Keeping The Team Intact


How to overcome a challenging dental labor market and retain employees.

Keeping The Dental Team Intact


Over the last few years, the dental labor market has seen a shift. Many hygienists and dental assistants opted to leave the profession after the COVID-19 pandemic disrupted the industry and their lives, while those who stayed saw an opportunity for change. Today, these critical team members are more selective about where they work. They want flexibility, a culture that promotes growth, and benefits like health care and paid vacation time—and if they don’t find what they’re looking for at one practice, most have no problem moving on to the next.

Many of the hygienists who remain in the labor market are choosing to work part time at private practices and dental service organizations (DSOs), onDiem CEO Joe Fogg says, and becoming acutely aware of key and pivotal differences between their workplaces. As dentistry continues to experience a serious staffing shortage, this means hygienists and assistants in the market have more options available to them, and more leverage to ask for more from their employers. For a dentist or owner to find success in this reality, it’s important for them to develop informed strategies to find and retain quality employees.

“There are roughly 7,000 hygienists graduating from school every year and roughly 15,000 retiring and leaving the industry. We know that nearly 30% of the combined full- and part-time hygienist workforce plans to retire in the next 6 years,” Fogg says. “In addition, the DSO sector is contributing a net positive of 2,000 to 3,000 new dental offices a year. That means fewer hygienists and more practices being built—and as a result, more of a burden on the clinical staff.”

These stressed team members are constantly looking for and taking on new opportunities, leaving dentists scrambling to fill open spots—often leading to bad hires and even more frustration for the employees left behind. In this landscape, you have to put procedures in place to first find the right employees for your open positions, and then create a culture that will make these team members want to stay.

If you’re having trouble attracting and retaining employees, it’s time to take a look at your hiring process, the benefits and compensation you’re offering and the environment you’re creating for your team—and how you compare with other practices. You might find it’s time to make some changes.

“This is an employee’s market,” says Mike Massotto, founder and CEO of New Jersey-based consulting firm Staff Driven Dental. “They can pick and choose what they want and they’re calling the shots. The challenge is, most offices weren’t good at this in the first place and everything has just gotten worse since COVID. Doctors aren’t trained in this; they didn’t go to school to become business owners so many of them make it up as they go along and the results are detrimental. Your team can make or break you.”

You can’t do it all on your own. To run a successful practice, you need a strong team behind you, with employees who are motivated to excel and who want to do their part to help move the practice forward, even if they’re only working 2 or 3 days a week. Finding and retaining high-quality employees will make your days less stressful and your bottom line more robust.

It Starts with Attracting the Right Employees

Dentists have always struggled with hiring the right people, Massotto says, and the more competitive market we have today has only magnified that. Clinicians need to learn the skills required to make better hires, and that likely means getting help from an experienced consultant.

Too often, dentists turn to traditional staffing agencies to handle hiring, Massotto says, but that’s just throwing money at the problem. Such agencies tend to charge 6% to 10% to send resumes your way, but making good hires takes a lot more than that, including pre-qualifying applicants before bringing them in for an interview. It’s also critical to learn how to write a proper job ad that will highlight the incentives you’re offering and attract the type of applicants you’re looking for.

“Today, hiring needs to be considered more of a campaign than a project,” says Darius Somekhian, head of strategic partnerships for Cloud Dentistry. “Posting jobs on multiple platforms, such as the one Cloud Dentistry offers, and social media is key to reaching potential new employees. Cloud Dentistry connects practice owners with the dental workforce through an on-demand/messaging platform that is quicker and more reliable than a traditional staffing agency at a fraction of the cost without any middle-man fees or contracts involved in-between like staffing agencies have.”

Somekhian also suggests contacting local school programs to ask about joining their job fairs, posting open positions on their job bulletin board, or having your job ads broadcast to the alumni association.

Asking the right questions is also critical, Somekhian explains. For example, you have to ensure the hygienist’s philosophies align with the practice’s. But these days, it’s also essential to make sure you understand what applicants are looking for. Be sure to ask if they’re more interested in temping or in taking on a permanent role and if they do want something permanent, at what point might they be willing to commit to that.

Massotto’s Staff Driven Dental also helps dentists find quality employees, working in partnership to pre-qualify applicants and bring in candidates who are the right fit for the practice and the job.

Whether you partner with a consulting firm or work through a hiring platform, it’s time to rethink how you approach hiring, especially in this ultra-competitive market.

“Dentists are trying to operate the way they worked before, but what worked before doesn’t work now,” Massotto says. “The business of dentistry is always changing, just like the clinical side. When I lecture to dentists, I ask them how much dentistry has changed in the last 25 years and they say it’s night and day. The business side is the same way. There was no social media or smart phones 25 years ago. The business of dentistry has changed, and if you don’t adjust with the times it can be to your detriment, just like it would be clinically.”

Offer Them What They Want

Dental team members are choosing to leave practices for various reasons. For some, it’s about compensation and benefits like health care and paid time off. Others want to feel appreciated and know they have the opportunity for growth. The point is, if you want to keep your team intact, you have to find out what motivates each employee and be willing to offer it.

“You have to be able to compete,” Somekhian says. “Practice owners need to realize they have competition out there that’s more real now than ever before, and you might have to pay more or offer more benefits to make your practice more attractive.”

Health care is on top of that list of benefits. Many hygienists don’t work enough hours to qualify for health insurance under the Affordable Care Act, Fogg says—which leaves health care providers without coverage of their own. This became even more of an issue during the pandemic, when dental workers had to risk exposure to COVID-19 every time they came into the office. Many left the industry all together or walked away from smaller offices to work for DSOs. (Unlike private practices, many DSOs do provide health insurance.)

Paid vacation time is also a sore point, Fogg says. Many dentists don’t offer paid time off (PTO) and only allow team members to take unpaid vacation when they’re out of the office. Otherwise, they’ll lose production while the hygienist or assistant is away.

“This is the way it’s been done for 3 or 4 decades, but now we’re at this intersection where hygienists and dental assistants are graduating and they’re not on their parent’s health care insurance. They’re also not working enough hours to qualify for mandatory insurance, and that creates a gap,” Fogg says. “Employers can close that gap by offering tangible benefits like co-paid, co-sponsored health insurance, or allowing professionals to take vacation time when it’s best for their schedules, families and well-being. Doing more to enable the happiness and health of your team, in turn, leads to better care and better business. ”

For dentists and owners to successfully navigate a challenging staffing shortage, it also helps to organize a consistent and complementary team of employees who can “fill in” for core employees when they deal with the usual interruptions of life—whether that’s a child’s recital or a family emergency, Fogg says. It’s why many dentists use onDiem to build a complementary team of consistent and flexible workers who can provide that all-important continuity of care—because they grow familiar with your office and your patients. Having this team also allows employers to treat more patients and get patients on the schedule faster, boosting productivity and giving some relief to your permanent part-time team.

Dental employees not only want more paid time off, they want more flexibility in their schedule (and that’s why so many of them have opted to go part time). Let’s say you’ve found a hygienist you know is a great fit for your team and who your patients will love. The problem is, she wants to work 3 days a week but you only planned to offer 2, and she doesn’t want to work evenings or weekends because she has young children at home. Instead of walking away, figure out how to make it work, Massotto says. You’ll be in a much better position than if you hire someone who isn’t the right fit but who is willing to work the exact hours you had in mind.

“Investing in your team members is also vital to retaining them,” Somekhian says. “Consider giving them a CE allotment of, say, $500 to take courses that will allow them to grow as clinicians. Professional development is essential; team members want to improve their skills and make a difference in the practice. They also look to you as a mentor, so demonstrating that you’re a leader they can learn from will help foster loyalty.”

Then, of course, there’s money. You have to pay them a competitive wage, Massotto says, or they’ll jump ship as soon as they can. While money isn’t the top motivator, it is important, and it’s worth an extra dollar or 2 an hour to get a really great person on board who will help your practice grow. The cost of not paying a little extra is much greater.

To understand the earnings left on the table with an unfilled position, think about it this way, Fogg suggests. A hygienist can, as an example, bring in $1,500 per day in production and another $4,000 in diagnosed treatment, for $5,500 per day. Multiply that by the number of days you have an open and unfilled position. That’s a ton left behind, and it adds up quickly. It’s simply a smart strategy for employers to provide the benefits, protections and flexibility our limited labor market demands—because the cost of leaving empty seats unfilled is much greater than the cost of providing PTO and a health care plan.

“At the end of the day, your employees want to feel like they’re part of a team,” Fogg says. “In the midst of a serious staffing shortage, providing benefits and protections that are common in every other industry is no longer a ‘nice-to-have.’ It’s a critical and indispensable part of hiring and retaining happy employees, maintaining a stellar quality of care, and ensuring a sustainable and successful business growth strategy.”

Creating the Right Culture

To retain quality employees, you need to create an environment they can thrive in, Massotto says. That means developing detailed job descriptions, preparing employee agreements and offering training. If the team members you hire aren’t working out, remember they may not be to blame. You have to set them up to win, and that means giving them access to all the tools they need.

“There are hundreds of jobs available and not enough people to fill them, so employees will pick what’s best for them,” he says. “And the good ones will interview you as much as you interview them to see if this is a place they want to be, if it’s a job they can make a career out of and if there’s opportunity for growth. Is there an incentive for them to make more money, or are they going to be stuck with the same wage with no chance for bigger opportunities.”

Remember, your staff is an extension of you, Massotto says, and you need to create a positive, supportive culture of growth. If team members are dealing with gossip and drama every day, at some point they’re going to move on.

The doctor has to set the example, Massotto says. In all great practices, team members love their doctor and are happy to tell patients about how great his or her work is and to promote the practice’s services. But your team members will only feel that way if you take care of them, and that means offering them training and benefits—basically all the things that show you value them.

“It behooves you to be a better leader and manager in your practice,” Massotto says. “It’s not enough to show up and be a good dentist. You should have that down by now. If they’re not happy with you, it doesn’t matter what you pay them. The 3 things team members want are appreciation, acknowledgment and security in their jobs. When you don’t give them those things, it goes to, ‘Give me more money.’ But it will get to the point it doesn’t matter what you pay them, they just won’t want to work there anymore.”

If their schedule is chaotic and their days full of drama and uncertainty about their jobs and their future, your employees will start looking for another position. That means they won’t be focused on your patients and providing the best experience possible. You really have to offer stability and a positive working environment if you want to keep quality employees on your payroll.

Effective communication is also key, Massotto says. Everything breaks down if communication is poor. It’s important to focus on creating strong communication in your practice. You have to communicate your expectations, goals and practice vision or team members will feel lost and systems won’t run properly—and that, of course, will lead to frustration that could send employees out the door.

Employees also seek out a culture that allows for flexibility in their schedule, and adding teledentistry to the mix can certainly help with that, MouthWatch CEO Brant Herman says. Providers can work 1 day a week at home to provide virtual consults, for example, helping to give them that work/life balance they’re after. They can take on cosmetic, ortho and new patient consults for 1 or multiple locations, present treatment and conduct a range of follow-up appointments. This opens up new opportunities for existing team members and boosts practice efficiency as well. It also helps shorten the wait time, as some patients can go right from the call center into a virtual appointment for an immediate consult.

“Some of our larger clients shifted more than 7% of their appointments to virtual, so now they have 7% more capacity for procedures in the office,” Herman says. “We found that almost 3 out of 10 emergencies don’t have to come in for appointments, so that also frees up chair time. You get that beautiful dual benefit of improving your staff’s flexibility and capacity while meeting patient expectations.”

MouthWatch recently launched Dentistry.One, a nationwide network of on-demand dentists providing virtual consultations. Dentistry.One serves as “a virtual front door to dental care,” Herman says, and they then route patients to dental offices for treatment. Through the network, Care Advisors help ensure patients receive a complete care experience, which includes coordinating in-person dental visits, navigating benefits, and offering guidance on how to improve home care and select the right dental products. This helps lessen the load for in-house team members, another benefit teledentistry can offer your practice, especially if it’s short staffed.

Building an Exceptional Team

Your team members are the backbone of your practice. Without a strong team, your practice will struggle. While it’s difficult to find and retain quality employees right now, there are steps you can take to make your office more attractive. Offering flexibility, opportunities for development, competitive compensation and a strong benefits package are among the ways you can attract and keep high-quality employees, even in this tight labor market.

And you don’t have to do it alone. There are consulting companies that can help guide you and platforms that can connect you with your next great hire, but you do need to invest a little time and money into making the improvements required to build an exceptional team. But the long-term results will make it well worth the effort.

“Dentistry is lucrative. It’s recession proof and labor proof, you just have to know how to manage your practice and to better manage your people. You need to become a better leader and owner and that takes training because you didn’t go to school for that,” Massotto says. “Dentists will spend thousands of dollars to become better clinicians but hardly any time or money on becoming better business owners. Focusing on creating a well-run business with good employees adds value to your practice. It comes back to you.”

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