Take a long look at labor cost

The article, "The Cost of Labor," by Dr. Charles Blair, could be chapter one of a textbook on "How to Promote Discontent and Disarray in Your Dental Office."

Marianne C. Kehoe, DDS

Geneva, Ill.

The article, "The Cost of Labor," by Dr. Charles Blair, could be chapter one of a textbook on "How to Promote Discontent and Disarray in Your Dental Office."

First, I`m appalled that the author would advocate paying dedicated employees by the hour. If a patient cancels, do you send staff home? They have mortgages, car payments, babysitters, and a life. Please respect that. What is their incentive for working efficiently and improving systems - an afternoon off without pay?

Second, extensive use of part-time employees ensures that your team will never be on the same page, much less be a team at all. Who suffers? Your patients, your ulcer, and your bottom line.

Third, why outsource payables and payroll when a $99 QuickBooks program will do the job in minutes? About collections, if your employees were dedicated, trained, and understood that it`s the patient (not you) who pays their salaries, they`d get the money at the time of service and you wouldn`t have a collection problem.

As for your other "excellent strategies," the one about no more sick leaves really will make you competitive in the hiring market and ensure that you`ll attract those high-esteem, top people.

Here`s something you didn`t answer. What is the true cost of employee turnover?

Response from Dr. Blair:

The intent of the article (which summarizes a survey of newsletter subscribers` labor ideas) is not to put doctors into the "scarcity" mentality as you call it, but rather to view their practice as a business. Many doctors have had very little training in being an entrepreneur and manager. Labor cost is by far the number-one cost of overhead. Doctors must take a long look at their current situation and decide how they can improve it, while providing top-notch clinical and customer service for their patients. The practice should charge fair fees and pay the staff well.

First, I think hourly pay is the fairest way to pay employees in the dental office. It is fair to all, directly related to work expended. Naturally, the overall work hours for the month or year should be agreeable for each employee. They should be paid for staff meetings, certain continuing education, holidays, and vacation time. If the doctor is out of the office, then the staff members will work for pay with specific duties, or opt to take time off without pay. Some will wish to work, while some would rather take time off without pay. If a bonus system were available, then compensation would be available to cover the shortfall. It`s the employee`s choice.

Secondly, I advocate some judicious use of part-time employees in the afternoons to augment business and clinical staff when the pace typically increases. You are off base to use the words, "extensive use of part-time employees." Provided part-time employees attend staff meetings, they will be a viable part of the team and play key roles in the office. They rarely suffer from burnout.

Third, outsourcing payroll and payables is smart business, in my opinion. It could even be the dentist`s spouse. The point is not to wear down the doctor doing routine, but critical, duties when he or she can do an extra procedure at the office (to pay for it), and otherwise be with his or her family. Also, we don`t like such a dependency on business staff, because the doctor can be "held hostage." Doctors should be clinically productive, manage and lead, and then take time off.

Fourth, you really missed the point about the "excellent strategy" of eliminating sick pay. Did you not read the article? It was suggested to pay "well pay." In other words, the employee is paid for true sickness, or if not, paid anyway. This encourages the team member not to "lay out" to get the sick pay.

As you pointed out, employee turnover is a killer. However, some turnover periodically can be a desirable situation, because we all cannot hire the right employee for the dental team all of the time.

The cost of being "held hostage" by employees who don`t have 10 years of experience, but one year`s experience 10 times - who may have a closed mind to change and lost the zeal for their job - is a much higher price to pay. They want more for less. Then, turnover is a godsend. That`s the question you didn`t answer.

Thank you for reading the article. Labor issues in the dental office are complex and there are many opinions.

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