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July 1, 2003
Can we talk? Although you've made it this far as a female dentist, there may be areas of concern that aren't being resolved.

Sally McKenzie, CMC

Can we talk?

Although you've made it this far as a female dentist, there may be areas of concern that aren't being resolved. Trusting that your practice challenges would disappear over time, maybe you've kept quiet about them ... not discussing them because you're embarrassed, concerned that you could do it better, or think nobody else has the problems you have. You might not want to be seen as a whiner, and you feel caught between the proverbial rock and an awfully precarious place. It's clear that something has to give. Let's talk about how you can be the heroine of your own story.

As you read through this article, keep this in mind: Ginger Rogers did everything Fred Astaire did, but she did it backwards and in high heels! Since the beginning of humankind, women have always had to bear a considerably more complicated load than their male counterparts. Dr. Jeanne Altieri, former chair of the Council on Dental Practice, put it succinctly, ... Women dentists tend to juggle more in life than their male counterparts."

Stop to think about that. Not only do you have to handle the responsibilities of being somebody's doctor, you're quite likely managing the formidable burdens of being somebody's wife or significant other, tennis partner, housekeeper, cook, family caretaker, social secretary, and/or general runner-of-things. If you're one of legions of women dentists with children, you're also handling the superhuman demands of being somebody's mother! Talk about "Mission Impossible!" Putting courtship, marriage, and family aside, let's focus on your professional role ... the challenges of being somebody's boss.

There is a difference

Male boss vs. female boss ... what's the difference? To be sure, more than the physical equipment. The difference lies not only in the emotional programming, the capacity for nurturing relationships, and the outlook, but also in the social construction of gender roles. From early childhood, boys are trained to focus on financial or professional success; girls, in terms of relationships. Aye, there's the rub.

In consulting with dental practices across the country, my team and I have long observed the differences between male-run and female-run practices. Here are a few of our observations:

When a doctor is having trouble with an employee not doing a job right, the male doctor will have someone call for support, get her some training, or fire her. The female doctor will do the job herself.

Female employees show respect to a male boss. But in the case of a female boss, staff respect must be won, and winning respect takes time. The doctor herself may have a tendency to try "female bonding," preventing her from having leverage as a leader. On the other hand, if she does not take such a sisterhood approach, staff members may resent her being "superior" to them — the ultimate Catch-22.

A green-eyed, resentful staff member may well sabotage the practice by openly challenging the female doctor's management practices or overruling the doctor's decisions behind her back. Envy and jealousy can play a major role in female staff/female doctor interaction.

If the female dentist has a "feeling" temperament, she needs to be tough when an employee comes to her with sob stories about why she needs a raise, more time off, a change in hours, or a rewrite of her job description.

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If the female dentist has more of a "thinking" temperament, her firmness and tough-mindedness will often be seen as caustic and critical ... a well-known recipe for revolving-door turnover.

Boss or bossy?

If you have your own practice, then technically speaking, you're the boss. Your training and socialization may not have prepared you for being the boss, leaving you feeling awkward. It's no wonder. Just look at your previous social roles and experiences — supportive sister, doting daughter, loving wife, adoring mom, true-blue friend ... fixing problems and running rings around home, workplace, and community to keep everyone happy. Even though this makes the world a nicer place to live in, it doesn't help in the how-to-manage-a-dental-staff department.

Wanting to be popular, accepted, and loved — not only by patients, but by staff as well — seems to be a "girl thing" that makes many female doctors go overboard in kindness, generosity, and putting up with lots of shenanigans that their male counterparts wouldn't dream of. Despite the comfort level that you'd love to have between yourself and your staff, you need to keep in mind that this is no sorority and you're not just one of the girls.

Our female clients often ask, "Why can't my staff do anything without me?" Sadly, the answer is, "That's the way you've set it up, Doctor." In an attempt to sidestep being seen as bossy, many female dentists relinquish the function — if not the title — of being the boss. Not delegating responsibility, many female doctors timidly ask for help, which they do only when overburdened. Hmm U something is dreadfully wrong with this picture.

Since the gender gap within the profession has narrowed — more than 37 percent of dental school graduates are women — we consult in almost as many female-run practices as we do male. Comparing male to female practices, it is our opinion that women not only have the greater number of challenges, but a greater range of skills to meet these challenges. Here's one scenario you might recognize.

Tales from the front

Dr. Brenda Boss purchased her practice from a retiring male doctor. Although there were some initial difficulties among patients in transferring trust and respect from the previous owner to her, Dr. Boss prevailed. Winning staff trust and respect was not as easy. Relentlessly, they tried to tell her how to run the practice, even to the point of insubordination. Because Dr. Boss had no history with this mutinous crew, she began firing them, one by one, and replacing them with young, inexperienced staff members who followed directions and didn't challenge her decisions. That's the good news; now for the bad U

Because these new recruits were unseasoned, they had not yet developed the communication skills necessary to present treatment plans that patients would accept. Lacking self-assurance, their requests for payment at checkout were anything but direct or assertive. They would run to the doctor for the most ridiculous minutiae. Standing around and chatting during huge holes in the schedule was proof positive that these novices had no sense of the connection between the doctor's patient load and their getting paid. Dr. Boss called us for an emergency practice consultation.

To the rescue

Whether female-run or male-run, when a practice is about to implode because of staff incompetence, it requires some very specific intervention. In this case, we were able to make a moderately quick and extremely effective save.

Despite her deliberate hiring of young, inexperienced staff, Dr. Boss apparently had a sixth sense — some would call it women's intuition — about the potential of each of those team members. They were bright, eager to learn, and eager to please their boss.

Meeting with both doctor and staff, we developed job descriptions in the context of what each would mean to the short- and long-term success of the practice. We set explicit parameters and stated specific expectations. For example, when Dr. Boss hired the scheduling coordinator, Megan, she told her that she should keep the books full, a nebulous concept to Megan. We explained to her that she'd be responsible and accountable for scheduling $3,000 per day in production U and that performance measurements would be established. Megan was given ample training to enable her to meet these expectations. The same strategy was applied to each employee for the responsibilities within their job descriptions.

At each Monday morning meeting, a business staff member gives a status report on her area of responsibility, such as recall, scheduling, collections, and accounts receivable. Dr. Boss immediately offers both positive feedback and constructive input for improvement. The focus is, "Let's do it better." After just a smidgen of management training, the doctor has become an outstanding people manager with an uncanny ability to nurture talent and skill through professional training, career development, management structure, performance measurement, recognition, and appreciation.

Now Dr. Boss exhibits such fine leadership skills that we think she could handle the original staff she inherited. Thanks to her "womanly" talent for creating satisfying relationships, she has turned uncertainty into respect and admiration, inspiring staff to want to be the best they can be for themselves and for the practice.

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Sally McKenzie, CMC
Sally McKenzie is a nationally known lecturer, author, and consultant to the Council on Dental Practice of the ADA. She is president of McKenzie Management, which provides consulting services to dental practices. Contact her at (877) 777-6151, sallymck@mckenzie, or visit