Content Dam Diq Online Articles 2016 11 Tough Decision 1

Thursday Troubleshooter: Should staff tell dentist poor dentistry is why practice is suffering?

Dec. 1, 2016
This team member is concerned about the dentist's poor dentistry. Patients return often to have work redone. The dentist seems clueless about why business is so poor. How should staff handle the situation?

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QUESTION: My employer bought a very successful practice from the previous owner, who was an excellent dentist. The staff has remained the same. When the current dentist bought the practice, there were 3,000 active patients. Three-and-a-half years later, we are down to 800 patients, and only about half of them are active. The staff knows the reason for the failure ... it's the dentist's horrendous dentistry. She is very sweet and patients love her personally, but they get tired of coming back two or three times because fillings chip, fall out, hurt, etc. Almost every time x-rays are taken, there is obvious decay under the fillings that she did previously. Her crown preps are a disaster. The lab technician tells the assistant that her preps are the worst.

The dentist's husband is a specialist. He blames the failure on everything but his wife. He doesn't see her work. He wants her to sell the practice and start working with him. But she would take a huge loss if she sold the practice as it is now. She also doesn't comprehend that she's the problem. Even when the staff tells her that patients are leaving because of having to make multiple return trips for the same tooth, it somehow doesn't sink in. She wants to build up the practice before she sells. Her solution is to offer evening hours, something we've never done before. None of the staff is happy about this because we know it won't solve the problem.

When she first bought the practice she brought in a consultant, who was unhelpful. It is highly unlikely that she will hire another consultant. We are considering an "intervention" to tell her that the problem is her poor dentistry. We're all scared of doing this but we don't know what else to do. Do you recommend this approach, and how do we do this as gently as possible? We all love her and don't want to hurt her. Even if we do convince her that her dentistry is the problem, how can she go about improving it? It seems like she needs to go back to college and retake all her clinical courses. She is very smart but we're beginning to think she simply does not have the clinical skills and never will.

ANSWER FROM KYLE SUMMERFORD, Editor of Dental Assisting & Office Manager Digest and founder of DDSGuru:
This is a tough situation, that’s for sure. I don’t feel that telling your dentist she performs poor dentistry will solve anything. Your dentist will not be able to change her clinical ways overnight, and you might end up stirring emotions and causing tension in the practice.

You mention that one suggestion is to extend office hours. Extending office hours might be helpful in the sense it will attract new patients, but the key is patient retention. Unfortunately, if the practice cannot retain current patients, how would you expect to have new patients become long-time active patients?

You also mention that the staff in not happy about extending office hours. The financial well-being of the practice is in jeopardy and everyone needs to pitch in and make some sacrifices. Otherwise everyone might be out of a job much sooner than expected if the practice continues this downward spiral.

I do firmly believe that the dentist knows what level of service and quality of dentistry she is providing. Based on the information you’ve provided, I would suggest having a team meeting and speaking to the practice owner as a group and really promoting the need for hiring an associate, hopefully one who performs “better” dentistry. I wish you the best of luck.

Wow, this is a tough one for you as an employee. I think you know you may risk your job if you spearhead this conversation with your boss. I commend you on your professional tone and assessment. But just because you’re right does not mean your message will be heard, so I’m going to focus on the “you” part of this equation.

First, are you the right person to have this conversation? Are you in a position where your intervention—asserting that she does not yet have the skills and experience she needs to bring the practice back and properly treat her patients—will have a positive impact?

Your story indicates that she does not currently acknowledge her own role in these issues. She’s losing patients, and wants to extend hours to cure that problem. It’s a non-sequitur solution. In your position, I would ask myself, what do the best and worst-case scenarios look like? What outcome do you hope to achieve, and how likely is it?

I’m assuming this is what you’re hoping for: the dentist and her husband will see you as someone who helped them. If the dentist follows through with a plan of action (training and/or mentorship), there would be measurable outcomes. Patients might start expressing gratitude and making referrals, attrition might stop, and patient numbers increase. We are talking a total turnaround. This sounds great, but again, that’s a best-case scenario. We should also explore the opposite end of the spectrum.

It’s difficult for adults to hear about their shortcomings from others, and sometimes more so for those in authority. An intervention like you mention requires being very thoughtful and careful. Your boss may become offended or defensive. She might be understandably upset at hearing employees’ negative opinions about her. Let’s not forget “kill the messenger” syndrome. People usually have to ask for input before they can receive and give something positive back. Many business owners never open the door to the kind of input you’re describing. Intervention in and of itself is tough.

How can you improve your chances? I would advise against opinion-based statements about character or abilities. Instead, bring something tangible to this conversation, perhaps a report listing patients who left, how many repeat visits they had to make, and past complaints. You could also ask for permission to conduct a post-visit survey to hear from patients themselves about issues, and to gauge their support for the proposed evening hours. Playing a blame game with your boss won't work well, but gently laying out some tangible evidence may help.

Even with evidence and all the positive intentions you can muster, there is a good chance your employer will blame other forces and continue with plans you feel will not save the practice. It’s going to get emotional.

I would have a backup plan for myself and my work life. And here is where you need to make a hard decision. I would decide if this is worth my time and if it is my role to try to help save her business. If I decide it’s not worth it, or that this just isn’t the way I want to expend my energy, I would look at what’s best for my own professional future, and for me and my family.

It’s a beautiful thing when we’re able to make a difference in someone’s life. That said, I would not get caught up in the hope of being her savior unless all the planets perfectly align. And they rarely do.

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About the Author

Team Troubleshooter

This weekly column on DentistryIQ features questions from everyday people who work in dental practices, who have issues they would like addressed by the experts. Those who regularly take the time to answer questions include Rebecca Boartfield, Patti DiGangi, Dr. Chris Salierno, Laura Hatch, Karen Daw, Jill Townsend, Lisa Marie Spradley, Shelley Renee, Judy Kay Mausolf, Robin Morrison, Paul Edwards ... and the list is growing.

Send your question or issue for an expert to address to [email protected].. You'll be glad you did.