Mitigating the Effects of the Staffing Shortage

Unfortunately, for many practices, while demand is at a high, staffing is at a low. Today, dental practice team members can be demanding or expect some of the highest wages in history. They also have more options than ever before to obtain a job elsewhere. They may opt for more money, a position closer to home, or a job that allows them to work remotely. This has placed a tremendous amount of strain on practice owners. Some have even been forced to perform the work of hygienists or to work without assistance. Because dentists can't keep up with the demand, procedures are either being scheduled far into the future or referred to other practices. When a business is busy but short-staffed, everyone feels stressed, which can strain the workplace culture. We have had to cancel patients' appointments many times this year as a result of being understaffed. This is not a good look, nor is it good for the bottom line. If your practice's bottom line is being affected by the staffing shortage, what can you do?

The most efficient and productive method of mitigating the effects of the staffing shortage is to keep your current team members. The reality is that you may be forced to increase your team members' wages to compete with the current market. Finding new talent takes time and money when compared with keeping the talent that you have. It can be a financial killer to your practice. However, if you find yourself unable to increase wages, you may be able to get creative with a bonus system based on production goals that allows your team to share in the success of the practice's growth. In addition, you can allow some of your nonclinical team members to work from home when needed. Set it up so that they can log into the practice management system remotely.

Another important component to staff retention is maintaining a great work environment and positive culture. Don't get desperate and hire the wrong people. Turnover affects the existing team members and is a killer to the culture. Furthermore, a negative attitude can spread quickly if you hire someone who is a bad fit. Embrace and appreciate the great team members that you have—the ones who come in daily and want to stay in the dental field and be on your team. That can be powerful, but only if you are someone who creates a culture that they want to work in. Consistency is significant part of this process. If you are all over the place with your policies and systems daily, your practice can become an undesirable workplace.

One-on-one check-ins with team members provide an opportunity for them to communicate their needs and for you to give feedback, which everyone craves. You should do this more than ever now. We used to do it yearly but are now doing it quarterly. I set up additional check-ins with team members as needed and for those who are new to the team.

Always be looking. You should always be searching for potential new team members—even if you are fully staffed. But be vigilant in your hiring process. The last thing that you need is to rock the boat with your current team by bringing in someone who negatively affects the culture. In the current staffing climate, you have to get creative. Look for inside referrals from your team members or even your patients. You can even offer a bonus to your team members if they refer an employee who stays for more than 3 months. There is no shame in saying that you are hiring.

Regarding external hiring efforts, try to think outside of the box. Consider applicants with unconventional experience from nondental settings, such as grocery stores or restaurants. Don't focus exclusively on people with dental experience; look for hard workers with great attitudes who are excited about joining your team. They can be trained in dental skills if they have strong work ethics and great attitudes. In some states, you can even train assistants with on-the-job training protocols. If you're having trouble finding the right fit for your front office, explore outsourcing and virtual help options. There are many companies out there that offer services for nonclinical assistance.

When it comes to ensuring appropriate staffing for a dental office, one of the most important things to be diligent about is controlling and maximizing the patient schedule. Many patients work from home or have hybrid schedules now, so they have greater availability and flexibility to come in during the weekdays when you want them to. Use this freedom to your advantage and put patients where you and your team want them to be in the schedule. For example, instead of asking patients what date and time they would like in an open-ended fashion, you can give them a few options by saying something such as, "We can fit you into the schedule on Monday at 11:00 AM, Wednesday at 2:00 PM, or Friday at 10:00 AM. Which time slot would you like to reserve for your treatment?" This puts your office in the driver's seat so you can fill the schedule as you would like. For your team to do this most efficiently, they not only need to know your schedule, policies, and fees but also the amount of time that it takes for you to perform procedures, such as crown preparations, fillings, and implant surgeries. The more they know and the less they have to stop and ask, the better. I have all of my procedure times on a shared document so every team member can quickly reference it.

During every morning huddle, openly discuss the essential items of the day's schedule, such as who needs radiographs, whose treatment requires assistance, who has overdue treatment, any important notes about the patients in the schedule, and any unscheduled time that is still open. The ability to schedule same-day appointments is a significant benefit of conducting a daily morning huddle. If your schedule and staff availability permit, you can pick out patients who are overdue for treatment from the hygiene schedule and attempt to get them to come in for a same-day appointment. You can also check the doctor's schedule to see who is overdue for a prophy and try to get them into any holes in the hygiene schedule. Making same-day appointments can provide a significant revenue source to reach your daily production goals, but you must have the staff power and systems in place to do it. You also have to keep emergency treatment time factored in. Put these slots in the schedule and don't violate them unless you have extra staff.

To optimize the patient schedule, documenting what days you will be fully staffed and what days you will have limited staff or be understaffed is vital. I have my team members put their availability into the practice management system's schedule for at least a month or two in advance. Sure, there will be changes; some team members may become sick or a have a child who becomes sick and won't be able to make it in. But this way, I can see who is available for coverage or even to increase staffing if needed. When the availability of staff allows, I have a side book in the second column for quicker procedures such as crown inserts, adjustments, postoperative follow-ups, etc. When staffing is limited, I keep my schedule to just one column to avoid overwhelming the team.

If you're working with less staff due to the shortage, it's important that your team members are trained to work as efficiently as possible. To ensure that my team members know exactly how to set up and assist each procedure, including what instruments and materials I need and in what order, I have them practice on a typodont. I will prepare a tooth for a composite restoration or a crown on the typodont, and then I have them perform the procedure to better understand their support role.

Having team members do the procedures on the typodont helps them with actual patients. They can better anticipate my needs because they have done it themselves. This makes procedures low-stress and efficient for me, the team, and the patients. And we all know that patients are more willing to rebook when they have quick and pleasant experiences.

There are many digital technologies available that can help dentists realize efficiencies while maintaining or increasing the predictability of treatments. For example, I use an intraoral scanner now. I no longer make traditional impressions except for specific indications. This has saved time for both me and my team. There is no longer a need to take the time to decontaminate impressions, pour them up in stone, and then package them up and ship them to the laboratory.

Another technology that comes in very handy during days when we are short on staff is an isolation device. With an isolation device, I can perform many procedures by myself. It illuminates and suctions patients while propping their mouths open, giving me a tremendous dry field of view. While I work, my assistant can be in the other room doing something productive, such as scanning for a night guard or breaking down/setting up the operatory for the next patient.

Another way to improve your practice's bottom line during a staffing shortage is to add low-stress procedures that can be performed with limited staff, such as clear aligner therapy. It's important to stay in your comfort zone when pursuing continuing education and training, regardless of any staffing situation, but especially if you're short on staff. Last year, I added clear aligners, and next year, I plan to add airway and sleep apnea treatments.

When adding any new treatments, proceed slowly and thoughtfully. Have you ever tried to instill change only to have it fail or not go as planned? Some new treatments may require team members to do things differently than their regular daily tasks, and you don't want to negatively impact their efficiency or productivity. In addition, too much change without sufficient clarity can overwhelm team members, and they may get frustrated and leave.

Being the owner of a dental practice is challenging, but a practice's workplace culture and the behaviors and attitudes of its team members start with its leader. I struggle to be a leader daily, as do many other dentists. And why wouldn't we? We were never trained to be leaders while in dental school. Be self-aware. Go out there and find mentors, coaches, consultants, peers, and courses to help you grow. Learn how to run a practice with a great culture and support your team. Empower them and tell them how much you appreciate them. Eventually, the issues driving the staffing shortage in dentistry will start to resolve, and staff will become more readily available, reducing the pressure on practice owners.

And remember, we are not the only ones experiencing challenges during these difficult times. A pediatrician who I know is experiencing the same stresses that we are. The bike shop across the street from my office is struggling because they lack staff, and they have supply chain issues so bad that they can't get bikes. Can you imagine having to tell patients that you couldn't do fillings because the composite was stuck on a cargo ship and that you'd let them know when some came in so they could get their restorations done?

Many of us are stretched thin and have to work extra hard. The most important thing is to not put too much pressure on yourself and to reach out for help from others in the profession. You don't have to go through these stressful times alone.

Eric Block, DMD, CAGS, is a fellow of the International Congress of Oral Implantologists, the founder of dealsfordentists.com, and the author of The Stress-Free Dentist. He maintains a private practice in Acton, Massachusetts.