Summer 2000

I hope readers have found the New Member Forum informative. I certainly have. In the last few issues, Dr. Mike Sales addressed the topics of centric relation articulator mounted models, views on using non-compliance appliances, and criteria for banding/bonding second molars.

For this column, he has recruited new respondents. We are grateful for the efforts of the past panel, Dr. Paul Kasrovi, Dr. John Trotter, Dr. Adrian Vogt, and Dr. Gary Stafford.
- Gerald Nelson, PCSO Bulletin Edtor

Dr. Bridget M. Powers

The secret of maintaining quality employees?

I have a small new practice of 14 months with four employees: two employees have been with me from the beginning, two are new. Here is what I believe is the secret to maintaining quality employees.

I spent a fair number of hours over the last few months trying to determine if the practice could afford to provide a few employee benefits: 401k and health and dental insurance. After all, if I wanted to retain quality employees I had to compensate them well. After much research, I proudly presented the options to the employees. They yawned and wondered when the staff meeting would end so they could go to lunch.

Today, as my newly acquired TMD has finally subsided and I no longer have headaches or a gnawing pain in the masseter muscles, I think how grateful I am that my office manager recently handled an employee situation. After weeks of training, handholding, discussions, and more training, another staff member closes the door behind her as she walks softly into my office (the door is never closed). She reveals a personal reason for the stress in the office and apologizes for the effect on others. Great. Smiles are back on everyone's faces and the weekly crisis has ended for today.

I have learned that orthodontic team members do not always think like an orthodontist. When it comes to compensation, expectations, or commitment to the overhead expenses, each person comes to the table with a variety of personal experiences that shape their responses to stress and to responsibility. To succeed at leading and dealing with people, it is very helpful to understand what motivates each person and how your own communication style affects their responses. It may be a simple and thoughtful "thank you," or it may be company stock options. One system will not work for everyone. Realize your own shortcomings and delegate to others who may have skills you lack. Lead by example which, personalities aside, also requires structure. To hold a person accountable for their responsibilities requires a written description. Define what they are to accomplish. We spend a decade in school in order to join the elite group of this great profession of orthodontics. I love my job. I love going to the office. I love putting on braces and taking them off. And, I really enjoy the constant people management challenges: parents, patients, employees, contracts, etc. Orthodontics is a team effort and without a great team, we do not succeed.

Dr. Bernard Chang

As you all know, having an excellent staff is vital to running an efficient orthodontic practice. Maintaining a good team and a good working environment has made practicing orthodontics more enjoyable for me. Currently in my fourth year of private practice, I was very fortunate to start off with an excellent staff. However, on several occasions I have had to hire new employees, which can be a difficult task. New employees are immediately shown the ideal working condition of my practice. They are treated not only as team members, but also as individuals. Many employees have young children and need flexibility in their schedules. Flexibility also allows us to accommodate unforeseen emergencies.

Another benefit we provide is paid time off. My vacation policy is based on the number of days each employee works. The number of vacation days increases with years of service. Employees may use their vacation days without restriction as long as our office can continue to provide quality patient care without them.

Continuing education is also available. Whenever possible, our staff attends meetings, not only to receive the credits, but also to help implement new and better ideas into our office.

Many practices offer a bonus program based on performance. I have not implemented such a system. I have seen employees become dependent on these bonuses only to be disappointed and upset when the office does not meet their expectations. Instead, I have routinely given bonuses when our office has a good month. I believe that the staff should be rewarded when they show that extra effort.

Just recently, our practice initiated retirement benefits: a 401K plan with a profit-sharing option. This is something the staff has asked for. Such benefits encourage long-term employment and improve staff morale.

Maintaining an excellent staff is very challenging - sometimes more challenging than the latent class III grower or your toughest adult cases. By providing benefits, encouragement, and constantly showing your appreciation, maintaining a great team is possible. I often find that just saying "thank you" at the end of the day can make all the difference.

Dr. Kami Hoss

In today's economy, with record low unemployment levels, it is becoming increasingly difficult to find qualified employees. That's a fact! So what specific measures do my partner and I take to find and keep good staff?

The best employees are typically found through networking. Throughout the years, our existing staff or other doctors have referred highly qualified staff to our office. Another overlooked resource is the patient pool. Both of our treatment coordinators, f or example, have been parents of our patients. If all else fails, I think it is worth spending a little more time and money to write an effective "want ad." In our practice, applicants have to pass three screening tests. First, we conduct an effective telephone screening to ensure that only viable candidates are interviewed. Next comes the first interview, usually conducted by our office manager and myself, to determine the applicant's personality, willingness, ability, values, goals and aspirations. Finally, we ask the best applicants to return for a "working interview" to assess their skill level and competency, and also to determine how they would blend in with the practice and other staff . Monetary compensation is obviously an important deciding factor for qualified applicants. In our office, we provide a comprehensive package including bonus systems, health insurance, and retirement benefits.

As important as the hiring process may be, it will have little significance if the working environment is not conducive to retaining staff members. Recently, my staff explained some of their reasons for staying in our practice as long as they have. A happy work environment was on top of everyone's list, inspired primarily by the doctor's personality. To me, the two most critical leadership qualities are fairness and consistency. The personality of fellow staffers and how they all got along was also ranked high. As a doctor, you can have a strict or casual management style, but if you are fair and consistent in your words and actions, your staff will respect you.

Professional growth is also very important. Orthodontics is going through many changes in terms of new materials, techniques, philosophy, and new possibilities. We provide our staff with continuous education through in-office training and outside education.

Finally, staff members want to participate in management decisions and they want to be appreciated for their efforts. Team participation is essential in creating a sense of ownership in the practice. Although I make many of the final decisions, I rarely do it without consulting with some or all of my staff.

Staff turnover is wasteful and expensive. Most of us would agree that staff manageme nt is one of the most challenging aspects of our offices. However, with adequate care and attention, it could be the single most rewarding investment we make in our practices.

Editor's Comment:

Dr. Michael Sales

There have been times, fortunately not many, when I have had to work without an assistant or without adequate help. It doesn't take long in these situations to be reminded of how critical an excellent support staff is to achieving the goals of an orthodontic practice. "Terri, can you take a pan-x on Bobby?" "Karen, would you please get Sarah ready for upper brackets." "We need a face bow transfer on Jim." "Please tie Cara with elastic chain." "Form a TPA." "Fit a band." On and on it goes, and where it stops? You'll know real fast when you lose a first-class employee.

In my years of practice, I have been privileged to work with some first-class people. As we learned each other's strengths and weaknesses, we grew and developed a camaraderie and esprit de coeur that translated into greater efficiency, a higher level of competency, and a happier work environment. Recently, I was most gratified when an observer parent commented on how well our entire staff worked together. She went on to explain that she had another child treated elsewhere and the difference in working relationships was most obvious. It made her feel good to see how well our team related to each other. Not every patient or parent is concerned with the morale at their orthodontist's office, but you can be sure that a genuinely positive atmosphere created by people who actually like each other will grow a healthier more prosperous practice.

In this day and age of marketing and practice management awareness, we are taught to say and do things according to a script and a plan. That may be helpful for some, but I believe that the application of the most fundamental principals of respect, integrity, sincerity, candor, and good humor are more valuable than a cookbook on how to manage people.

The relationship you develop with your staff depends on many factors. Specific things that motivate employees will vary from person to person and employee to employee. When first starting, there may not be available funds to pay the highest wage or provide the most benefits. This may preclude the possibility of some employees working for you. There are others, however, who do not need or value compensation in the same way. These people can be nurtured within a growing practice and become vital members of the practice's foundation. As the practice grows, it is essential to acknowledge that it doesn't happen without their help. Reward your employees for their talents, expertise, and loyalty. We can't do it alone. Say "thank you"often and share the rewards.

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