I am a dentist and I have an office manager (hired a little over half a year ago) who I feel does not 100% believe in the value of what we can do for our patients. The most egregious example was when a patient was in such pain and I would have even treated at cost and I told her to help the patient make the numbers work and that I just needed her to ask up front for just enough to cover some up front costs. I kid you not, I brought the patient to her and said to both of them that I would really want to work with her to get things to work, and all this employee did was take out a paper, point to two things on said paper, “this is how much it costs and this is what we can do for you”. That was it. word for word. I was flabbergasted.
I feel like she diagnoses the patient’s financial wallet and makes judgments about their situation and even said that patients would rather spend money on an iphone or other items than their dental health.
It’s her job to talk about money and I have never heard her ask a patient “how can we make this work?” or “okay, I understand that you cannot pay everything up front, but what can you do?”
I try to explain the rationale behind some treatments to her and why the patient needs it but at this point, she is too set in her ways. She doesn’t believe that many important swaths of the field, like orthodontics, etc. are worth the money. I need to put her on a performance improvement plan soon but I’m not sure how to say, “the biggest performance issues is that you do not believe in the value of dentistry”. If she believed 100% that patients NEED to be able to chew and eat and NEED to have their cavities treated, I think the office would do a lot better. I’ve never struggled with this kind of issue before.
Any advice?
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I’m being brutally honest with you, this person might be an asset. I understand the reasoning behind comping some work, but it sounds like this is happening super often. Are you running a business or a charity? It’s very possible that in the next 10 years the govt could enact restrictions on what you bill patients. I empathize with what you’re doing, but comping work should be something you do maybe 2-3 times a year.
Have you had this exact conversation with her? Or rewrite the post and give it to her and let her respond. Clearly you want her on the same page as you, your practice and values. Yes a performance evaluation with specific improvement goals may be necessary to move her to where you need her to be she represents your practice.
If you are asking Reddit, you have the wrong person as your office manager. Do not underestimate the seriousness of this situation. You are building a practice and a culture. Just one person who doesn’t buy in on a small team is a major headwind. Implement the PIP, let her know exactly how she’s not meeting your expectations and start documenting performance issues. When it comes time to let her go, you’ll want to be able to refer to the disciplinary documentation in a matter-of-fact manner. She may show improvement for the short term, but you really want someone who promotes your culture, not someone who can just barley be good enough. You want patients promoting you as the dentist who cares, not just another dentist with a rude staff. These decisions are more about leadership than HR practices. With that said, the employment market is such that all of us sometimes have to eat shit in the short term when it comes to putting up with employees
I don’t get it. Don’t you tell the patient up front what it costs and then get a card on file ?
PIPs are useless. It’s usually a way you prepare ti fire someone. It doesn’t miraculously make them a better employee. It gives them a warning to basically start looking for another job. So even if they survive the PIP because you had no intention for firing them, you r created a very resentful employee.
Recently, Square and Twitter’s founder, Jack Dorsey, says he’s getting rid of PIPs and just letting underperforming employees go.
I applaud your patient focused approach and for recognizing your staff problem.
I don’t believe this calls for a Performance Improvement Plan, but a new Office Manager.
My advice: Prior to interviewing her replacement, You should have a fully written detailed job requirement document.
You need someone who has similar values as you with a “patient first” focus and who has experience with the financial aspect for both the practice and the patient.
If you don’t have a system in place then all an employee can do is perform their job based on their own home made idea of what is best.
You simply need a pipeline to funnel your customers into different baskets and a flow chart for your office workers to follow.
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Insured
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Full cash
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Needs financial assistance.
Then define what to do with each basket.
But all that aside, this person is toxic AF and why would you want someone like that in your life. This is your baby, your practice, the culmination of your life’s work.
Success and fulfillment as a business owner is correlated to your ability to hire fast and fire fast.
My step father was a dentist, my favorite doctor is a dentist who does jaw surgery exclusively. He is a saint. He has about 20 people in his practice and does trauma and facial surgeries for babies, amazing person. And yet his practice is all fucked up because he hasn’t been able to fire some toxic personalities and now his practice is divided and the customer experience is awful.
My step father was also a kind person and did a ton of work for underprivileged. But also suffered from the same issue. My mom was able to help him out. The reality is there are some people who prey on doctors and get into their practices and start to mentally manipulate them. These folks often end up embezzling money.
You have to find it in yourself to protect yourself AND your other employees AND your patients from these type of people.
You never know who these people will be but sadistic beliefs like the type you described this person having is a big red flag.
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Curious: what has your training on this looked like so far, and what resources do you have to help her improve her skills?
I manage a similarly rigid employee. What I have found works for us is having a written approval authority matrix about alternatives that can be offered, and if additional approval is needed, who can approve. People are more conservative in their thinking when they aren’t sure what is specifically allowed (or required) - it makes sense to me, you don’t want to approve something and find out later it wasn’t OK. By documenting boundaries up front (including what is always acceptable and what is never acceptable, and what the middle ground looks like), my employee is empowered to know what they can do. They will still sometimes roll their eyes about something being requested, but so far they’ve been able to set their personal feelings aside to offer what I’ve asked them to.
I would respectfully ask you to consider whether you’ve been specific enough in your expectations with your employee to start formal performance plan stuff. My impression from your post is that you’ve said “be flexible” without being clear about what you want - and I can imagine that being a scary position for an office manager who is typically expected to care about the bottom line.
I could be off base, but I also get the impression that you, yourself, feel a little bit uncomfortable standing up for your prices. Sometimes being perceived as expensive (even if you’re comparatively not) can make for uncomfortable conversations with clients, but if your business is going to be successful (whatever that means to you), the line has to be drawn somewhere- and having a clear understanding of where that line is might help you as much as your own employee.