Specialist referrals take time and commitment

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A successful specialist relationship is more than the annual drop-off of holiday goodies. An excellent specialist is an extension of your office who takes the time to understand your philosophies of optimal patient care.

A patient who has been complaining of intermittent biting pain is scheduled in your operatory for a crown. This conclusion was decided after an image taken weeks ago revealed no abscess; however, you suspect a hairline fracture, and antibiotics were given just in case. As you start the prepping the tooth for a crown, the tooth fractures at the gumline — now what?

Preparing to send a patient out to see a specialist can be a stressful task, especially if the visit put your schedule into the “running late” zone and you are kicking yourself that the production is not staying within the practice.

While the assistant and office personnel fumble through drawers attempting to locate referral pads, the patient asks how much it will cost and questions why you are not able to complete the procedure. In addition to the patient’s concerns, you have your own anxieties: Did you educate the patient properly on this treatment procedure? Will the specialist communicate with your office? Will the specialist follow your treatment philosophy? After all, this is your patient and it is your responsibly to act within the patient’s best interest.

Even if your practice is thriving, you need positive, comfortable relationships with specialists who you trust for those difficult cases. What are your criteria for choosing the best specialists, and where’s the win-win?

The revenues for specialty practices have declined overall, according to a 2013 ADA Health Policy Institute research brief. Referrals have also declined, because of two main factors in my experience:

  • The rise of corporate dental offices having a full specialty team within the facility
  • More general private practices keeping periodontal therapies, prosthodontic, endodontic, and oral surgery services within the office

Private dental practices are still looking to recover after the 2008 recession, as Dr. Roger P. Levin and others have noted, so keeping higher production procedures in the office is appealing. Also appealing are the courses that are offered to general dentists to train on more specialty techniques, including everything from quick orthodontics to placing mini-implants.

“Filling your schedule with more efficient procedures … could end up being more productive.”

Many specialty practices allow time in the day for same-day emergency appointments and are able to provide patient insurance answers quickly. This is a great option if you do not have the time in your schedule to pursue a challenging case. Although the patient who needs a difficult endodontic procedure may seem like high production, filling your schedule with more efficient procedures rather than a long, multiple-appointment case could end up being more productive in the end.

General practitioners often express a fear of the specialist taking more treatment liberties as another reason for not referring. One dentist told me about a patient who was referred to an endodontist: “It seemed every time I referred a patient to this certain endodontist, my patient would return with an implant, without my knowledge, from the periodontist who was in the same building [as the endodontist].”

I’ve heard this type of sentiment many times. Clear communication between the general practice and specialty practice is imperative. Are you looking for another opinion, or do you want the specialist to treat? Is the oral surgeon giving you a second opinion, or will that office be treating that suspicious oral lesion you discovered? Does the orthodontic office return the patients to your office for three-month orthodontic prophys, or do they preform them in their office? Do you want a periodontist or an oral surgeon working with your implant cases?

Both parties need to take the time to understand expectations and the preferred method of communication. What are the systems in place for information such as consultation fees and scheduling appointments? Will there be a same-day phone call or e-mail with current images and chart notes? These questions should be addressed and relationships formed with those sharing your practice philosophy long before attempting to locate a referral pad.



In dental practices throughout the U.S., certain employee issues continue to be concerns from dentist bosses. These concerns can be typically narrowed down to the following:

  • Employees who are simply the wrong fit for the position in which they were hired
  • Employees who violate office polices regularly without regard or consequence
  • Employees who create regular negativity within the team by their personal or professional attitudes and work ethic

In most cases, the employee who was once thought was a catch should be released to find a new employment home.

When the dentist boss complains about a problem employee, much of the focus of the conversation comes down to the question of “Can I fire this person?”

This is often followed by a desire to give that person more chances to change. An evaluation is certainly in order if it is discovered that the problem employee has not been properly trained or the job description/expectations through the office manual and written terms have not been read or signed. However, in most cases, the concern that dentist boss expresses regarding the employee in question simply indicates that the individual is no longer the best choice for the practice.

Most dentists are unskilled with human resources (HR) solutions because of the nature of their education. They are skilled clinicians and caring oral healthcare providers, not HR specialists or state employment law experts.

Because of this, many are scared to pursue any process of corrective action, discipline, or an actual employee release. Often, the relationship between dentists and their team has become too personal, therefore skewing the actual employer/employee relationship.

One dentist shared with me that he and his clinical team were “getting tired” of his chairside dental assistant’s continual early departure during the work day. In any other job, she couldn’t just leave early all the time without permission and not be fired, he said.

When asked why he had not given her a warning or corrective action, and then possibly an employment release if correction actions were not taken, he told me it was her family’s financial condition.

“I know her family needs the money, and, therefore, she needs this job,” he said.

Being too nice is a poor reason to keep an employee who disregards the office policies and the consideration of co-workers.

Office manuals

How do you make sure everyone understands their responsibilities and duties? One way is to make sure you have an updated office manual in place that clearly states the policies that you want your team to follow to create your office culture and that are within the law to protect yourself. Seek out a legal expert or company that specializes in office manuals and knows your state laws and what can and cannot be stated in your manual.

All employees are required to read and sign that they have read the manual and understand the policies, including HIPAA and confidentially statements. This manual should be updated annually.

Fear of retaliation

Some dentists fear retaliation via a drop in office morale, slander on social media, and a loss of patients if they fire an employee, especially during a practice transition.

Initially, having seemingly solid, long-term employees who know the patients well probably seems like an asset during a practice transition. However, sometimes it becomes obvious that the previous owner’s team, or even one member of the team, is not loyal to the new dentist and may even hijack the office culture and not move the new owner’s philosophy forward. This is especially frustrating when this is a time when new dentist owners need all the support they can get.

Once a new dentist owner decides not to continue in a working relationship with the previous owner’s employees, often there are threats if someone is fired, that person will tell your patients negative things about you, or that a supposedly popular hygienist will take patients with her if she’s fired.

The reality is there will be anger, and perhaps some fires will be started, but as the saying goes, “This too will pass.” It might be surprising how employees and patients alike start expressing their relief of the bully’s departure, and the fear that existed was really not warranted. Everyone is replaceable.

I also recommend having a transition agreement in place with current employees during a purchase. This is not a guarantee of employment, but rather it would outline the new doctor’s expectations and set a time frame for employment trial (such as 90 days).

The current employees would also sign an agreement that protects you against a situation in which a released or soon-to-be-released employee attempts to contact patients outside of the practice.

Even if a dentist owner is not experiencing a transition, it is advisable to have written employee documents in place to protect your business.

Trust your gut

In my experience of advising private practice dentists on employee releases, I have found that dentists really should trust their gut when they are contemplating firing an employee. Dentists are naturally compassionate and work every day with patients where they have to discern patient physical, emotional, and financial need. This compassion trickles into the aspect of employee management, and, sadly, jeopardizes the business and work environment of the practice.

If there is any doubt in the ability of the employee, and the proper measures have been taken, it is time to kindly release that person to find their best employment home — and for your practice to have the excellence you deserve!

How Team Morale can Make or Break Your Dental Practice

Team morale can make or break your dental practice. It’s a bold statement, but there are several reasons why it is true. The morale of every member of your team impacts other team members, your patients, and over time, even your bottom line. If you want your dental practice to be a success, team morale needs to be a priority.

Unhappy staff are less productive. When a member of your team is unhappy in their job, they work more slowly, are less efficient, and are less likely to “go the extra mile” to ensure a great patient experience. When an unhappy staff member isn’t giving a great patient experience, that patient is less likely to be a repeat patient and unlikely to refer anyone else to your practice. Over time, this could potentially cost you dozens of patients and thousands of dollars.

Unhappy staff make other staff unhappy. When one person is feeling unmotivated, unappreciated, or disgruntled, their attitude affects those around them. Other staff are forced to work harder to compensate for the lack of productivity. One person complaining about being unhappy can hurt the morale of every other person in your office. What starts as a seemingly small problem can quickly gain momentum if it isn’t addressed quickly and correctly.

Unhappy staff are more likely to quit. On the surface, this may seem like a good thing: take the poor attitude and low morale out of the equation. However, the cost of finding, hiring, and training a replacement can be high. Even more, the most common reason why an employee quits a job is that they feel unappreciated and/or unsupported by management. Chances are good that if one of your staff feels that way, others aren’t far behind.

Overcome team morale issues with good leadership. As the dentist and CEO of the practice, you are the primary person your team is looking to for leadership. Hold yourself accountable to your team for following through on your promises. Deal with conflicts as soon as they arise. Have an open door policy that makes your staff feel comfortable coming to you with problems so you can address them before they become unmanageable.

Hold regular effective team meetings to ensure every team member understands their place in your vision for the practice. Recognize individual and team successes. Show appreciation. Ensure that you are supportive of any staff empowered to make decisions. If you need to coach them on a change in policy, do so privately to avoid undermining their authority.

You are the leader of your team. The trust, support, recognition, appreciation, and respect you give to your team is the foundation of your team’s morale. When you create a great working environment, your team morale is high. High team morale creates a better patient experience and greater productivity, which benefits everyone. To ensure your practice thrives, make your team’s morale a priority.

Promoting Change

Why do we resist change?

Change is scary. Change forces us out of our comfort zones and into the unknown, often into situations outside our control. We are afraid of change because we are afraid that this new challenge might make us look foolish, feel less capable, or even fail.

Change is also necessary. It is impossible to grow your practice, increase your service offerings, or stay competitive without change. Dentistry is a dynamic field, with new technologies and creative techniques being explored continuously. It is critical to be open to exploring these changes and to implementing the ones that will best improve your practice.

Unfortunately, one of the realities you may face is that your most loyal and long-term team members may be the ones who are most resistant to accepting these changes in your practice.

Over time, people tend to develop routines to perform their tasks. On one hand, this can be beneficial, as it can ensure consistency in job performance and can simplify the training of new employees. Often, these team members take pride in mastering the routine of their position and equate this with mastery of their role in the practice.

On the other hand, routines can lead to complacency, which can be devastating for your practice. Complacency can cause team members to “go through the motions,” putting less thought and effort into their routine, and may make their work become sloppy over time. A complacent employee is unwilling to change their routine to embrace the new ideas, methods, or technologies that you need to better serve your patients and grow your business. A complacent employee can even harm team morale and slow the adoption of the changes you seek to implement.

How do you protect your office from complacency and promote change as a part of your practice?

First, create an atmosphere of change. Start small, but design a series of changes to be implemented over the next few weeks or months in your practice. Make the idea of change something that is a normal and accepted part of your routine. This will make bigger changes easier to implement when the time comes.

Second, talk to your team. Make sure every team member understands the changes you want to implement, your reasons for making the changes, and your expectations of their compliance. Be open to answering questions, but do not allow “that’s not how we’ve always done things” to be a reason to slow or avoid changes.

Finally, make your team and yourself accountable for the changes. Track that your changes are in place and that every team member is on board. Meet with your team and discuss the outcomes of the change and how everyone feels about the change. Celebrate victories and strategize improvements. When your team is able to own the change and its outcome, it will be easier to implement the next and to suggest new ideas for future change.

Why Your Practice Needs Effective Team Meetings

Regular effective team meetings can play a crucial role in the health of your dental practice. That one simple-sounding factor can impact every aspect of your business. Your people, your patients, and your practice all benefit from regular effective team meetings.

Your people need team meetings. The core of your practice is your vision, your goals, and your strategy for achieving your goals. Each member of your team needs to understand all of these things and, just as importantly, needs to understand their part in your plan. Without that understanding, your team is working blindly and is unable to actively contribute toward reaching your goals for your business.

A team meeting is an ideal format for open discussion about your vision, goals, and strategy. Not only can you use this discussion to ensure every member is clear on your expectations, but you may find that their unique perspective creates an exchange of ideas on more effective ways to reach your goals and how each person can best contribute.

While not every team meeting needs to include high-level discussion of vision, goals, and strategy, it is a good idea to include this at least once or twice a year and when bringing a new employee into the team. Additionally, many successful dentists find that it is highly useful to touch on how the strategies are being implemented and to discuss any measurable progress toward goals on at least a monthly basis. This helps to keep your team engaged and motivated toward achievement.

Your patients need team meetings. One of the most common components of an effective team meeting is education. Your team needs to know what the policies are, what is on the agenda for the day, if there are any specials being offered, if anyone is sick or on vacation. Any new ideas, training, or techniques that can be shared should be. Your patients need to know they will be given correct and consistent information from any member of your team. Make sure everyone is on the same page.

Your practice needs team meetings. Teach your team how to ask patients for referrals. Word of mouth can have a huge impact on your new customer base. Even happy, satisfied patients rarely refer anyone unless asked to do so, according to a recent study. Your team members should be engaging your patients in every interaction to ensure a positive experience and should be able to ask for referrals when patients are pleased.

Only you can review your practice, your time, and your schedules to determine when and how frequently you should hold team meetings. Whether you meet daily, weekly, or on some other timeline, make your meetings regular and effective. You will see benefits to your team, your patient experience, and your practice.