Being a dentist, but not the 'boss'

After four rigorous years of dental school, I anxiously awaited the arrival of my dental license. A lifetime had been spent to reach this point, sacrifices made both emotionally and financially, and finally I would see my dreams realized-treating patients, eradicating disease, dispelling dental fears, and changing lives.

Managing a team when you don't sign the paychecks

Emily Ishkanian, DMD
ADA New Dentist Committee member

After four rigorous years of dental school, I anxiously awaited the arrival of my dental license. A lifetime had been spent to reach this point, sacrifices made both emotionally and financially, and finally I would see my dreams realized-treating patients, eradicating disease, dispelling dental fears, and changing lives. I was as hopeful as they come; after all, this was what I had worked so hard to achieve. I had signed a contract earlier that summer to work as an associate in a private practice for an owner dentist who had opened his doors 30 years earlier.

My initial focus was on the dentistry-was my prep ideal, was my margin crisp, were my patients satisfied, and among many other fears, was I fast enough? I quickly learned that although the dentistry is important, what is equally important is the ability to manage your team. But what does that look like for a new dentist joining a practice? Yes, I'm the dentist, and you think that would be enough, but I'm not responsible for hiring and firing, I do not write annual evaluations, and most importantly, I do not sign my name to paychecks or bonuses.

It is a precarious position with the following considerations: If I upset the team, will they sabotage my schedule, will they follow my directives, will they question how I operate, and will they treat me with the same respect as the owner? I'm a new dentist, female, and as if that weren't enough, I'm younger than most of the staff. I soon realized that the dentistry rests in my hands, and it's something I have direct control over, but the management of people is not solely my decision. It didn't take long until I saw how one weak link could quickly break down my efficiency, productivity, and spirit. I realized I had to effectively manage my team without being their "boss."

When I started working, I was able to integrate into the practice, learn how the office operated, and create positive relationships with the existing team. I'll admit I didn't know everything, and quite honestly, most days I secretly felt like I knew nothing. I relied on the team to help me navigate through my first months; they warned me about patients, reviewed unfamiliar dental materials, and occasionally served as a crutch regarding daily operations, if I needed one. It's important to state that, for the most part, the team wanted me to succeed because it is as much their office as it is mine.

In time, the dynamics of the office transformed. I had my bearings, we employed new staff, and the team changed. During this transition, I found it very difficult to work with an existing team member, and daily challenges became evident. As a result, it appeared that our team was frustrated and morale was low. This put me in a difficult position because while I was the dentist, I had not been given full power or authority as the "boss." Eventually, I recognized that I'd worked too hard to get to this point to be unhappy in my career. Consequently, the owner dentist was consulted, and together we came to a resolution.

How do you manage a team and not be their 'boss'?

The following elements were critical to achieving that task, and my success and ultimate happiness depended on it.

Establish the chain of command-Prior to signing a contract, determine the hierarchy of the office. As the incoming dentist, will you have clear and equal power to address office issues and input on annual evaluations and employee bonus incentives? Does the office manager or dentist address issues, is the existing staff aware that the owner sees you as an equal, and finally, will the owner support you when personnel change is necessary?

Keep open lines of communication-Establish a monthly time to meet, even if it's just for a few moments, with the owner dentist to discuss daily operations and personnel issues. This reflects to the staff that the owner values the associate/partner and that teamwork starts at the senior level.

Use the office manual-It's extremely important to be familiar with the office manual. As the dentist, daily operations cannot be followed or enforced if the policy is not known. Adhere to the policies, be confident, be consistent, and never forget business is business. If the office guidelines are not followed, make it a practice to leave emotions at the door, and address each issue as outlined in the manual. If your practice needs to develop a manual, check out the ADA Practical Guide to Creating an Employee Office Manual book, available from the ADA Store at a discount to members.

Develop relationships-Part of managing a team is developing a relationship with each member. This means taking the time to listen to and acknowledge their concerns. Tom Rath's book, Strengths Finder, says it best: "Having a manager who ignores you is even more detrimental than having a manager who primarily focuses on your weaknesses." Engage your team so they feel their input is significant and they feel invested in the practice. What do they like and dislike, does the team work together, and can anything be improved? Giving each team member a voice in your office gives them purpose to share your goals of efficiency, productivity, and a positive working environment.

Create trust-When someone comes to you with a concern, it is imperative that you're given the power to address and resolve the issue. Without the influence to incite change, you are powerless. When the team learns you're powerless, you drop off the chain of command and lose your credibility as a superior in the office.

Document everything-As dentists, we know what it means to document. It's just as critical to document personnel issues as it is patient charts. If there's an issue, reference the office manual, document the incident, review the incident with the individual, have a clear plan to follow and evaluate performance, and have each party sign and date a document indicating the person is aware of your expectations, and that failure to comply could result in termination.

Compliment and thank-Abraham Lincoln said, "Everyone likes a compliment," and 150 years later, this is still true. Magnify your team's strengths, praise them for a job well done, and verbalize that each person is an important part of your team and success. Compliments and saying thank you are free, and yet people do not offer them generously. Make a point to show team members that you appreciate them. When individuals feel valued, morale and motivation increase, and everyone wins.

Final thoughts

To the dentists who aren't the boss-Use your leadership skills to guide your office. You're the dentist, and your team inherently looks to you for guidance. Although office politics can put you in a precarious position, discuss management roles with the owner dentist to ensure that your team works well to serve you and your patients. Remember, without the dentist, the team does not function.

To the boss-As the owner, make sure the team knows you've empowered the associate or partner in terms of management decisions. Create equality among dentists so that the team respects and takes direction from both dentists. Most importantly, involve your associate/partner in management decisions (annual evaluations, hiring and firing, bonus incentives, and more). After all, his or her success translates to your success.


Emily Ishkanian, DMD, graduated from UNLV School of Dental Medicine in 2010 and began practicing at Green Valley Dental Center in Nevada, as well as serving as an adjunct faculty member at UNLV School of Dental Medicine. Dr. Ishkanian is the District 14 Representative to the New Dentist Committee, and serves as the new dentist liaison on the Council of Ethics, Bylaws and Judicial Affairs with the American Dental Association.

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