Welcome to another episode of dentistry support the podcast. I am Sarah Beth and your host on episode number five today we're diving into the deep end of dental offices and tackling the very worst conversations head on. From confronting poor performers to addressing theft of company time.
And yes, it's a real thing. Even navigating the waters of embezzlement. We are bringing light to the uncomfortable truths that many leaders face. And there's something I've got to tell you, leadership just isn't for the faint of heart. It's about making tough decisions, even when they're uncomfortable and just downright difficult because let's face it leading a team that is out of alignment is far harder than having these hard conversations. And in this episode, We're exploring how being a generational leader means stepping up to solve problems rather than turning a blind eye, losing money and possibly losing your business.
So buckle up, we're going to navigate through these challenges of leadership together. And remember, you're going to choose your hard. You have seen all the memes on your favorite social media platform.
What hard will you choose to pave the way for a better generation of leaders?
I have a couple nitty gritty of real life scenarios straight from the trenches of dental offices. These stories hit close to home because they're not just hypothetical situations. They are happening in offices, just like yours right now. Take Cali, for example, a once stellar front office team member who seemed to have it all together until everything took a nosedive. Then there's Mandy, a billing expert with a decade of experience. Yet, somehow managing to rack up the highest 90 day plus accounts receivable I have ever encountered in my 25 year dental career. And let's not forget Dr.
Arnold. Who just six days ago, confided in me his gut wrenching suspicion that has trusted front office team have to have been pilfering him for the last 18 months. These aren't just isolated incidents. They are harsh realities of managing a dental practice. So let's dissect these stories. Let's learn together a few new things and uncover some strategies to navigate the challenges that lurk within the walls of dental offices everywhere. And most importantly, today. We're going to learn how to have the worst conversations in dentistry. First, let me clear the air. There is no such thing as a self-made man. You cannot accomplish anything without the collective efforts of everyone in your corner and on your team. So as I talk about each of the stories. Let's keep that in mind, even if you feel like you are the one man show making it all happen in your business. You absolutely are not.
I will literally die on the hill right here that there is absolutely no such thing as a self-made man.
In 2007, I was a new office manager of a dental practice just outside of the Chicago Metro area. I was introduced to the front office team and told by the spouse of the dentist that this front office team member was the very best. She was always able to quickly fill the schedule and just make it happen at the office.
Her name is Callie. Callie was one of the sweetest front office people I've ever met. She was so friendly with every patient when children would come in, she would get down on their level. When the schedule fell apart, she was our girl. I learned a lot from how she did things while I managed this practice and many things, I still teach my team today. But there's some things I've got to share with you about Callie and how she handled her job. Things that I didn't care for things that led me to having those worst conversations. One thing.
I learned about the schedule at this office about two weeks into my career here. Was that it always fell apart. Nearly every day. There were always patients just dropping like flies. So I sat at the front desk with her one day and I offered to help her fill the schedule. She recited this phrase to me that I think about all the time.
And I even teach my team this today. Today is the most important day then tomorrow. That's how I work. Okay. Got it. So I went to work calling and calling and calling and calling some more. She was doing the same thing only. I would rarely hear her actually talking to patients and magically.
I would just see the schedule of getting a new appointment. At first I was of the mindset that maybe I was just crazy and I just missed the conversation she had while I was talking to a patient. Like, what am I missing here? So the next day, the same story happened, the schedule crumbled again.
And I had helped her fill the schedule this time. So I asked Callie what was going on. And she said, she didn't know, she can't control when patients don't show. So I went to my office and I started calling every patient that no, showed the ones that she spoke to because none of them were patients I had spoken to.
They were only the appointments that Callie scheduled. I wanted to know what was going on. So I called them from the perspective that I wanted to reschedule their missed appointment.
After three calls of successfully connecting with a patient. I learned a common theme. Every patient was telling me that they received a confirmation call for their appointment, but they had never actually made an appointment. And that they were either at work or they were home with a child. Or they work from home and they can't come during that time. It was call after call the same story. Maybe this is you.
Maybe you have a similar situation going on in your office. But you're not actually sure why the schedule keeps falling apart. You're not actually sure. What's going on in your front office. Maybe you haven't taken the step. To start calling patients yourself. And finding out what's going on with those calls that your team is seeming to make. But maybe I've got it all wrong. And this isn't a story that rings true for your office. Let's go to my next story.
Here at dentistry support, we service dental practices all over the United States and we have a very large office that's located out of California. They've been with dentistry support for about four years now. We handle all of their eligibility verifications . When I say this office is large, it's an extremely large dental practice. It is a single location practice.
They are the top 1% Invisalign provider. They have six dentists, 12 hygienists. They produce north of $850,000 per month. About a year and a half ago, one of the main owner doctors, there's a couple of them that own the practice, but she has majority ownership. She called me and asked if there was any way that we could help with their dental billing.
Immediately. I could sense the nervousness. She absolutely loved her dental billing team. She loved the leader that oversaw this department. She was confident that they really could do the job, but she was concerned she said they're over 90 days, aging was incredibly high.
The girl that oversees the billing has convinced her to allow her to work from home. And she constantly says how she has billing under control. She uses really strategic words. She really sells it to this dentist that she's got everything under control. But they're over 90 days is crazy.
And I kept trying to get the doctor to tell me exactly what crazy meant. I also kept trying to get her to tell me what her over 30 days aging was since that's how we operate a dentistry support, we always look at over 30 days, a lot of dental offices, they focus on over 90 days because they say the claim is in processing, but. We believe that your business can be ran a lot tighter than that. So finally, the doctor tells me that they're over 90 days was that $2.7 million. And when I tell you, I had to try to hold back the gasp, I literally had to try to hold back the gasp. Are you kidding me? Are you kidding me?
$2.7 million in over 90, she hadn't even told me what her over 30 was. She just knew what the over 90 was. So I go on and I quote her a fee that we would charge her. The goal that our team would set for her office would be that there would be little to no claims.
Over 30 days, I gave her advice on the type of claims that they may possibly see that would reach over 30 days. But a healthy AR and dental office should never equal this volume. I mean $2.7 million is almost three times their revenue. So, if you were to pull your aging report right now, and you saw that you're aging over 30 days, Was over three times what your monthly revenue is.
There are definitely problems in the dental office.
As she was so cautiously sharing with me, her dental billing, woes. She went on to share with me that Mandy, who was the lead person in charge of the billing had been in this position for 10 years. And she was the best, the very best this office had ever seen. And I'm over here thinking. What are you talking about?
How could she possibly be the best? I found myself speechless. And obviously you're learning that because I record a podcast. I could never be speechless. I sit back and wonder sometimes. How leaders can find someone to be the very best when their performance is literally the very worst. Let's keep going. Mandy worked the billing.
She was convincing the doctor that the claims had all been resubmitted and everything was pending. But when we dug a little bit deeper, things were different.
Before we took on this assignment. I requested that the doctor allow us to have a sampling of claims that needed to be called on. So that our team could find out the status and see what was going on. She was able to provide us with seven random claims. There had been no follow-up on all seven claims that we called on. We ended up pulling reports from previous months. And you could clearly do the math, that all of the claims that kept rotating to the next bucket. We're just doing that. All I could see was that there was no activity on these claims.
We started working. And after about three months of support, we had cleared out around 40% of the claims that were aging over 90 days. Our team was also in charge of sending claims out immediately after services were rendered. They were simultaneously working on closing out claims and the same month services were rendered. and working the over 90 day batch that the office was really concerned with. At this three month, mark. We received a message from Mandy in our HIPAA compliant chat system that we use to communicate with our dental offices in. She said the doctors decided they wanted to end the support they have with us for the dental billing side. They still wanted to continue on with our eligibility support, but that the dental billing was not something that they were interested in any longer. I was a bit confused because we were making huge strides.
I mean, massive. I ended up texting the dental office owner that I had spoken with originally. She got on the phone with me and we talked about her dental billing and how we had made this massive improvement in their office. in just three months. , I was wondering why she wanted to end the support. She went on to share with me that Mandy didn't really like our team working on dental billing. She didn't like our team having our hand in this task, she wanted everything back and would make sure everything was cleaned up.
So we ended up. Terminating the rest of their support. Recently I've gone into look at the aging for this office. And it's over $3 million.
As of right now. That was about a year and a half ago. This office is not collecting where they need to be at. And maybe this is a similar story to you. Maybe you're an owner of a dental office and you are gasping at the numbers and you're over 90 days. Maybe you have no idea why your team is so good at telling you how they have billing under control, but the billing's out of control. Or maybe I've got it all wrong. And you are just not having that worst conversation and dentistry. To actually ask the hard questions and find out what in the world is going on. But let's head to another conversation we've had. Before I owned dentistry support. I worked in six different states, leading dental practices or working in the front office and dental practices or working for large dental groups.
In 2010, I worked for a pediatric dental group. This dental group was amazing. I absolutely loved working there.
I was not an office manager. They didn't have titles like that. But they did have titles like business administrator. And so that's what I was, I would travel from different locations seeking to improve those locations with best practices and training. One of the locations was about three hours away.
I would drive to this practice several days a week. At this location, three hours away, there was a team member that worked in this small town and she had been at this office for over 20 years.
It was wild to me at this time in my juncture, I hadn't really known anybody. That had been at a dental office for that long. But this town was so small that hiring people was really a challenge. Well, whenever there was a treatment plan that was diagnosed and it did not get scheduled. There were always supposed to be notes following up on what was going on. After a while, I started to notice a common theme that it would just say followed up on January 1st, 2010. I think in dentistry, we have all of these tasks that we have to get done. We just try to put notes somewhere to say that we did a task, but we don't actually realize that the lack of doing that task. Results in a future punishment of a schedule not being full.
And that might sound a little bit dramatic, but that one gesture of not doing something does impact the business several weeks down the road.
I learned very quickly that this team member did not have a passion for this office because her notes of "followed up on January 1st, 2010". They weren't actually notes where she did follow up. I learned that because I decided to sit down with her and start calling to follow up on these patients. I won't go too far deep into what happened when I called on those patients, because I do want to protect her a little bit and she may be listening to this very podcast.
But what I will say is that when you go to follow up on a patient's treatment plan, I'm going to encourage you to teach your team. To follow up from the perspective of, we just want to know how your visit was. You can always segue into talking about the treatment plan, but don't start with the treatment plan, the patient, or the mother or the father or the guardian of the patient. I might already be on edge and ready to defend themselves. If your treatment coordinator is doing the right job or the office manager who acts as treatment coordinator is doing the right job. Before you even call you'll know what you're up against.
You won't see a note that just says followed up. You'll see a note that talks about all of the things that they did in that conversation. You'll see details. Like we had this conversation, we talked about this treatment. We offered this payment plan. We offered to start with one portion of their treatment to get them started to work with finances.
You'll see a lot of information in there. And oftentimes the reason that patients or guardians are not scheduling is because of one of several factors, time, fear, money. Your goal, when you're trying to grow your practice and fill your schedule is to meet one of those needs. Head-on.
Maybe this example is exactly what's happening in your office treatment that doesn't get scheduled that day is just never getting scheduled. And when you ask why people keep telling you, I am filling the schedule, I am doing it. I'm calling on all of these patients. I can't control when a patient won't schedule, Or maybe I've got it all wrong. And these aren't situations in your office, let's keep going.
My last story. It's a hard one for me to share, because it really does break my heart for the dental industry.
And it's not the only story that I've heard like this. Six days ago, I spoke with a dentist, Dr. Arnold.
His office is located in Ohio. He called me to talk about his dental practice and he was interested in enrolling and dentistry support. He has been in dentistry for 20 years he has two team members who work the front office. They've been there for just shy of 10 years. He said that there is an issue going on in his office and he is planning on terminating both of them. Immediately my mind goes to embezzlement because nobody ever says. That like that, if you will. We continue talking for about an hour. He asks me a ton of questions. We go through all of the information about how our remote support works. he finally shares with me that he believes they're embezzling.
I am intrigued at this point, but I'm not shocked. We continue on talking and get to the aspect of support. He tells me that what we charge, he could just hire two people to replace the two that he's terminating. He goes on to tell me how they are in a small town and salaries.
There aren't too high. Why should he choose my company over? Just replacing them? Well, at this point, I shifted the conversation. I didn't want to banter back and forth on cost until I really understood the full gravity of his situation. First of all my team, they go above and beyond any similar support company that exists.
I promise you. I know this is true because I have personally called them all, researched their websites and understood exactly how my competitors work. We charge a flat rate and we're all inclusive for everything we do. We never tell a client. No.
And when I say we never tell a client, no. That means that all of the services we offer. I completely cover the dental practice for any of the categories of services we offer. We also staff so efficiently that there is no possible way the cost of our services would ever match or surpass the cost of an in-house team member, especially when you factor in taxes, time off and other expenditures that are related to in-house employees.
Second, I'd like to know more on the suspected embezzlement. So here's how our conversation went.
I asked him, what does he think that they're stealing? And he said, you know, Sarah Beth, the thing is when I knew they were stealing 500 or $1,000 a month, it was easy to overlook.
We do really well. The practice produces about $170,000 a month and has for the last three years straight. He said money just keeps coming in. So it really doesn't matter. But then it got to being 10 to $12,000 a month. And then it was a little bit harder to swallow. And now I think they're stealing about a combined dollar amount of around $50,000 .
I said to him, Dr. Arnold. I hate to break it to you, but the cost of our support doesn't even come close to what you're paying your staff right now. Not only do they get their regular base salary, you're paying out, but they're also clearing near $50,000 a month of embezzled funds in the form of a bonus.
I also said, did you know, your practice would be producing a whole lot more per month and per year? And while you keep telling me you're producing 170,000 a month, You're really producing like 220,000 a month. I mean, that's a far cry from where you're at right now.
I'll spare you the rest of the conversation, but I really hope that if you suspect embezzlement and your dental office, that you aren't just letting it slide, even if it is just $1, it is never okay.
For someone to steal money from a dental practice, a business owner, or from any one single person. So I want to encourage you today to learn how to have the terrible, awful, totally uncomfortable worst conversations in dentistry.
And I am going to start by giving you your very first tip. There is a theory called the Babel effect. If you have never heard of this before. It is the idea. That a leader will be in a room, launching a new initiative, following up on a project they would like to complete or hiring for a specific job. During this time that all of the details of the project are being shared and conversations are happening across the boardroom table.
The leader is attempting to get their team on board and subconsciously the leader is paying attention to whoever is interacting.
The very most, whoever is listening while you're talking and speaking and responding. Once they have finished speaking. When it comes time to decide who is going to champion this project or who will be hired for this job. The leader is oftentimes selecting the person who has spoken the most or babbled.
Throughout the conversation, the leader unknowingly has already selected this person and ultimately chooses them aloud.
Because in their minds. They spoke the most. They knew the most, it builds confidence in the leader to select that person.
And as a leader, whenever you have a new task at hand or something that has to do with the progression of your leadership. You always want to select the strongest candidate so that, you know, it will be a successful adventure. You know, that there will be a successful outcome.
And now we've heard this person babble and speak the most, and we think we're going to be successful because they sound extremely competent. And in some cases, this does work out really well. But in most scenarios, it does not Bidwell for the person who has selected this babbling team member to lead the pack. The reason is because we have decided as a leader, we're going to confuse two very simple words. We are mistaking confidence for competence. This happens frequently in a dental practice. And what I mean by that is maybe you are recognizing a scenario and your dental office. As I was telling stories today, you were listening to those and you were thinking, well, this kind of fits my dental office, but not really.
And I would like to argue and maybe even say, I bet you that you are mistaking.
The words your team members are telling you over and over for their confidence and not their competence.
So today as we learn to be generational leaders together and have these absolutely terrible conversations, I'm going to challenge you to begin with the end in mind. That after the conversation is done. You are challenging yourself to notice the competency of your team, to complete the tasks, like filling your schedule. Collecting the money that you work so hard to produce. Running your dental business, creating a profitable environment year over year.
As a business owner or generational leader. Theft of time and your business can be very challenging. And as a business owner, I know theft of time is real. And in your dental office, theft of time can look like so many things. Like clocking in and finishing their lunch before they take back a patient. Saying that they're calling to fill your schedule all day long.
They spent eight hours on it. The schedule looks full and tomorrow $10,000 in canceled appointments. At my company, it looks like people downloading applications that make mouse movements happen. So their time clock doesn't end early when they finished all their tasks for a dental office and they can squeeze in another 30 minutes of time. There are a million ways.
Theft happens in a dental practice, and it's not just the money that your team members could take from you. Theft happens and small businesses and theft happens to people just like you and me. But you don't have to be okay with it. Let's finish this out and talk about how you can have better conversations to evaluate the competency of your team. And look past the confidence they may have because that confidence could be costing you thousands of dollars.
Poor performers is our first lesson. There are three specific ways that you can address poor performers to check their competency levels and evaluate if you're looking at them from, oh, I put them in this place because they were really confident or I put them in this place because they were really competent. For example, you can focus on specific behaviors that you're noticing.
Begin your conversation by pointing out specific behaviors or actions that contributed to that poor performance.
I don't want you to make assumptions or generalizations of what you think happened you need to have concrete examples and present these to the team member. The schedule yesterday. You told me it was going to be full the rest of the week. Then you filled the schedule.
The rest of the week today's schedule has fallen apart. I've seen this happen for the last four days in a row. Tell me what happened. When they try to give you a generalized answer, like I can't control when a patient cancels. I want you to instead acknowledge, completely understand where they're coming from and then ask them for clarity.
Can you share with me exactly what you did to fill the schedule? And help me understand why I'm consistently seeing the schedule fall apart? Because mathematically, it's impossible for you to fill the schedule every day, completely full. And then all of a sudden we lose 10k 7k 5k every day. That effort is wasted effort, and I want you to feel successful every day. Your goal as a generational leader is to offer support and resources and express how you actually want to support the employee in improving their performance.
You can do this by sitting next to them, making phone calls with them. You can do this by displaying the behavior that you want out of them.
And lastly your goal as a generational leader. As to create clear expectations with goals and time limits attached to them, your team members need to understand exactly what success looks like. And whatever category you're approaching them with set realistic timelines and milestones that you can track. And reward them as they go. This is empowering your team members to take ownership of their own development.
And you are providing guidance along the way.
Theft of company time. This is a hard one because you're going to see now that theft of time comes in a lot of different variations. You're going to address whatever the behavior is directly approach the conversation with a focus on the specific thing that the team member did that was theft of time, rather than making it a personal attack.
Take out the word you. Every time you say the word you, a person is going to feel like they did something. They need to do something. Take it out. Clearly communicate the company's policies regarding attendance and timekeeping and how this directly affected the company policy. Explore what the root causes what's going on.
That's making this activity happen. Are your team members clocking in finishing lunch for 10 minutes, then getting a patient. Do they not have enough time for lunch what's happening in the schedule that we can create a better work-life balance. And lastly, reinforce accountability outlined with the consequences of continued theft of time will result in and emphasize that the employee has accountability for their actions.
Any time that you overlook a situation, another team member thinks, oh, well, I can do that because I saw that person doing it. You need to talk about disciplinary measures in accordance with how the company policies are. And if it's more effective to do this in a group setting, then do that. Make sure that everyone's on the same page. Especially if your office has been known to allow certain things to just kind of slide under the rug. How a Team meeting, talk to everyone at the same time? Let everyone know what you've been noticing. And that from today forward, things will be different.
And that topic that nobody wants to even know is happening in their office. Embezzlement. This you need to handle with sensitivity, gather as much information as you possibly can. And decide how you want to proceed. If you believe that addressing the team member will result in them returning the money. Do that. But be professional, be sensitive to the situation. Have this discussion and a private setting and maintain confidentiality and any unnecessary embarrassment you don't need to involve the entire office when you suspect something.
This is something to be kept close to the chest.
You need to present all of the evidence that you have related to this. And a factual and non-confrontational manner, especially if you want this to go in your favor. Follow company procedures. What have you decided is the action that you take now? Some of you listening to this might be like, well, I'm going to call the police.
That's exactly what I'm going to do. Okay. You can do that. But there are many ways to handle situations. There are many ways to approach theft or embezzlement, and you have to decide what your policy is going to be. If you don't have a policy, you need to create one and make sure everyone on your team is aware of that and signs a document stating that they fully understand that this is something that will require immediate termination, the authorities involved or whatever the policy is within your company. In every one of these conversations. The goal as a generational leader is to approach employees with empathy, respect, and a genuine desire to support their growth and development and future. When you foster that open communication and you demonstrate that servant leadership. You navigate your difficult or worst conversations ever. Effectively and you maintain a positive relationship with employees.
As I'm recording this podcast right now, I'm reflecting on so many thoughts. Good moments. Your that's good moment for today. Is to reflect on the importance of competence, overconfidence. Teamwork and everything that encompasses the collective efforts of those around us and what that really means. I need you to remember what we talked about at the beginning of this episode. That there is no such thing as a self-made man. You cannot accomplish anything without the collective efforts of everyone in your corner and on your team.
Leadership is hard. But having a team out of alignment is harder. A team member unwilling to clean up dental insurance aging. That's a hard conversation. But not meeting payroll is also hard. Confronting a team member about why the schedule fell apart after they ended yesterday, completely filling it. Is really hard. Maybe awkward and even frustrating. But losing your business five months after that.
As much harder. Choose your hard, what hard will you choose to have? What hard will you choose to have a better generation of leaders built as a result of. Every risk. And every hard thing you choose to do is continuing to create a perpetual movement of strong generational leaders. Your journey and leadership is big time about building trust, integrity, and accountability within our teams and businesses.
My hope. Is together you and I, we can navigate the challenges that come along with leadership and dentistry and in small business. And emerged stronger United and more resilient than ever before. One last thought and insight into my company. Dentistry support. We can't exist without dentists.
And so one day we hope to be just as invaluable to your dental practice as you are to our very existence. I'll catch you on the next episode.