This review highlights some of the more important employee relation aspects involved in starting, establishing, or expanding an existing dental practice. Despite a competitive compensation package, staff-related conflicts can sometimes hamper the progress of a dental practice. Such conflicts can be reduced by having policies and procedures in place for each employee that set expectations concerning the hours of operation, professional manner, dress code, job tasks, performance evaluations, disciplinary actions, and termination if violations occur. Understanding the legal requirements set by various governmental agencies such as OSHA can help ensure that the rights and well-being of every employee are protected.
The face of employee relations has changed a great deal in the practice of dentistry. Several years ago, a dentist may have had only one staff member who answered the phone, made appointments, and assisted at the chair. This situation is a stark contrast to the dentist of today who may have 20 or more employees on his or her dental team. From insurance specialists to scheduling coordinators, the staff has expanded and become more specialized to improve the efficiency and productivity of the individual employee and the practice as a whole.
No dentist could argue the value of a pleasant, competent, and reliable staff. Hiring and retaining excellent employees in the dental office is integral to the success of the practice; however, managing a staff of several employees can be challenging. This article attempts to assist the dentist in this regard by discussing some of the most pertinent human relation topics in the practice of dentistry.
Recruitment
When starting a new dental practice, expanding an existing practice, or replacing someone who has left, there are several aspects to consider before hiring a new employee. Some of these aspects are establishing job expectations, advertising, interviewing, and pre-employment credentialing of applicants .
Job expectations
A job description should be written that clearly communicates job expectations and the type of person needed for the job. The job description should include specific job duties, skills required to perform the job, physical attributes an employee must have to perform the duties (eg, the ability to lift heavy objects or sit for long periods of time), credentials, an acceptable education level, and experience necessary for employment . The description should incorporate the practice philosophy or mission and how the employee will fit into the big picture. In addition, a statement should be added that articulates compliance with local, state, and federal laws .
After the job description has been written, it is time to begin recruiting. Having a happy and successful team of employees can be an inexpensive and effective recruitment tool. Open positions or soon-to-be vacancies may be communicated to internal employees so they can be on the lookout for potential candidates in their network of friends and associates. A dentist’s social, professional, or academic colleagues may also aid in recruitment.
Advertising
If advertising is necessary, a budget should be determined beforehand and appropriate publications for advertisements selected . Hourly positions such as dental assistants, dental hygienists, receptionists, and business managers may be advertised in local newspapers and online job postings. When recruiting a dentist, particularly someone with a specialty degree, it may be necessary to advertise regionally or even nationally. Journals, dental schools, state dental associations, and specialized online publications are a good way to advertise for dentists. The advertisements should reach a diverse population .
Because the advertisement should spark interest and create a positive first impression in potential applicants, it should be constructed carefully and thoughtfully. It may be helpful to talk to existing employees and find out what attracted them to the practice, incorporating that information into the advertisement . For example, the training provided, flexible hours, or an attractive financial or benefit package may serve as the selling point.
Interviewing
After advertising, the next step in the process is interviewing. Before or after interviewing, references should be checked carefully and thoroughly. Before interviewing, it is necessary to decide what questions will be asked . There are generally two types of interviews, traditional and behavioral . In a traditional interview, questions are asked that have a straightforward answer, for example, “What are your strengths and weaknesses?” or “Describe a typical work week .”
In a behavioral interview, questions should be posed to find out if the candidate has the skills necessary for the job. Instead of asking the candidate how they would behave, they are asked how they have behaved in previous experiences. How one behaved in the past generally will indicate how they will behave in the future . A few examples of behavioral interview questions are as follows : “Have you handled a difficult situation with a coworker and, if so, how?” “Tell me about how you worked effectively under pressure.” “Can you give an example of a time when you had to deal with a patient who was disgruntled or in uncontrollable pain?”
Questions should be directly related to the job and the job duties the employee will be performing in the position. Certain questions cannot be legally asked of the applicant , such as questions related to age, race, color, sex, disability, religion, national origin, pregnancy, and other protected classifications .
Pre-employment credentialing
Before an offer is made, the dentist should ask for licenses and credentials to keep on file for legal purposes. It is important for potential candidates to know that maintaining all required credentials is their responsibility. These credentials could include a state license, tuberculosis testing, basic life support training, a handling of biologic hazardous materials certificate, continuing education units, and any other items your practice may require .
An offer may be made contingent upon the applicant passing a pre-employment drug screen or national criminal background check. If pre-employment screening will be required, it should be stated in the advertisement. The type of screening may depend on the type of job for which the applicant is being hired. For example, when hiring for the position of billing and collections officer, it would be important to know if an applicant had been previously arrested for embezzlement. The cost of screening varies from state to state .
Compensation
As is true for any business, a dental practice is only as strong as the providers and staff it has hired, trained, developed, and retained. People form the foundation and life blood of any organization . A key component to attracting the best, most qualified employees is to establish a competitive compensation package . In traditional terms, compensation is the salary and benefits paid to employees; however, in its broadest sense, compensation may encompass the value of professional development opportunities, training, bonuses and incentives, as well as the provision of services by the dental provider .
Salary
In many instances, salary is the single most important factor in determining whether an employee will become a member of the dental practice team. For this reason, it is critical that the practice owner or trusted office manager keep apprised of salaries being offered in the local and regional market by competing dental practices. In various locations around the country, the demand for qualified dental providers and professionals outpaces the supply; therefore, a practice’s ability to first attract and then retain the best talent is becoming more and more critical to its success. To maintain the most recent salary data regarding market salaries, a variety of options exist. One of the simplest options is to call area colleagues and inquire about pay scales. Reviewing the positions posted in the local newspaper may also give you an idea of approximate ranges being offered for certain positions . Yet another, and more technically savvy, approach is to access the vast resources available online. Multiple Web sites exist that will provide salary data based on industry and position description or title. These sites do much of the legwork involved in compiling and even analyzing data to assist in the process of determining appropriate salaries for the dental team.
An additional factor in determining an employee’s pay is deciding whether the position is to be paid on an hourly or salaried basis. Among other topics, the Federal Fair Labor Standards Act outlines whether a position can be paid on a salaried basis, also know as exempt . If a position is non-exempt or hourly, the position must be paid at least the minimum wage and be eligible for overtime. Depending on a practice’s particular staffing patterns, the use of overtime may create an opportunity to provide additional pay to employees who work longer hours rather than hiring an additional employee.
In certain instances, practice owners may elect to provide compensation to employees based on certain performance goals set by the owner. For example, office staff may receive additional remuneration based on a percentage of payments collected on the date of service or improvements in certain other financial indicators. Similarly, other associates may be paid all or a portion of their salary based on the patients treated, billed charges, dollars collected, or some combination of these factors .
The final piece of the salary component involves maintenance and administration of a structure that specifies how and under what criteria an employee may be considered for a salary increase. Procedures for administering increases can range from an “as-needed” basis to a much more formal process of periodic evaluations, typically annually, with increases tied to performance ratings. The types of scoring systems used can vary widely depending on the preferences of the practice owner.
Benefits
In addition to providing a competitive salary to employees, practice owners must also determine the level of benefits offered as part of the overall compensation package. The most common benefits include paid time off for vacation and sick leave, which may be provided individually or grouped together as simply paid time off, commonly known as PTO . There is no federal mandate to provide paid time off, but certain situations are covered under federal regulations with respect to unpaid leave, such as time granted under the Family Medical Leave Act.
As a further means to attract and retain quality employees, practice owners may decide to offer benefit packages that include certain types of insurance. These insurances commonly include health care insurance and life insurance but may be extended to include vision plans, disability plans, and paid professional liability insurance for providers . Although these plans are typically available individually, many state and national professional agencies have developed arrangements with insurers to offer discounted group rates for those belonging to an association, such as a state dental association. The benefit provided to employees can be the ability to access the discounted group rates, or the practice owner may elect as a further benefit to pay all or a portion of selected benefits chosen by the employee.
Additionally, one of the most common benefit options presented to employees is the provision of reduced-fee or no-fee dental services. Although this benefit, if offered, is often capped or otherwise limited, it presents a significant potential allowance for employees.
A further benefit that is becoming more popular is offering some form of retirement plan to employees. There are many options for practice owners, some of which are designed to be more attractive to small business, including employer-sponsored 401(k) plans, Savings Incentive Match Plans for Employees (SIMPLE), and Simplified Employee Pensions (SEPs) . According to the 2000 Small Employer Retirement Survey, among small employers that do sponsor a retirement plan, 47% report that this benefit had a major impact on their ability to hire and retain good employees . Practice owners should consult with tax, accounting, and legal professionals to determine the alternative most suited for a particular practice.
Professional development
Aside from salary and benefits, total compensation packages may include other perquisites such as continuing education or other professional development. These perks may further be segregated into those that are required to obtain or maintain the certification required to perform basic job duties, such as continuing education credit needed for licensure or certification as an expanded duty dental assistant, and those that are strictly for professional development, such as memberships and dues to certain professional organizations. Again, the level of benefit provided can range from allowing for paid time off to attend seminars and conferences to subsidizing the cost of travel, lodging, registration fees, or other expenses associated with attendance at the education or development events. The practice owner may also choose to provide certain training and education opportunities for employees in an effort to impart a better patient experience and to protect the practice from a liability perspective. These training options may include sessions on the Health Insurance Portability and Accountability Act of 1996 (HIPAA), basic life support, sexual harassment, the Occupational Safety and Health Administration (OSHA), and so on. Certain states may also have additional required training courses.
All of the factors alluded to in determining the overall compensation to be offered to a prospective employee or administered for existing employees are best specified in writing to lend clarity. The simplest form of documentation comes in the form of an offer letter. This offer letter may be brief and simply outline compensation proposed and an effective start date. For a more formal and detailed documentation of employment arrangements, such as hiring a provider, the practice owner may elect to require a practice manual or an employment contract. Although several examples of employment contracts are available online, this contract may typically be prepared or reviewed by a legal professional and includes more specific details of working hours, overall compensation, non-compete provisions, and separation of employment, whether resignation or termination. By providing an employment agreement, both the practice owner and the employee have a more defined summary of responsibilities, expectations, and compensation.
Compensation
As is true for any business, a dental practice is only as strong as the providers and staff it has hired, trained, developed, and retained. People form the foundation and life blood of any organization . A key component to attracting the best, most qualified employees is to establish a competitive compensation package . In traditional terms, compensation is the salary and benefits paid to employees; however, in its broadest sense, compensation may encompass the value of professional development opportunities, training, bonuses and incentives, as well as the provision of services by the dental provider .
Salary
In many instances, salary is the single most important factor in determining whether an employee will become a member of the dental practice team. For this reason, it is critical that the practice owner or trusted office manager keep apprised of salaries being offered in the local and regional market by competing dental practices. In various locations around the country, the demand for qualified dental providers and professionals outpaces the supply; therefore, a practice’s ability to first attract and then retain the best talent is becoming more and more critical to its success. To maintain the most recent salary data regarding market salaries, a variety of options exist. One of the simplest options is to call area colleagues and inquire about pay scales. Reviewing the positions posted in the local newspaper may also give you an idea of approximate ranges being offered for certain positions . Yet another, and more technically savvy, approach is to access the vast resources available online. Multiple Web sites exist that will provide salary data based on industry and position description or title. These sites do much of the legwork involved in compiling and even analyzing data to assist in the process of determining appropriate salaries for the dental team.
An additional factor in determining an employee’s pay is deciding whether the position is to be paid on an hourly or salaried basis. Among other topics, the Federal Fair Labor Standards Act outlines whether a position can be paid on a salaried basis, also know as exempt . If a position is non-exempt or hourly, the position must be paid at least the minimum wage and be eligible for overtime. Depending on a practice’s particular staffing patterns, the use of overtime may create an opportunity to provide additional pay to employees who work longer hours rather than hiring an additional employee.
In certain instances, practice owners may elect to provide compensation to employees based on certain performance goals set by the owner. For example, office staff may receive additional remuneration based on a percentage of payments collected on the date of service or improvements in certain other financial indicators. Similarly, other associates may be paid all or a portion of their salary based on the patients treated, billed charges, dollars collected, or some combination of these factors .
The final piece of the salary component involves maintenance and administration of a structure that specifies how and under what criteria an employee may be considered for a salary increase. Procedures for administering increases can range from an “as-needed” basis to a much more formal process of periodic evaluations, typically annually, with increases tied to performance ratings. The types of scoring systems used can vary widely depending on the preferences of the practice owner.
Benefits
In addition to providing a competitive salary to employees, practice owners must also determine the level of benefits offered as part of the overall compensation package. The most common benefits include paid time off for vacation and sick leave, which may be provided individually or grouped together as simply paid time off, commonly known as PTO . There is no federal mandate to provide paid time off, but certain situations are covered under federal regulations with respect to unpaid leave, such as time granted under the Family Medical Leave Act.
As a further means to attract and retain quality employees, practice owners may decide to offer benefit packages that include certain types of insurance. These insurances commonly include health care insurance and life insurance but may be extended to include vision plans, disability plans, and paid professional liability insurance for providers . Although these plans are typically available individually, many state and national professional agencies have developed arrangements with insurers to offer discounted group rates for those belonging to an association, such as a state dental association. The benefit provided to employees can be the ability to access the discounted group rates, or the practice owner may elect as a further benefit to pay all or a portion of selected benefits chosen by the employee.
Additionally, one of the most common benefit options presented to employees is the provision of reduced-fee or no-fee dental services. Although this benefit, if offered, is often capped or otherwise limited, it presents a significant potential allowance for employees.
A further benefit that is becoming more popular is offering some form of retirement plan to employees. There are many options for practice owners, some of which are designed to be more attractive to small business, including employer-sponsored 401(k) plans, Savings Incentive Match Plans for Employees (SIMPLE), and Simplified Employee Pensions (SEPs) . According to the 2000 Small Employer Retirement Survey, among small employers that do sponsor a retirement plan, 47% report that this benefit had a major impact on their ability to hire and retain good employees . Practice owners should consult with tax, accounting, and legal professionals to determine the alternative most suited for a particular practice.
Professional development
Aside from salary and benefits, total compensation packages may include other perquisites such as continuing education or other professional development. These perks may further be segregated into those that are required to obtain or maintain the certification required to perform basic job duties, such as continuing education credit needed for licensure or certification as an expanded duty dental assistant, and those that are strictly for professional development, such as memberships and dues to certain professional organizations. Again, the level of benefit provided can range from allowing for paid time off to attend seminars and conferences to subsidizing the cost of travel, lodging, registration fees, or other expenses associated with attendance at the education or development events. The practice owner may also choose to provide certain training and education opportunities for employees in an effort to impart a better patient experience and to protect the practice from a liability perspective. These training options may include sessions on the Health Insurance Portability and Accountability Act of 1996 (HIPAA), basic life support, sexual harassment, the Occupational Safety and Health Administration (OSHA), and so on. Certain states may also have additional required training courses.
All of the factors alluded to in determining the overall compensation to be offered to a prospective employee or administered for existing employees are best specified in writing to lend clarity. The simplest form of documentation comes in the form of an offer letter. This offer letter may be brief and simply outline compensation proposed and an effective start date. For a more formal and detailed documentation of employment arrangements, such as hiring a provider, the practice owner may elect to require a practice manual or an employment contract. Although several examples of employment contracts are available online, this contract may typically be prepared or reviewed by a legal professional and includes more specific details of working hours, overall compensation, non-compete provisions, and separation of employment, whether resignation or termination. By providing an employment agreement, both the practice owner and the employee have a more defined summary of responsibilities, expectations, and compensation.
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