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The benefits of a cross-trained staff and how to create one

March 5, 2024
Dr. John Wilde says determined dentists who implement cross-training will see their profit rise, stress reduce, satisfaction enhance, and staff turnover decrease.

No dentist can achieve utmost efficiency without developing a cross-trained staff. Doing so allows maximized productivity and profitability, and, perhaps most importantly, the mutual appreciation that arises when team members help one another, enhancing camaraderie and team spirit.

Dentists’ careers are challenging. Mine lasted 40 years, and that’s a long time if you’re unhappy! Working with ebullient people who love their jobs is essential for those who desire gratifying careers.

I dislike articles without supporting documentation that insipidly claim a suggestion to be “good” or “helpful.”

To establish my credentials, allow me to share that, according to ADA statistics, my midcareer net per hour in rural Keokuk, Iowa, was 13.2 times the national average. Cross-training was essential to that achievement.

I’ve discussed expanded training with colleagues, but I’ve never known one who implemented the concept. One concern expressed is that staff turnover makes additional skill enhancement impractical financially. Frequent personnel changes are signs of severe, systemic, and crippling problems that must be promptly addressed. However, I believe the primary barrier is practitioners not knowing precisely how to accomplish the goal of cross-training. Stick around, as I’m about to correct that glaring deficiency.

How to start the cross-training process

First, every team member should compile a comprehensive listing of the duties inherent in their position. One can best accomplish this in a staff meeting or other group-think venue where all may contribute. When completed, prioritize these skills for teaching purposes. (While the entire list proves invaluable when adding or replacing a staff member, we’ll only teach the most essential items in cross-training.)

Next, identify the individual responsible for instructing each skill, and then create a daily checklist for each skill, complete with the experienced staff member’s name.

The dentist, new hire, and assigned trainer must discuss progress at every day’s end; use this time to identify problems, make any adjustments, and encourage efforts. The new hire and dentist should also meet privately at the end of every week to review progress.

I don’t include trainers in these conversations, so if interpersonal problems have arisen, they can be candidly addressed. It’s much easier for experienced staff to perform the procedure than to guide another, especially on busy days, but that choice can leave the trainee frustrated and bored. When this frequent difficulty arises, I gently reinforce the trainer’s role, knowing their job isn’t easy.

Chairside cross-training

Chairside cross-training teaches how to schedule ideally and inculcates the concise phone skills your team has developed. Having extra hands available assures no call goes unanswered, and after the phone rings twice, team members can quickly respond.

As to scheduling, every team member can make appointments accurately using in-operatory computers and a document listing the minutes required for all procedures. Having precise times on a printed form is mandatory to enjoying an on-time, smoothly running, productive office. Receiving timely treatment and then having to wait for a busy front office to reschedule is as frustrating as enjoying a fine meal and not getting the bill promptly.

We teach all front office staff to take panoramic x-rays, break down and set up an operatory, and scrub and sterilize instruments. Maybe I’m spoiled, but I don’t want inexperienced staff working with me chairside.

Taking x-rays

Once the overview is completed, we can get specific. We immediately begin training a new front office hire to take panos. Under supervision, they can take each one we need until their designated trainer feels they are capable on their own. Also, instead of panos, several patients will be scheduled for FMX, as mastering this skill is the most expeditious way to ensure the staff member can take any PAX we need. We have an overflow room where these films can be taken without disrupting our schedule, as the first FMX might take an hour to complete and include numerous retakes. (My first FMX sure did.) It is advisable to confirm with your state practice regulations regarding radiology certification for the dental team.

The new team member is scheduled from 11:00 a.m. to 12:00 p.m. daily, when things tend to back up, to scrub and sterilize instrument setups. We post a list of the instruments required for all procedures in our lab, as a crown and bridge tray differs significantly from what we need for a denture impression.

Having established teaching techniques, let’s consider some additional advantages of cross-training.

Handling emergencies

Given an adequate physical facility (five operatories is ideal for me), such highly skilled individuals allow an effective office to tell emergency callers to come in immediately. My chairside assistants and I are invariably busy, but the front office team will complete medical histories, expose needed x-rays, and set up a room. We advise patients they may have to wait but promise to see them that same day.

Sometimes, these suffering folks have been told by their longtime dentist of record they won’t be able to treat them until next week! Our response creates gratitude that manifests in patients who arrive on time, pay promptly, and enthusiastically refer. Many, if not most, of these grateful people schedule a new-patient exam, and because they trust us, they are predisposed to accept recommended care. The added emergency production, with almost no increase in overhead, improves our bottom line.

Benefits of cross-training

Being one staff member short creates a daunting, often exhausting day. Our enhanced ability proves invaluable on the too-frequent days when we are shorthanded due to vacation, illness, staff turnover, etc.

I’ve also had two occasions where someone hired for one position discovered they liked the other job better. We honored their request when an opportunity arose due to turnover or expansion. Making them happy improves overall staff longevity and results in a super-employee thoroughly trained in every detail of our office.

Thomas Edison advised, “There is much more opportunity than there are people who see it.” Those determined dentists who implement cross-training will see their profit rise, stress reduce, satisfaction enhance, and staff turnover decrease. Success leaves clues, and the previous information is one. Challenge yourself: what are you going to do about it? 

Editor's note: This article appeared in the March 2024 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.


After eight years of higher education, paying 100% of the cost himself, John A. Wilde, DDS, spent two years in the Army Dental Corps before beginning a practice from scratch in Keokuk, Iowa. By age 30, he was debt-free, owning outright his new country home and the practice he had designed and built. By 40, he was financially able to retire. At age 53, he fully retired. Dr. Wilde has authored six books and more than 220 articles, and may be reached at (309) 333-2865 or [email protected].

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