Michael Moore, Esq. Director McKenzie HR Solutions Printer Friendly Version

Cliques And Queen Bees Equal Loss Of Sleep
And Profits - Part I

I’ve written of the dysfunctional office before, but I’m always hearing of new ways that things go bad when the boss isn’t in control of the staff. The same situations continue to appear with somewhat different guises, but always the same in terms of impact on the practice’s bottom line.

As a doctor, you can have the best advice and counsel on practice management but if you do not foster a collegial and professional atmosphere in the office, all of your efforts will be undermined. Not only that, such situations can easily lead to claims of wrongful discharge, discrimination, and retaliation - not to speak of unemployment compensation claims and other nasty sequelae.

The two most prevalent offenders that the office has: the “clique” or the “queen bee.” These are bad enough separate, but if the office has a queen bee who creates a clique as well, you the doctor are in trouble.

The clique is pretty much self-explanatory. This is the office in which there are a couple or more staff who are bound together to see that nothing gets done of which they don’t approve. Usually, the clique is composed of the most senior staff. Woes betide the new member who doesn’t abide by the unwritten code of conduct that the clique imposes.

The queen bee is the long-term employee who, over the years, has gathered to herself more and more responsibilities. She views herself as the “right arm” of the doctor - and in most situations the doctor has acquiesced in her view. As long as she does her job professionally, the doctor is okay. However, repeatedly we’ve had doctors come to us in desperation because they just discovered that the queen bee has been poisoning the office, chasing good staff away, and often covering up her own failures.

Very recently, a new twist on the “clique” situation came to my attention. We are now finding that associate doctors are just as vulnerable to the destructive potential of cliques as a new front desk assistant. If the doctor’s exposure to a legal claim is substantial when a staff person brings it, consider how devastating the consequences are if an associate dentist is forced out and seeks legal counsel. Because every doctor who has or considers having associates should be acutely aware of this, I’m citing one associate doctor’s own history of what is happening in her office:

The office has a receptionist and two dental assistants who are continuously scheming to get me to quit. It seems they feel I am intruding on their turf because I am a new dentist and they have worked there much longer than me. Because the owner only works two days per week in his practice and is not there when I am working, I have emailed him explaining the unethical and unprofessional manner in which these employees conduct themselves. He refuses to intervene or take any action to stop their bad behavior. He says because he is not there and he has not witnessed the behavior, we should work it out among ourselves. They know he does not back me up, so they do not listen to anything I say - even though the practice owner has stated that I am supposed to be in charge when he is not there.

The receptionist has stolen from me (which I can prove), hidden and shredded my paychecks (they are now mailed), hidden faxes, phone messages and my mail, is rude to my patients, and has intentionally told patients the wrong days and/or times for their appointments.

The two dental assistants make negative comments about me within earshot of patients. They try to intimidate me by bringing in both of their husbands, so that the five of them can sit around and insult me just loudly enough so that I can hear their inappropriate comments. The assistants have also intentionally handed me the incorrect irrigation solution while assisting me, which could have compromised my patient's treatment. They also challenge my treatments/procedures in front of patients, which makes my patients very uncomfortable. Several patients have told me they can feel the tension in the office and have asked my why these people have not been fired.

In this associate’s case, we have the worst of all possible scenarios. First, we have a “queen bee” - the receptionist - from whom the other staff takes their cues. We have the clique actively obstructing and sabotaging the doctor’s work and creating potential dental malpractice claims against the owner. We have an office environment that has become so toxic that patients are questioning it. This means that patients are leaving, or even if they are staying, they are not referring their friends to the office. If we dig a little deeper, we will no doubt find that profits are down because of the inefficiencies that result from such a situation.

Next week, in the second part of this article, I will address the potential for a major legal claim if the associate is forced out, and further discuss the importance of an effective employee policy.

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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Sally McKenzie, CEO McKenzie Management Printer Friendly Version

Conquer Conflict in Eight Steps

Rolling eyes, snide comments, poor attitudes, the silent treatment - these are all tell-tale signs of staff conflict. Disagreements and personality clashes can bubble to the surface in many different and seemingly subtle yet profoundly destructive ways. And when times are stressful, disagreements and hurt feelings can become all the more prevalent.

Certainly, if you’re not in the “line of fire” it’s human nature to want to ignore these undercurrents of tension and discontent and pretend they don’t really affect you. The fact is, most of us really do not like conflict and seek to avoid it. For dentists, conflict avoidance comes at an extremely high cost. Yet their first, middle, and often last solution for dealing with it is to look the other direction and quietly hope that the problem will eventually just disappear. Such wishful thinking is certainly comforting until reality kicks in. Conflict is expensive and the ramifications of not addressing it are plainly evident: lost productivity, absenteeism, increased cancellations, lower treatment acceptance, costly mistakes, and the list goes on.

The negative attitudes and poor performance that are too often dismissed with an “Oh that’s just Pam,” or some other weak excuse costs practices thousands of dollars a year. Understandably, most people prefer to turn on their heels and run in the opposite direction than stand toe-to-toe with conflict. But the only way to manage this subversive morale destroyer is to tackle it head on.

The process need not be painful or particularly difficult, but it does need to be clear and direct. Take charge. Yes, it’s easier said than done, and admittedly many dentists would prefer to hide in a patient’s mouth. But focusing on staff communication and accountability can significantly reduce the differences and get the practice back on track. Here’s how:

1. Make a conscious effort to expand communication with your staff. If they are working against each other, exhibiting poor attitudes and equally poor performance they may not be getting enough direction and feedback from you - the doctor.

2. Invest a small amount of time and resources in personality testing. Staff members who understand the personalities of their colleagues, including the dentist, are much better prepared to work with them effectively.

3. Clearly define job responsibilities. With job descriptions, team members understand their roles on the team. Subsequently, they recognize who is responsible for which systems and who is accountable for those systems.

4. Establish expectations for employees and, if necessary, provide training to enable them to meet those expectations.

5. Hold daily huddles to address day-to-day issues that can cause rifts, such as placement of emergency patients both today and tomorrow.

6. Schedule regular meetings with staff and follow a specific written agenda.

• Require each employee to report on the system(s) they are accountable for.
• Discuss what is happening with each system – scheduling, accounts receivable, recall, etc.
• Identify constructive strategies for addressing any concerns that arise related to the performance of specific systems.
• Assign deadlines and delegate responsibility to individual staff to pursue the problem solving strategies that have been identified.

7. Insist that clear information be shared among the team. For example, give front desk staff necessary details on time required for procedures and charges associated with procedures.

8. Establish clear standards for professional office behavior. Do not tolerate destructive personal attacks among team members. Focus on systems and what is or is not working in the systems. Give employees regular feedback. And celebrate the success of both the team and the individual players.

Staff conflict will not disappear on its own. The best way to manage it is to confront it head on. 

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.

Hear Sally’s FREE podcasts at The Dentist’s Network - HERE

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Thomas L. Snyder, DMD, MBA Managing Partner The Snyder Group, LLC Printer Friendly Version

An Alternative to Forming a Partnership

I’ve often been asked the question, by successful solo practitioners who are still in the early stages of their careers, whether or not they should form a partnership with their associate. I am sure you’ve heard stories that partnerships have a high failure rate. That may be true to an extent. However, no research has been conducted, to my knowledge, to document partnership failure rates. One can only assume that if you form a partnership and continue practicing for 20 to 25 more years, a true co-ownership relationship may encounter some problems along the way. Most successful practitioners desire to maintain control, so why risk their success in sharing ownership with someone else. If control is paramount and maintaining your personal and financial flexibility is key, then you may want to consider an alternative strategy. 

The alternative is forming a solo-group relationship. Typically, several business entities are formed in this model. If you’ve had an associate working in your practice for a few years, rather than offering the traditional partnership buy-in, consider this approach. If you are a sole proprietor, the first thing you need to do is to form a new business entity such as an LLC/LLP, or PC. 

Your associate candidate, in turn, will form his/her own business entity. A third entity (facility sharing entity) is then formed that will employ your staff, collect all fees, and pay certain operating expenses. After these predetermined operating expenses are paid by this entity, the respective net income for each doctor flows to your respective business entities. This third entity can be an LLC or PC, as well.

Valuing the Associate’s Patient List
For those practices that have been employing an associate, one way to value the patients they will purchase is determined by applying a multiple of the last 12 month’s associate collections. Other formal valuation methods may be applied as well. This patient list is the goodwill payment to the owner for the associate’s patient base.

Purchasing/Leasing Tangible Assets
Based on the personal financial situation of the owner, the owner can sell an undivided interest in the practice’s tangible assets, or the associate can lease the half or a pro-rata share of the tangible assets. Appropriate contracts must be prepared, such as an Asset Purchase Agreement, Promissory Note, or in cases of leasing, an Equipment Lease Agreement. If the host doctor owns the facility, a Security Agreement may also be in order.

Staff Issues
All staff will be employed by the Facility Sharing entity.  Typically, staff costs will be allocated based on time spent with each member’s practice. Fringe benefits are also included. Health insurance and, most importantly, pension plans fall under certain state/federal requirements - especially if the employee works more than 1,000 hours a year in both practices. So you need to be very careful if either member has a different pension plan, for example.

Dental Supplies and Lab Expenses
In many facility sharing arrangements, dental supplies and lab expenses are paid directly by each solo-group member. Sometimes, pro-rated formulas on clinical production by provider can be used to allocate supply costs. A pro-rata approach becomes less feasible if one member is placing implants and doing ortho.

Facility Sharing Arrangement
A Facility Sharing Agreement between both members’ entities needs to be prepared. If you own the facility, a lease must also be prepared between your real estate entity and the facility sharing entity. If you are a tenant, you’ll need to negotiate a new lease with the landlord to include the other solo-group member on the lease. Some of the items to include in your agreement should be:

• Facility management and decision making
• Division of certain facility related expenses
• Facility repairs and maintenance
• Sharing of certain staff members as well as respected payment of staff compensation, including fringe benefits and retirement plan  
• Use of telephone lines
• Termination provisions

Death and Disability
Cross Purchase Agreements between the members need to be included in your Facility Sharing Agreement in the unlikely event of death or disability. Specific formula for valuing the Intangible Assets of each entity should be prepared as well as a mechanism to determine the Fair Market Value of each respective partners’ Tangible Assets.

Buyout Clauses
Part of the proper transition planning for the “host” doctor is whether or not there will be a mandatory buyout upon retirement. This issue has been a major problem in many “true” partnerships, as the younger partner often refrains from a buyout, not wishing to incur more debt, or doesn’t need the other half of the practice to be successful. The solo group model affords more flexibility in succession planning in the sense that you can recruit a third party to purchase “your interest’ in the solo-group. The successor would then abide by the terms and conditions in the Facility Sharing Agreement.

In summary, solo-groups are viable alternatives for young practitioners who are uncertain about successfully co-owning their practice for 20 to 25 years.

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.

Hear Dr. Snyder’s FREE podcasts at The Dentist’s Network - HERE

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