Rural Staffing
I’ve never been able to deal with people that I find to be totally one sided. No situation is perfect. If you aren’t willing to recognize the downside of whatever situation you’re in then I find you to be totally devoid of integrity and not a credible source of information. We’ve all interacted with these people before. I had a friend once who tried to convince me how great camping is. He went on and on about how much fun it was, how it’s great to be in nature, how much his family loved it, etc. My take on camping is very similar to Jim Gaffigan’s. “Hey, you wanna burn a couple of paid days off to sleep on the ground? Chances are you’ll wake up freezing and covered in a rash!” I was willing to admit that being in nature would be enjoyable, but I wouldn’t enjoy it enough to outweigh going without the comforts of life that I enjoy. My buddy on the other hand was unwilling to concede that there were aspects of camping that were terrible. Call it pride, call it delusion, call it whatever, but camping is not so awesome that there are no drawbacks or difficulties.
I think it’s been pretty clear that I am huge proponent of practicing in a more rural community. That being said, I’m not blind to the difficulties that come from practicing this way, and I’d like to address those issues in this blog post. I don’t want anyone to read these posts and think that I am painting an unrealistic picture of practicing rurally. If someone were to ask me what the biggest drawback of practicing in a rural community is I would definitely say lack of manpower. I currently have three practices and only one associate to help me. The only reason I even have one associate is because he is the previous owner of the practice and had to stay on and keep working or else I couldn’t buy his practice. My entire reason for writing this blog is to help persuade dentists to explore rural opportunities. I have a little bit of a self-serving mission in this because I need help where I practice, but I also know that there are rural communities throughout the country that need providers. There are rural practices in every state where the owners are overworked and would love to find dentists to come and help them. There are rural practice owners that want to retire but don’t feel like they can because they don’t want to just lock the door one day and leave their patients and staff in the cold. Again, my current situation is that I can’t handle the volume of work that my patient’s require. Not only am I struggling with my workload, but I know that there are multiple practitioners in my area that are going to be retiring within the next handful of years and I’m wondering how I could even absorb any of their patients, assuming they can’t sell their practices, which has been the history in this area.
While finding associate dentists is difficult in rural areas, finding staff in general can be an issue, especially hygienists. Similar to the associate problem, there are only so many hygienists that are wanting to practice in a rural area. Of the 5 hygienists that I currently employ, all 5 of there were born and raised here. Not only that, but they all went to a fairly local hygiene program, roughly 30 minutes away from where I practice. Again, as you’ll find with most rural areas, this isn’t an area where you will find people moving to. That can create a situation where the owner get’s “held hostage” by the staff. They know that the supply of employees is low and some will take advantage of that scenario, either by threatening to leave if they don’t get more money, or by leveraging their “replaceability” in order to get what they want. The opposite is also true. If you are the best office to work for in town, then staff might take less money to work for you as opposed to being unhappy somewhere else. I’ve also frequently seen owners act like tyrants because they know there are only so many dental jobs in town and they are going to leverage that into taking advantage of their staff and treating them poorly. In my experience I have been both scenarios at the same time. I have tried to create an environment in my offices where staff don’t want to leave. I’ve also had staff members who have walked all over me because they think that they’re irreplaceable, and to a certain degree they are. It’s so much work to replace staff. You have to spend so much time interviewing, hiring, and training. I’ve always been of the mindset that it’s easier to keep staff and overlook some of their less desirable qualities than try to replace them. There’s no guarantee that whoever you hire won’t be worse. At a minimum you are just trading one set of problems for another.
With all that said, I’m not talking about overlooking gross misconduct. If someone is openly stealing from you, lying to you, or sabotaging your office, you have to let them go. The behavior I’m talking about is more annoying traits than anything else. For example, I once had an assistant that refused to work Fridays. She’d been used to a 4 days a week schedule and she didn’t want to stray from that for any reason. I even had an employee who’s mother passed away and she wouldn’t fill in for her on that Friday. It’s immature and petty behavior. Do I wish she was more selfless? Of course I do. Is it worth firing her over and finding a new assistant? Not for me. She’d worked in the practice for over 30 years. Letting her go would cause way more damage than good. I have a hygienist who has tons of patients that only want to see her. She has cut back to two days a week because she is taking care of her sick father. She is pretty rigid on when she wants to work and she doesn’t really want to adjust those days for any reason. It upsets me because she is a great hygienist and I enjoy working with her, but it’s really put me in a bind to have to work around her part-time schedule. Again, is it worth letting her go and find someone full-time? Not to me. She’s a tremendous asset to my practice, even if it’s only part time.
These are the struggles of working in a rural community. One can make the case that these are staffing issues no matter where you practice, urban or rural. While the issues are the same, the ability to replace staff is more difficult when you have less people to choose from. In previous places that I have practiced, if you put out an ad for a dental assistant you’d have a robust response to your ad. Where I currently practice, I might get a couple of resumes and that’s who I have to choose from. Sometimes the easier route is to find someone who has good customer service skills and train them to be a dental assistant. It’s more work, but you also can find someone who doesn’t come with any dental baggage or bad habits. They will learn things your way because they don’t know any better.
Staffing is the largest expense in every dental office and it is also the source of the most headache in any dental office. You’re staff can make or break your day. The vast majority of my days are easier because my staff are a tremendous help and they do the things that I don’t want do to. Then there are the days were I have to cut a final impression for a partial out of someone’s mouth because the assistant locked it in. You win some, you lose some. All things aside, staffing in a rural setting is definitely more difficult than it is in an urban setting, at least that’s been my experience.