Chapter 20

Promoting Staff Effectiveness

Part 1: Selecting and Hiring Employees

You’re only as good as the people you hire.

Ray Kroc, Founder, McDonald’s

A properly trained and motivated staff is essential for survival in today’s dental practice world. Although this at first appears to be a singular task, in fact, dentists must meet several steps or objectives along the way. These objectives include:

To accomplish these goals, dentists must organize and manage the staffing part of the practice. Staffing is a critical resource area (along with financial, technical, and physical areas). It should be called “Human Resource Management,” to equate the importance with the other management areas of the practice.

Various types of dental staff members were described in the chapter on duty delegation. Each practitioner will need to decide the type and number of each category of employee. Because the dental staff is the single largest item of expense in most practices, the dentist should take care that the staff member will be fully used before making the hiring decision.

Attracting the Best Applicants

The obvious purpose of the employment process is to place the proper person in a given position so that the dental office can operate efficiently and effectively. This apparently simple process is founded on several background facts. A dentist must specify what the ­position entails, and he or she must also specify what characteristics and training is required of a person who would hold the position. The problem then becomes one of matching, finding the right person to fill the job.

The Job Description

The first step in the hiring process is to write a job description that explicitly lists the duties that the job holder is to do. The reason for doing this is to clarify the qualifications that are important for an applicant to ­possess. In addition, the dentist can discuss in more detail with each interviewee the tasks that he or she will do.

The dentist must first know what is entailed in performing effectively in the given position. What are the duties of the person who holds the job? Who will the person in this job interact with and what are the responsibilities associated with the job? The job description defines the duties of the job. The dentist should write this description so it is easy to understand, succinct, and yet detailed enough that a person who applies for or holds the position knows what is expected of them. This description should consist of specific, observable job-related behaviors rather than attitudinal or general characteristics that are immaterial to performance on the job. A useful offshoot of developing a job description is that this essentially becomes the performance appraisal instrument. Because this consists of what a person should do on the job, assessing performance on these specific behaviors is easy. Perhaps the easiest way to write a job description is to have the person who presently holds the job write all the procedures that he or she does during a typical day or week on the job. This list of what a person does on the job should be the basis of the job description.

Recruiting and Advertising the Position

Recruiting involves the development of a pool of potential employees. Advertising is one obvious method to gather these people, either through newspapers or Internet bulletin boards. Another is through internal (staff) referral or through raiding or soliciting existing employees of other practitioners. Each approach has advantages and disadvantages.

Advertising is the most common form of identifying potential employees. Generally an advertisement is placed in the local newspaper (Sunday employment section) or on Internet lists. The ad should be specific for the job the dentist is filling, be positive in tone, and avoid misleading or discriminatory statements (Box 20.1). Several techniques can help an advertisement to stand out from the others. Simply making it larger, placing borders or white areas around it, or using bold or different type face can all draw a prospect’s eye to the advertisement. Unless the dentist wants many calls or is looking for a fresh face, he or she should consider including the phrase experienced or the more restrictive dental office experience required included in the adver­tisement. The dentist may either want to have the applicant phone or send a resume to the office.

Internet bulletin boards and lists are rapidly replacing newspaper advertising for many dentists seeking employees. They are inexpensive and common. Not everyone knows or uses these information sources. A dentist might miss many qualified potential employees, especially older workers, using Internet-only advertising.

Another common form of recruiting is by having existing employees of the practice identify friends or associates who may be searching for a change in employment. These people can then be contacted so that their interest can be determined. A dentist should not “raid” neighboring dentists of their staff people. If the potential employee is presently working for another dentist in the area, that person (employee) should ­initiate the contact and express an interest before the hiring dentist has any dealings with him or her. Although this may not eliminate ill will between the hiring dentist and the other dentist, it should reduce it. Some dentists offer a bonus or reward for the employee who identifies a new employee for the practice. If the present employees are happy and satisfied working for a dentist, they should be some of the best recruiters.

Other dentists may keep a list of acceptable candidates from previous job opportunities in the practice. Others may use a private placement service or a university-based work force service. The dentist should be aware that private placement services charge a substantial fee for finding an employee that a dentist can find just as easily.

Short-term and part-time employees can be found in similar ways. Temporary placement services will furnish employees on a daily basis. The dentist might use them as an opportunity to “try out” several people, looking for the person or the characteristics that he or she wants. These services are, again, expensive, but they do offer a solution to limited time needs for the practitioner.

Selecting the Best of the Applicants

When dentists have attracted a number of applicants, they need to select the best one for their office.

The Application

Unless a dentist wants the office staff to be unaware that he or she is hiring a new person, the potential applicants should phone the office. (The dentist should not use the primary patient lines in the advertisement and should have the applicants call a private number, if possible.) This allows the present receptionist to assess telephone communication skills. It also allows the receptionist to screen out unacceptable candidates by briefly describing the job and asking qualifying questions, such as salary requirements and experience. If the job has some ­undesirable component (e.g., evening hours 2 nights a week), the dentist should tell prospective applicants at this point rather than wasting everyone’s time with an interview. If the prospect passes the basic screen, the dentist should have them come to the office and pick up an application, complete it, and return it by mail to the receptionist or have them send a resume to the office instead of an application.

Some dentists prefer to use experienced employees only. They simply do not want to take the time to train a person who is new to the job. Others believe that dentists should find a person who has the personal characteristics wanted; the dentist can then train the person to do the components of many dental office jobs. It is an individual choice. The dentist will obviously pay more for an experienced staff member and that person can help the dentist learn additional ways of conducting the practice. However, that person may have learned undesirable habits previously and may be difficult to control, believing that he or she knows more than the dentist about the way the office should run.

As a rule, new practitioners should hire an experienced receptionist. An experienced person can help establish the business systems that every office requires. Otherwise, a new practitioner and a new receptionist will be searching for answers that may be common knowledge for a more experienced person. Often, after several years, the established receptionist and the now more-confident dental practitioner will have control problems in the office (i.e., who is really the boss?). By then, the office should be running smoothly enough and the dentist should be knowledgeable enough to hire another receptionist that fits the office personality.

The application form should ask information about the individual’s qualifications for and ability to do the job that the dentist has previously described. The dentist can gather information about an applicant’s credentials, background, and qualifications more efficiently through a written format than through interviews. He or she can also determine a basic level of written and expressive abilities by having an “essay” section to the application form. Applications are better than resumes in that a dentist can ask specific questions that may be important to him or her. The dentist should also have the person fill the application out by hand to assess handwriting skills and neatness.

Many dentists prefer to have prospective employees send a resume, instead of filling out an application form. If a dentist requests resumes, he or she should review them carefully. The person who wrote the resume will obviously try to place himself or herself in the best possible light. The dentist should look for gaps in employment history or frequent jumps from one employer to another. The dentist should examine the form and neatness of the resume. People often place references on resumes. They are seldom useful because people are obviously only going to give as references people who support them. A dentist may get more useful and honest appraisals from former employers, although this is even doubtful in today’s litigious society. Resumes may not give the dentist the specific information he or she needs about a particular candidate (e.g., can the person use a computer?) Nevertheless, the resumes are a good method for screening many potential applicants. Often business office applicants will have resumes prepared. Assistants or hygienists will usually not have a resume prepared and might not apply if that is required. The dentist may be missing a group of qualified candidates for these types of positions if a resume is required from them.

The Employment Interview

One means of gathering additional information is the employment interview, which is the final step in the employee selection process. The purpose of the interview is twofold: to aid the dentist in gathering information to select the best qualified applicant and to provide information so that the applicant can decide whether he or she wants to work for the practice. The dentist, therefore, may use the interview to “sell” the prospective employee on the practice.

As mentioned previously, the dentist should know as much as possible about every applicant. Before the interview occurs, the applicant should fill out an application form, which the dentist reviews before proceeding with the interview. Dentists do not need to restate any information that they can obtain from the application form during the interview. However, if there are any questions about the information on the application form, the dentist should discuss them during the interview. If, for example, the application shows a gap in the recent work history, the dentist should ask the interviewee to explain this unaccounted time.

Purpose of the Interview

The employment interview should be a required step in the recruiting and hiring process. The interview serves several useful purposes. These include:

• Verify information on the application or resume Most people will not actively lie on an application or resume. (Although one management study showed “inaccuracies” in nearly two-thirds of all applications examined.) Nevertheless, everyone wants to place their best foot forward. A person may, for example, not include a specific piece of employment history as a result of a probable poor reference from the employer. Other people may embellish their duties, abilities, and responsibilities. The interview gives the dentist the opportunity to ask more in-depth ­questions of the applicant and to find missing information from the written application.
• Find additional information that is not on an application or resume Dentists can assess many skills and attributes from a resume. For example, does the person have the required years of experience, training, or background required of the job? Dentists cannot glean other attributes simply from the employment application. How well does the applicant ­­communi-cate? Is he or she able to think quickly on his or her feet? How does he or she react when put in a difficult situation? Dentists can often deduce these and other traits and abilities during the employment interview when they are not evident from the application.
• Let the applicant assess the dentist and the office A prospective employee obviously wants to know about the office for which they will be working. The interview gives that person the opportunity to meet the dentist, the staff, and to see the physical and operational components of the dental practice.
• Time to actively recruit the applicant The marketplace for skilled dental auxiliaries is a competitive marketplace. An excellent staff member may have ­several possibilities for employment. Therefore, the dentist may have to convince the prospective employee that his or her office is the one for which the applicant wants to work.
• Assess dental personnel and compensation policies It is difficult to learn what a fair wage and benefit package is compared with what other dentists and other forms of comparable employment are paying. During the interview process, dentists find if they are “in the ballpark” regarding their compensation package. Many employees are looking for a particular situation (hours, benefits, etc.) that are not obviously apparent until asked. A dentist might satisfy that person through a minor adjustment to personnel policies.

Findings from the Interview

The dentist should try to answer three questions about each applicant.

• Can the applicant do the job? By reviewing the training and work experience of an applicant, the dentist should answer this question with a high degree of certainty. This question relates to information that should be readily available. However, the dentist should scrutinize these qualities closely to make an objective evaluation.
• Will the applicant do the job? This question is ­probably more difficult to answer than the first question. Even if the applicant has the skills to do the job, a lack of motivation may impede job success. From the information obtained before selecting an applicant, an objective evaluation may not be possible. For these reasons, dentists should ask previous employers and educational personnel from whom the applicant received instruction how willing he or she is to do what is expected.
• How does the applicant get along with people? The dentist wants to know how the applicant will respond to him or her as the employer, to other personnel in the office, and to patients. In an organization such as a dental practice, there are many interpersonal relationships. An employee should relate effectively with other people. In the interview, the applicant should talk freely and easily. If the applicant has difficulty carrying on a conversation or shows a dislike for working closely with other people, the dentist should suspect that the applicant might have difficulty working in a dental office.

The Structure of the Interview

After reviewing the application form, the dentist is ready to talk with the applicant. An introduction is an easy way to begin an interview because it immediately lets the interviewee know that the dentist is the person for whom he or she will be working. In addition, it avoids that awkward situation in which both the dentist and the applicant are at a loss in beginning a conversation.

At this point, the interview may continue in one of two ways. The dentist may use the nondirective style or he or she may find that a more structured approach is appropriate (Box 20.2). In a nondirective interview, ­dentists do not try to direct the applicant’s conversation. The nondirective approach can be helpful when the interview is not yielding enough information. Dentists conduct this kind of interview in a conversational manner with the chief difference being that the ^­interviewer listens and occasionally comments in ways that encourage the applicant to talk freely about any subject of interest. For example, the candidate may wish to talk about his or her scholastic background, but the interviewer may be more concerned with work experience. At this point, some direction may be necessary to elicit the kind of information in which the dentist is interested. Experience has shown that if dentists let applicants talk at length about matters that seem ­important to them, it is likely that most of the topics in which an interviewee is interested will be discussed.

The main advantage of these nondirective interviews is that it puts the applicant at ease and creates an atmosphere in which the applicant feels that the interviewer is accepting and understanding. They are also excellent means to assess the employee’s organizational, communication and interpersonal abilities.

The primary disadvantage is that the interview may result in little exchange of information occurring between the interviewer and the applicant. If the dentist does not elicit any information that helps to make a choice among applicants, the dentist has wasted the interview time. Veteran interviewers can use this technique productively, but for the novice, a more direct approach is likely to be more productive.

In structured interviews, the interviewer assumes a more active role than in an indirect interview. The topics discussed are usually those of interest to the interviewer and rather than waiting for particular points to emerge during the interview, the interviewer usually imparts information or asks questions directly related to those points. Applicants for openings in a dental practice are usually interested in the following:

Duties to be performed

Types of personnel employed

Working hours

Scheduling of vacations

Number of holidays

Sick leave policy

Professional development

Insurance programs

Dental care at reduced cost

Salary level

Covering these points directly is easier for the dentist and less time consuming than using the indirect approach and hoping that points that he or she wants to discuss will arise. Therefore, in an interview the dentist should control the discussion and mention those things that he or she feels are important rather than waiting for the interviewee to ask questions about them.

Interview Questions

As a rule, whether the dentist uses a directive or nondirective approach, he or she should try to use open-ended questions whenever possible. Open-ended questions typically start with how, why, what, or tell me about. . . . Responses to these questions allow the dentist to assess the interviewee’s communication skills and allows them to explain their answers in much more detail than a closed-end question. For example, the close ended question “Did you like your last job?” simply asks a “Yes” or “No” response from the interviewee. However, the more open ended “Tell me what you particularly liked about your last job” causes the respondent to give a discourse, rather than a simple one-word answer. The dentist will then be in a much better position to assess the person’s communication skills. Box 20.3 gives many different questions that can be asked during an interview. It is not intended as the ultimate list of all possible interview questions, it is a list of suggestions on the types of questions that a dentist might ask to gain the most effect from and employment interview.

The dentist should listen to the answer of the question asked. Many people are so concerned with preparing to ask the next question that they fail to listen to what the interviewee is saying in answer to the previous question. Listen attentively. If something sounds strange or wrong, ask a follow-up question. If the person is struggling with an answer, allow them to struggle for a moment. In this way, the prospective employer can tell how a person may react under pressure.

Legal and Illegal Questions

People may legally ask any question of an applicant that pertains to the work or his or her ability to do the work. It is illegal to ask any questions that are discriminatory in nature, or that do not apply to the job. It is illegal, for example, to ask someone if they have any children. That has nothing to do with their ability to do the job. However, an applicant who has children in day care may not be able to work the extended hours required when an emergency patient calls. That affects job performance. Dentists must be sure to ask the question that is work related. The question, “Mary, do you have any children?” is illegal. Instead, dentists can ask, “Mary, due to the nature of dental services, we often have to work late, often until 7:00 pm. Is that a problem for you?” If Mary has day-care issues, that is a problem. She may have a spouse or other family member who can willingly pick the children up at day care before closing. Box 20.4 gives several examples of illegal questions.

Common Interview Pitfalls

Several practices and habits may lead to an interview being a frustrating experience for both the dentist and the applicant. To reduce these frustrations and make the interview more productive, consider the following suggestions:

• The dentist should not allow interruptions during the interview Staff members should hold calls and not interrupt the dentist’s time with the applicant. This is both efficient and courteous.
• The dentist should beware of dangerous first impressions People often make an intuitive judgment of a person in the first minute after they have met. A familiar style of dress, smile, or tone of voice can lull an interviewer into a false first impression that cannot be overcome through the rest of the interview.
• The dentist should not be too formal or too authoritative The failure to exchange a few pleasantries and develop rapport makes it difficult for the applicant to relax and talk freely.
• The dentist should plan the questions The dentist should plan what he or she intends to ask of each applicant before the interview. Lack of planning on the part of the dentist may result in not obtaining information that could aid the dentist in selecting the best qualified applicant. The dentist should get as much information as possible before the interview, so that he or she can use the interview itself to build on this information.
• The dentist should not talk too much One purpose of an interview should be to find out if the applicant can express himself or herself verbally. If the dentist does most of the talking, it is unlikely that he or she could assess the verbal skills of the applicant.
• The dentist should not mislead the applicant about the duties involved The dentist may inadvertently do this if a clear job description is not available. He or she should be prepared to discuss duties and responsibilities in some detail. If a job turns out to be different from what the applicant expected, a new employee may quit within a short time.
• The dentist should not make the interview too shortThis makes it difficult to obtain anything but the most superficial information about the applicant. Lack of information frequently leads to errors in selecting the best qualified applicant.
• The dentist should not allow the discussion to wander. Discussions about mutual acquaintances or common interests may be entertaining, but they probably do not aid in judging the applicant’s qualifications.
• The dentist should not be too influenced by the ­applicant’s physical appearance, dress, or groomingAppearance only peripherally relates to the tasks ­normally expected of a dental auxiliary.
• The dentist should avoid making assumptions Just because a previous employee with a particular background did good work, the dentist should not assume that another person with a similar background would also be a satisfactory employee. Each person should be looked at individually.
• The dentist should avoid biases Age, education, and background are important only as related to job performance, so the dentist should avoid prejudging applicants on these qualities.
• The dentist should use intuition carefully The dentist should base a decision about a job applicant purely on intuition. Careful analysis and objective decisions should enter the selection process. The dentist should use intuition to complement these decision points.

Working Interviews

Many dentists have an employee work for a day in the office. This allows them to assess knowledge, skills, and abilities and to observe their interpersonal relations with patients and the other employees. It also allows the potential employee to assess the dentist’s office as a place to work. The dentist must pay applicants for these “working interviews.” If the employee is currently employed, it may be difficult to arrange a suitable time for such an interview. The dentist must also be sure that the employee understands that this is not regular employment but is only for the purpose of assessing skills and compatibility for the prospect of employment. Given these caveats, working interviews can be a valuable final step in the selection process.

The Hiring Decision

The decision of which of the final applicants to hire should be based on all the information that dentists can gather. It includes the application form, the interview process, reference checks, work history, and staff information. Personality and skill tests are legal (if they test attributes that are essential to the job), but their cost and low reliability make them impractical for the typical dental office. References should be checked, if only as a formality. Not many people will offer dissatisfied former employers as references. Few businesses are giving honest references on former workers (for fear of slander suits), but it is worth the small effort required for the dentist to pick up the phone and ask. A dentist may get lucky and find an honest evaluation. The dentist should call any previous dental employers; they will generally still give valid appraisals.

Once the dentist decides who to hire, he or she should move quickly! Really good employees seldom remain available for long. The new employee should be contacted (preferably by telephone) and offered the job. The dentist should be prepared to negotiate. The top applicant may have several other possible employment opportunities. The dentist should send a follow-up letter that details the expectations of staff in the office, the duties of the person holding this job, the pay rate, and any benefits that the person will receive.

Once the person accepts the job, the other final applicants should be contacted immediately and informed of the decision so that they can continue with their job searches. If more than one applicant had been acceptable, the dentist should ask that person if he or she can keep their name as an applicant if another opening becomes available. This may shorten the recruiting process in the future if the dentist needs to fill another position.

Probationary Period

Many offices hire employees into a “probationary” status that typically lasts 30, 60, or 90 days. Many ­dentists believe that they can try out an employee, then terminate him or her if the employee can not do the job duties or does not fit in with the other personalities of the office, without fear of legal repercussions. The ­dentist also does not pay employee-related benefits for the probationary period. If the employee passes the probationary period, they often are rewarded with a raise and qualifying for the employee-related benefit package.

Many large organizations have gotten away from probationary periods. They believe that their time is better spent in being sure that they select the right employee and train them appropriately. Most states support at-will employment, which means that dentists employ persons at their own will. Dentists can also fire these persons at their own will. Paradoxically, a probationary appointment may imply that once an employee passes the probationary period, he or she can only be fired for cause, essentially nullifying the at-will employment idea.

If a dentist wants to use a probationary period, he or she should probably call it a waiting period, which doesn’t imply long-term employment and supports at-will employment. The office benefit policy can state when employees become eligible for various benefits, eliminating this justification for the period. A good hiring process will do more to insure excellent employees.

Integrating the New Employee into the Office

The employment process does not stop with job acceptance. The dentist must orient the new employee to the office procedures and possibly train or send him or her for education or certification. Taking time for orientation helps to encourage the employee’s loyalty to the office, promote positive interpersonal relationships among staff members, and acquaint new personnel with all facets of the job. The following are tasks for new employee orientation activities:

• The dentist should start a personnel file This should include the person’s resume or application, W-4 and K-4 (state) withholding forms, Social Security number, and any other necessary tax-related information or work permits.
• The dentist should have the new employee fill out any benefit or insurance forms, if applicable Give the employee pamphlets and policies that describe those benefits (again, if applicable).
• If applicable, the dentist should verify and display the license or certification.
• The dentist should require the employee to read the Policy and Procedures Manual for the office The dentist should review each section of that manual with the new employee and should do the same for the personnel manual. The dentist should have the employee sign that they have read and understand the manual.
• The dentist should explain opening, closing, and emergency procedures The dentist should have the employee sign for office keys, if applicable.
• The dentist should give a detailed tour of the office so that the new employee can see where instruments and materials are The dentist should show the new employee where to store personal effects during working hours.
• The dentist should introduce the new employee to all existing employees The dentist should assign one employee who functions in a similar capacity to be the “information contact” so that the new employee knows who to ask office procedural questions.
• The dentist should arrange for OSHA and Health Insurance Portability and Accountability Act (HIPAA) compliance The new hire must have Hepatitis B vaccination within 10 days and must have the training required by OSHA and HIPAA when feasible.

Part 2: Compensating Employees

It’s not the employer who pays the wages—he only handles the money. It is the product that pays the wages.

Henry Ford

Dental practitioners compete with each other when recruiting staff for the office. The truly excellent dental office personnel will generally have several offices to choose from when looking for a new employment opportunity. Why would one choose one office over another? One reason may be the pay and benefit package of the dentists. A new practitioner probably cannot pay the top-dollar wage and benefit package that an established colleague or other business venture can. The dilemma that a starting practitioner will face is that he or she does not have the immediate cash flow to pay for the best employees, yet they need the best employees to become profitable.

How to set Staff Compensation Levels

Usually, dentists will pay the “going rate” for comparable employees in their area. The going rate is what most employers pay for similar positions with similar job requirements. This is in turn determined by technical skills or knowledge required, interpersonal abilities, and availability to work certain times. There also may be legal or licensing requirements (such as hygiene license or assisting certification) that limit the number of potential employees, driving up their cost to the dentist. In the end, supply and demand of the labor pool determines what dentists pay employees. If hygienists in the area typically earn $45 per hour, then a dentist will pay about $45 per hour for a hygienist. (There is a range around that average figure.) Various groups, including the popular dental press and organized dental groups, do periodic staff salary surveys. These are a good place for a dentist to start when looking for comparable wage levels.

When thinking of “pay,” dentists should think of the total compensation package, which is composed of the hourly wage, legally required benefits, and any optional benefits offered. Wages and benefits are, to a certain extent, interchangeable. A wage of $20.00 per hour with no benefits may be comparable to a wage of $17.00 per hour with a health insurance plan. Every employee is different. He or she will value the balance between pay and benefits differently, according to his or her own needs. Benefits hold tax advantages for employees over straight pay. Many dental office employees would prefer part of their total pay to be in the form benefits. However, many others, especially low-paid employees, do not appreciate this and would rather have cash in hand. Benefits, like salary, help in recruiting, hiring and retaining employees. However, some employees poorly understand benefits. Often they do not understand their true value, and view benefits as employee “rights” rather than forms of additional compensation. Any paid time off (holidays, vacation) is additional compensation and comes from office profit. Unpaid time off decreases office production. To bring these confusing ideas together, many dentists compute the total compensation for employees each year at wage adjustment time. An example computation sheet is given in Table 20.1. Adding a staff member is a large investment, but if he or she increases office collections more than they cost, the addition is a good investment.

Staff Pay

Equity means fairness of the reward system. There are many reasons for promoting equity besides the altruistic desire to treat employees fairly. As a business, dentists compete with other businesses for the pool of labor in the community. Dentists compete with other dentists for the services of assistants, hygienists and receptionists. Dentists compete with the local bank and grocery store for the general labor pool. Although people work for many different reasons, one reason certainly is pay and benefits. Therefore, dentists must pay a competitive wage and benefit to hire and retain excellent employees.

Many pay issues are governed by the Fair Labor Standards Act (FLSA). This is a federal law that is carried out at the state level. So some state-to-state variation exists in the terms of the law. Dentists should check with the state’s Bureau of Labor Standards (or similar state organization) for the exact interpretation in the state of practice.

Hourly Wage

Hourly employees earn an hourly wage. Their total pay is based on the number of hours that they work multiplied times their hourly wage. Most dental office employees earn an hourly wage for their work.

To figure out total pay accurately, dentists must have accurate information describing how many hours each employee worked for each day of the week. Either written pay records (pay sheets) or a time clock accomplishes this legally. If a dentist uses a written record, the person should record “time in” and “time out” for each session (morning and afternoon). Simply recording 8 hours is not adequate documentation. Also, the dentist should require each person to sign the time sheet or time card. This says that he or she agrees it is an accurate description of the time that they worked. Most office management computer systems have built in time clocks to help in recording hours worked. This also makes it easier to process payroll.

Salary

Salaried employees earn a fixed amount (salary) regardless how much time that they work (given some limitations). Some dentists prefer paying a salary for several reasons. The accounting is easier to calculate. Each pay period, the owner calculates how much Social Security tax, federal, state, and local (if any) income taxes, and voluntary employee contributions to withhold from each employee’s gross pay. Salaried employees make the same gross pay and therefore have the same amount withheld each pay period, making this function easier. Some dentists erroneously believe that any salaried employee can work an unlimited time. (In fact, only “exempt” employees can work overtime without additional pay.) On the down side, a salaried employee gets paid for a full week’s work, even if they work fewer hours.

Commission

Dentists may pay staff a percentage of the work that they produce. This pay scheme is valuable when the employee controls their own amount of production and when money motivates the employee to work harder. That is not always the case. A hygienist may be able to control patient volume, but a chairside assistant has much less control over how many patients he or she sees in a day. A commission is a much less effective way to compensate the assistant. A common problem is to decide which procedures should be included in the hygienist’s base for commission. The periodic exam, for example, can only be done (in most states) by the dentist, so should not be included. Radiographs, although taken by the hygienist (on the dentist’s equipment) must be read and interpreted by the dentist. Eliminating these procedures for compensation decreases significantly the hygienist’s compensation and can lead to dissatisfaction.

Table 20.1 Example Annual Employee Compensation

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