical skills, and prior work history (if applicable).

Summary
Take the time to organize your thinking and write out your questions prior to the interview. It’s important when you are interviewing more than one candidate to ask the same questions so that when it is time for you to finalize your choice, you will have a more organized way to do so.

Dr. Thomas L. Snyder is Managing Partner of The Snyder Group, LLC, a nationwide practice transition and financial management consulting firm. With more than 75 years of experience in the field, The Snyder Group can provide you a full range of services relating to practice transition matters and retirement planning. They can be reached directly at 1.800.988.5674.

If you would like additional help, email Dr. Snyder at drsnyder@thedentistsnetwork.net.

Interested in having Dr. Snyder speak to your dental society or study club? Click here.

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Michael Moore, Esq.
Director McKenzie
HR Solutions
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Policies For Handling Money

In recent weeks, I have seen a real upsurge in calls from client doctors who have learned employees have been stealing from them. I have come to the conclusion that the economic stress on everyone is causing folks to do some things they may never, in other circumstances, have done. Doctors need to understand that those employees in which they have put complete trust are not immune.

In the “worst-case-scenario” category, consider the situation of Dr. G from New York. Dr. G is the third generation in his practice. His mother for many years was the office manager and handled all the money. In the last decade, she was assisted by Pam. When Dr. G’s mother died, Pam took over all the bookkeeping, money handling, and deposits. As the years went on, she gradually assumed more and more responsibility. Dr. G eventually gave her the checkbook and his stamp. He then turned over his collections to Pam, paying her a percentage of what she collected.

Things were uneventful until recently, when Dr. G’s female friend who was helping out with some computer issues happened on the audit trial function for his office system, and learned of substantial discrepancies in the trail. This alerted Dr. G to some issues, and he began to probe more deeply. He asked Pam to give him a report on the accounts receivable, and was stunned to learn that she was reporting a $360,000 balance on receivables, this against $1 million per year in billings, and only $600,000 in collections. Dr. G called on me to try to figure out what to do.

In the second case, Dr. T, from Chicago called because he had just learned that his petty cash box – which is supposed to hold about $200 – is empty. Dr. T had given complete control over the box about a year ago to a front desk staffer – she had the only key other than Dr. T’s. For reasons which Dr. T isn’t entirely sure of, he decided to take a look in the cash box one day last week while he was out front with his office manager. When he opened the box and found it empty, his office manager could not explain it. Nor could the front desk staffer, who claimed she had not been in the box for a month, having repeatedly forgotten to bring the key to work with her.

Now, Dr. G and Dr. T both have strong evidence that employees have been stealing. In Dr. T’s case, rather than be concerned about trying to recover the money, he decided to fire the staffer immediately. His concern is that if he doesn’t act – the fact of the missing cash having gotten around the staff – he will lose this authority with the staff. Another option is to confront the staffer, offer her the opportunity to repay the money through a payroll deduction, and not terminate her. This option he chose to forego.

Dr. G ’s situation is much trickier for him. First, Pam is the only one who knows the documentation of the practice. His concern is that if he summarily terminates her, he may never be able to reconstruct the financial situation – even if he brings in a forensic company to dig into the operations. He cannot, however, ignore the possibility that hundreds of thousands of dollars may have been siphoned off by Pam.

An additional complication is that Dr. G has been seriously considering selling the practice. Without the ability to give a trusted picture of the finances, the impossibility of valuing the operation is self-evident.

In this case, Dr. G is a crisis management client. There are a number of ways to approach the challenge, and one that we are working on is the tightrope walk of eliminating Pam’s ability to steal while keeping her on for a period of time so that she can be compelled to come up with the source data for such issues as the accounts receivables. That may not be possible, and sooner or later, Dr. G is going to have to bite the bullet and dig into this mess. This means, of course, that Dr. G is going to have to devote lots of hours to cleaning up the mess that he finds himself in.

How to avoid these surprises is pretty simple. First, review your insurance policies. Find out if you have theft/embezzlement coverage, and, if so, what are the limits and the deductible. Important too, is to find out who has to bear the cost of the analysis of what has been stolen – this can cost tens of thousands of dollars.

Second, review how cash and deposits are handled in the office. No matter how small an operation you might have, never allow a single staffer to have control over handling money and deposits. If the employee knows that you, or your designee, will be periodically – without notice – reviewing the office cash records and bank records, there is little likelihood of some serious loss. This means, as well, that you need a cash receipts process that requires documentation of all cash into, and out of, the practice.

Third, talk to your accountant about having him or her conducting a detailed semi-annual review of your books. If the accountant makes an appearance at the office, and interviews those staffers who handle the cash and deal with deposits, it goes a long way to deter theft.

Fourth, you want to make sure that employees all provide an authorization to you to deduct from their paychecks amounts they owe the practice. This ordinarily addresses amounts owed from dental work done for staffers or family members, but it can apply to money or the value of personal property taken. I am always asked by the doctor in these situations if he or she can take the money out of the paycheck. In the absence of prior authorization, the state wage and hour agencies uniformly reject that self-help action.

Every office has some variation on how cash and deposits are handled. Now is the time to take a long look at your practices. Even if you have no reason to believe that something is going on, by tweaking the practice, and requiring some oversight, you will be discouraging someone who might otherwise take a “loan” for his or her own benefit.

Mike Moore is ranked among the best in employment law and has been named one of the top 10 lawyers in Ohio. As Director of McKenzie's HR Solutions, Mike is the creator of the Employment Policy and Handbook, geared to providing dentists who are unsophisticated in the legal arena with a step-by-step policy manual.

Click here to hear Mike present “7 Elements of an Effective Employment Policy.” Email Mike at mike@thedentistsnetwork.net.

Interested in having Mike speak to your dental society or study club? Click here.

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