Dr. Gerald Nelson
San Francisco, CA
PCSO Bulletin Contributor

As corporate and group practices grow in number, the management of the private orthodontic practice has become more challenging. Graduates who have an education-related mortgage-sized debt (but no house!) are not in a position to borrow money to open a new practice or buy into an existing one. Still, many private practices are run by an individual or partnership. A challenge for the practice owner is how to maintain competent team members who are enthusiastically on board with the practice mission. Can you have a warm family environment in the team, or is that limited by pursuing the bottom line? Team members will have a variety of needs. Does he or she have a spouse, children, or elderly parents? Is it possible to have and raise a child? Does the job offer salary advancement or security?

If the practice owner wants team members to be loyally employed for the long term, many of these questions arise, and sometimes management decisions that may seem financially problematic in the short term are very valuable when considering the long term. The example in this essay is sick leave. With all the media information regarding COVID-19, I first address the question of vaccination requirements by saying Just do it. It simplifies the employees’ expectations and, even if a vaccinated team member does test positive, the effect on the practice will be mild compared with the likely severe effects on a vulnerable unvaccinated team member. There could be liability considerations if your unvaccinated practice member passes COVID-19 on to a patient.

If you do not want long-term employees, to provide any benefits, or to strive to keep salaries as low as possible, this essay will be of no use to you.

Sick leave and well pay are two ideas that can be part of a practice policy (note that some states, e.g., California, have specific laws regarding sick leave). There may be a required hour minimum applied to all full-time or part-time workers. In addition, there might be other details to consider; for example, while the sick leave benefit must accrue starting the first day of employment, no benefit is paid out during a trial employment. Be sure to check with an expert on your state’s requirements.

The question of verification of illness is one that concerns employers. The concept of well pay is meant to address that issue. Providing well pay will encourage employees not to lose workdays so they will receive more well pay.

Here is a sample description of the benefit that could appear in an employee handbook:Sick Leave and Well Pay:

  • Sick leave is paid for bona fide illness or injuries. It can be used in caring for oneself or for a parent, child, spouse, or registered domestic partner. You are eligible for the same number of days for sick leave in a calendar year as you are regularly scheduled to work per week. For example, if an employee works five days per week, that employee is entitled to five sick days in a year, whereas if an employee works three days per week, that employee is entitled to three sick days in a year. Sick leave does not carry over from year to year. Instead, employees who do not use all their sick leave in a given year will receive well pay for any unused leave at the end of the year at their hourly rate. Well pay is paid on January 15 of the following year. Sick leave days may not be substituted for or added to vacation days and do nearn bonus dollars. (The last statement is a topic for another essay). If an employee is unable to come to work, she or he must call (a named person) at (home number) or (cell Employee Benefits in Private Practice 56 PCSO Bulletin Winter 2022 Practice Management Diary number), preferably the night before or that morning before work. Please speak to that individual rather than leave a message.


I have used this description in practice, and the balance of forces between taking a day off and forfeiting a day’s pay works well. Occasionally, an employee would come to work clearly unwell, hoping to limit their use of sick leave, and we would send him or her back home. If the employee happens to be sick beyond the five days, the employer can decide on the action to take. It is a case-by-case issue. Pregnancy leave is usually covered by state regulations.