The Dentist's Network #78

Sally McKenzie, CEO
McKenzie Management
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Inconsistency Consistently Irks Your Staff

“But you approved my vacation three months ago, I can’t help it that you don’t remember.” “If the office doesn’t open until 8 a.m., why do I have to be here earlier for a meeting?” “Are we paid overtime for this? “Why can’t I wear flip-flops? The patients don’t notice my feet.” “Why does Amy always get away with that?”

Employee questions and issues come up every day in the dental practice, and too often dentists find they’ve positioned themselves as the go-to person for all the answers. Although it’s not necessarily a role they want or enjoy, they reason that because their offices are small operations, they don’t really need formal polices and staff wouldn’t want them anyway – which are both incorrect assumptions.

The dentist, meanwhile, is dealing with matters on a case-by-case basis thereby digging her/his way into the biggest practice policy hole of all – inconsistency. Without established policies or documented procedures for even the most fundamental management issues, the doctor sets him/herself up for a multitude of personnel headaches, not to mention possible litigation.

Oftentimes, when consistency is lacking, the staff perceive the doctor to be perpetually waffling. One person asks the doctor what the policy is on a matter and the doctor says one thing, but the next time there’s a different answer. Or “special circumstances” will warrant an exception, but nowhere is it spelled out what those “special circumstances” might be – employees are left to guess on how the doctor will respond.

Situations become extremely stressful and frustrating for both doctors and team members when there are few, if any, clearly established guidelines for handling day-to-day concerns such as time off, dress code, vacation policy, sick time, work hours, etc. Moreover, most employees walk into a job wanting to be successful, seeking to understand the expectations so that they can effectively meet or exceed them. But without clear policies and established expectations, employees are at the mercy of the doctor’s whims. Consequently, the practice becomes fertile ground for insecurity.

That insecurity breeds secondary issues, in particular, fear. If employees do not have the guidelines in place to know exactly what they are responsible for, how their performance is evaluated, or how to bring concerns, problems, and issues to the attention of the doctor, they will be far less likely to raise issues that need to be addressed for fear of a negative reaction.

If the doctor appears to be making up the rules as he/she goes along, or if the doctor seems to repeatedly make exceptions for some employees and not others, morale plummets. Backbiting, bickering, and a culture of distrust and ineffectiveness permeates the office. This is not an environment in which many employees can succeed, and few will stick around for long.

Study after study confirms that teams want clear guidelines, in writing, that are easily accessed. Staff seek structure and an understanding of what policies and procedures are to be followed in the office. And they want it in writing and easily accessible in an employee policy handbook.

Rather than serving as a laundry list of rigid rules and requirements, a human resources policy manual sets up guidelines that reflect good business practice and build strong employer/employee relationships. It can be used to articulate the doctor’s philosophy for the practice and general goals for the team as a whole. It’s an effective means of conveying a positive message of teamwork and encouragement.

But most importantly, the handbook enables employees to know what is expected. With a clearly defined human resources policy manual in place, employees don’t feel as if the ground is always shifting beneath them. They aren’t strategizing and mentally calculating when would be the best time to ask for the doctor’s ruling on this or that issue because the answers are already part of well-established practice policies.

Remember that in most cases your employees, as members of your team, simply want to know and understand the rules of the game and how they are to proceed when questions and concerns arise. Expecting teams to be fully functioning and successful without a written policy manual that is accessible to everyone is a bit like taking your instruments away and expecting you to successfully practice dentistry. You might be able to figure out a way to do it, but the results won’t be acceptable to anyone.

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.

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Thomas L. Snyder, DMD, MBA
Managing Partner
The Snyder Group, LLC
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Selling Your Practice: Is It Time?

The “Great Recession” has had an impact on many dentists who considered selling their practices a year ago. Although we are not out of the woods yet, there are some signs that the negative direction we have been taking is turning around. So, it may be time again to analyze whether it’s time to sell. There are several things to consider in this process. Here are a few:

1. Financial Planning
First and foremost, can you answer this question: “Can I afford to retire and if so, how will my current lifestyle be affected?” Has your retirement dream been postponed indefinitely due to the downturn, or can you sell within the year and if it’s still tight, can you supplement your income for several years by remaining as an associate? Using a financial planner to assist you with this analysis is critical.

2. Condition of Physical Plant
If your practice has a worn out look, if your equipment is dated, and if you plan on selling in two years or less, don’t reinvest in new equipment as you’ll never get the return on investment. However, at least refurbish your office with fresh paint, tile, etc. Accept the fact that your practice’s value may be lower if you do not upgrade. If the time is right, accept less and move ahead with your plans. If the difference of possibly getting a higher value with new equipment makes or breaks your sale decision, you are not ready to sell!

3. Technology
If you have not purchased a dental computer system, we strongly urge that you do so if your timeline remaining in the practice is less than two years. Most purchasers are afraid to purchase a practice without a software program, because it is difficult to assess the potential of a practice if there are no computer records to be generated. Clinical technology is not as important, and we would only suggest you make that investment if you feel you can derive benefit from it immediately based on clinical care.

4. Practice Enhancement
If your practice can benefit from professional consulting, it may be well worth it to hire a firm to assist you in building up your practice. This investment only makes sense if you plan to practice a few more years, and then sell. By increasing your practice revenue, as well as profit over the next few years before selling, you’ll increase your current income and possibly get more for your practice.

5. Real Estate Issues
Many practitioners own their professional building. There are some things that you need to consider. First of all, most buyers do not want to purchase the real estate at the same time of the practice sale. Most purchasers prefer to pay rent for the first few years. However, after a few years of paying rent, many accountants recommend purchasing the real estate so the new owner can begin to build equity in the property. Often times, the debt service on the mortgage is close to the rental payment. If they are going to purchase the building at a later date, you should place in your Agreement of Sale a future purchase option, which allows the buyer a first right of refusal to purchase the building. A fair market appraisal of the property should be conducted at the time of purchase.

Cases where the real estate’s value is greater than your practice’s value can prove to be problematic, particularly if you plan to sell both assets simultaneously. In this instance, unless the buyer has liquid assets to make a down payment, the lender providing the practice acquisition financing is severely limited in being creative as to provide some funds for the down payment. In cases where the property is worth less than the practice, there is a chance for possible creative financing to offset the lack of liquidity on the buyer’s part to make the down payment.

6. Landlord Role
In the event that you are going to be serving as a landlord for a period of time, you must charge rent that is comparable to other professional practices in your geographic area. The lease terms need to be similar to the financing terms for the practice acquisition loan.

In summary, reassess your financial picture, determine if now is the time to sell or if not, and figure out what type of timeline you envision to complete your transition plan.

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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Separating Yourself From A Bad Employee

A consistent source of inquiries about terminations is: “How do we deal with a nasty, unreasonable employee when we must let her/him go?” Most doctors are understandably confrontation-averse. And nothing causes the stomach to churn like the fear of a termination turning into a real donnybrook. There are definitely steps you can take to reduce the possibility of an unpleasant or even dangerous confrontation.

Let us begin with the observation that even the best employee can -- and sometimes does -- metamorphose into a vindictive, impossible burden. Sometimes, too, a really evil person can hide their true nature until you have brought them on board. It happens all too often. The truth is that in almost all situations, there is a good deal of advance warning. Employee behaviors tend to deteriorate over time. If your eyes are open, seldom should a crisis come as a surprise.

If you have a solid policy in background checking applicants, you can often weed out the employee from “Transylvania” before they are on the payroll. If you have a well-constructed, affirmative employment relations policy, conscientiously followed, your chances of ameliorating the behaviors that lead to terminations are greatly increased. This can save thousands of dollars in replacing that employee. But even in the best run offices, the worst sometimes happens. And there are special dangers in handling these situations, which cannot be underestimated.

Who is the employee from Transylvania? The answer to that question is: we know them when we interact with them. Doctors frequently consult me about the productive long-term employee whose behavior has always been challenging, but who recently has been driving away good employees and patients. The doctor has resided increasing reliance on that employee over the years, and may often consider her a friend. So, the decision on what to do is a challenge, both from an organization and personal standpoint.

The other pretty common scenario is the employee who has but a few months with the practice, originally was an okay if not exemplary employee, but the doctor begins to hear through the grapevine that this person is complaining, abrasive and intimidating with colleagues and even patients.

Any doubts you might have had about how serious the situation is are put to rest when you try to counsel these employees. It is not unusual for the employee to become immediately hostile and threatening when confronted with the behaviors and performance issues. Whether they do so in your presence or you hear about it shortly after through the grapevine, inevitably things will rapidly go downhill from that point on.

I was recently consulted by a doctor who was stunned to hear – when she presented a chronically low performing assistant with a final warning – that she could do a better job “if Raymond (the general manager) was not sexually harassing me.” This bombshell creates a whole new set of hazards to be navigated – and we did with this employee – but the message came out loud and clear. There was no saving that relationship.

A company called CinCom Systems, Inc. learned the hard way how not to handle a contentious termination. Carl Uebelacker was a sales rep for the IT company whose relationship with his supervisor, Veith, deteriorated – as the court described it. Ubelacker complained to Veith’s supervisor, who, as the jury found, minimized the issue and told Ubelacker he would talk with Veith.

What happened next was that Ubelacker received from Veith a “Final Warning of Dismissal” which he responded to by memo and challenged the performance issues set out in the warning. Veith’s superior eventually approved the termination. One afternoon, Veith showed up at Ubelacker’s cubicle with two employees, Butler and Ream, who were carrying boxes. Veith told Ubelacker he was fired, and demanded that he immediately gather this personal belongings, put them in the boxes, and be escorted from the building.

The jury found that at that point, Ubelacker demanded to speak with the personnel office, Veith “became incensed” and stopped Ubelacker from calling on the phone by grabbing his wrist, and Butler stood in the cubicle entrance, blocking his exit. This incident spanned only a few minutes.

Ubelacker sued, alleging, among other claims, false imprisonment, assault and battery, defamation and intentional infliction of emotional distress. After numerous court hearings, including a grant of judgment for CinCom that was reversed by the Court of Appeals, a trial was held on Ubelacker’s claims.

The jury awarded him $100.00 damages on each of the claims, and $90,000.00 in punitive damages. The court then awarded Ubelacker all his attorney fees and costs and assessed them against the company. On appeal, the judgment against CinCom was upheld. The award of compensatory damages is very small in this case, so the potential hit was substantially greater than CinCom actually had to pay. This single example, and there are many more, reveals the catastrophe that a termination can be.

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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