10 Reasons Why Your Staff Keep Leaving: Some Hard Truths and Straight Talk for My Dental Colleagues
You are confused. You’ll say things like “good staff are hard to find” or “this younger generation just doesn’t want to work anymore”. If you are like many of my dental colleagues, you don’t even know what you’re doing wrong. The universal theme of the complaints is that there are never enough quality employees, and that if they only found the right employee all of their office problems would go away.
I think this is a false premise, and here’s why: People want to work, just not under the present conditions of their employment. Statistically, according to the Bureau of Labor and Statistics or the BLS, the average length of employment for an employee is 4 years. Don’t believe me? For dentistry, it’s 2. (actually, it’s 1.9-I rounded up). That’s half the average employee tenure across all industries, or, looking at it another way, we lose our employees at twice the rate of other industries! What are we doing wrong? Keep reading.
This is not a universal problem. I know of many offices around the country who have managed to avoid this problem. Rather than focusing on what they are doing right, which has been done repeatedly in numerous articles over the years, I’m going to point out what YOU are doing wrong in the hope that you will learn and understand and hang on to your team members. Like I said, some hard truths.
Here’s a caveat. I was once in your shoes. I ran my own practice for 11 years before having to retire due to a hand injury. I, like you, made many of these same mistakes and I like to think I learned a few things along the way. And after having finished a master’s degree in organizational leadership, I now know these things are correct from an academic standpoint.
So here goes.
1. You think that everyone is replaceable. Though this is technically true, by being outward about your mindset in this way, this becomes prophecy. If you believe it, it becomes it. You have to want to try to keep your employees around. Why? Aside from the benefits of having team members who feel like their boss sees them as a person, it actually costs less when you don’t have to replace team members on a regular basis. Lost productivity, lost hours as your team has to integrate a new team member into your practice, the added stress and the loss of productivity that results, these are just some of the reasons.
2. You micromanage. Okay, I’m just going to say it. Please, for the love of all that is good, do not do this! I mean it. Just don’t! Why? When you do this, your employees think that you don’t trust them, and who wants to work for someone who doesn’t trust them? I don’t. You will find the few employees who will work for you under these conditions, and honestly, they are probably dealing with some deep-seated psychological martyrdom behavior. They are the exception not the rule. The rest? They don’t bother trying anymore and/or they leave. A strong authoritative style is needed in some situations in dentistry (while you are working on a patient in an emergency for instance) but for most of our day to day, this leadership style stifles self-motivation and initiative. Over the long term, employees who work for authoritarian style bosses find that their autonomy and ability to make independent decisions atrophies, because why would they keep doing this when their boss keeps vetoing their efforts? The end goal is to be a leader, not a manager. My approach has always been to 1. Hire competent people and do it slowly so that you find the right person, 2. train them in the ways that you want them to be trained, and 3. get out of their way. Decades of employment research backs up this approach.
3. They don’t feel financially secure working for your practice. Job security is one of the top reasons employees leave an office, and this takes many forms. It can be that you don’t pay them enough. I know I will face the wrath of many in the dental industry for saying this, but it’s true-when an experienced dental assistant is making only slightly more than a new employee working for McDonald’s, this is reflective of years of dental offices not paying their employees enough and not a current fluke in the industry. Knowing all the training and expertise that goes into being a great dental assistant, they should be paid for it! You can’t do your job without them-they’re worth every penny. Or, maybe the office is not doing well financially, and efforts are made to control costs. Believe me, I get it. I’ve worked in practices where disgruntled team members have to “clock out” when there isn’t a patient (and this usually is through no fault of that assistant that there is a hole in the schedule), or, as I’ve read in some forums, when there’s a team meeting, team members aren’t paid for that time, or they are paid for half of that time even though they are required to be there. Even if they don’t say so, your team members are less than happy and become resentful when this happens and this dampens motivation for them to stay working there long term.
4. You don’t give them a greater purpose in working for you. Just having them show up and do the work is simply not enough anymore. They need to have more. Once upon a time, in previous generations, that was sufficient to keep an employee. They came to work for you, you paid them for doing their job to a satisfactory degree, and that was the end of it. Not anymore, not with Gen Z employees who comprise most new dental auxiliary team members. According to a 2024 study done by the consulting firm Deloitte, they found that nine out of ten Gen Z employees report that having purpose is tied to their job satisfaction and well-being, and many will leave a position if it doesn’t offer that. So, what does this mean? You need to give them more than just a paycheck. They need to feel that they are part of something bigger than themselves, that they are doing more than just holding the suction and removing excess cement from that crown you just cemented. Tie their job into bigger things. It’s all in how you frame it. We’re not curing cancer, but we are making a difference in our patients’ lives on a daily basis, and even that entry level dental assistant is a part of that.
5. You see your team members as liabilities and not assets. Yes, on any profit and loss statement, money that goes toward paying your employees is seen as a “liability”. It’s money out vs money in. Your employees feel that. Trust me. Your hygienist needs to get certified for CPR as part of her license. You know, a crucial part of her ability to work for you. And you don’t want to reimburse her the $50 for her renewal? Yes, I have many colleagues who make this calculation. Just pay for the certification. It goes a long way toward building loyalty.
6. You don’t recognize them. Recognition is a key component for why employees stay in a job, and this doesn’t often happen in certain practices. I have colleagues who rarely reward their employees beyond their salary and a small bonus. They think that their being there for the job and completing the task that was assigned them is enough. But what about, at the end of a hard procedure when you see that your employee handled a difficult patient with the care that the situation deserved, or your treatment coordinator closed a large case you were to give your team member a high five? Maybe even a $5 Starbucks gift card? If they worked through lunch to finish that filling that turned into a crown, why not buy them a pizza? It doesn’t need to be much, because, in the end, it’s not the content of the reward, but that a reward was given in the first place. The recognition. It’s a reminder to them that you see them and their efforts.
7. You don’t deal with conflict in the office. In a leadership vacuum, someone steps up to take the lead. And it is often that that person is not the best equipped to deal with that conflict, but they do so because no one else will. The number one reason why a team member leaves a practice is because of internal office conflict which leads to a toxic work environment. You’re the doctor, the de facto leader, you need to start acting like it. Start thinking of conflict as “opportunity” rather than something to avoid. Conflict is, at its heart, about unmet expectations. When you start dealing with conflict early on, this presents an opportunity for discord to smooth itself and for parties to come to an agreement. The longer it festers, the worse the outcome, which adversely impacts employee retention.
8. You don’t allow your team members to grow as individuals. This is one I’ve heard this more times than I can remember: “I can’t train them to do something else or they will leave me.” Really. Some of you think that. What about the alternative? What if you thought, “I see my employee as a person who has human needs, and I am happy that they want to pursue a path toward excellence.” And guess what? Those other team members, those whose ambition levels may not be as high as that team member who just got into hygiene school, they are watching. They see your reaction. If you are cheerleading the accomplishments of the aforementioned assistant, they see a leader who believes in them. And that makes them want to stay around. If you don’t celebrate it or are less than enthusiastic? Yeah, they see that too.
9. You don’t share the success with your team. Our patients are generous. They bring us gifts for a job well done. That job was not done just by you-it was done by the entire team. So why would you take that plate of cookies home with you? Your team sees that and is taking notes. It seems like a small thing, and you may not even be aware that your taking the cookies home with you instead of sharing them has a negative impact on your team. Remember, the intention is irrelevant if the impact is negative, so even if you didn’t think your taking the cookies home would matter, it does. Not every doctor does this, and some may only do it every once in a while. Bottom line? Those who make it a point to share with their teams don’t have the turnover you do.
10. You don’t follow through on your commitments to them. This one is a hard one to write about, because I know that I did this from time to time. This comes down to integrity. When you follow through on your commitments, when you have integrity, this quality is what makes people want to follow you. When you don’t, they won’t. It’s as simple as that.
I say all this to help us as a profession. There are many instances where our actions may be unintentional, but there is a difference between intention and impact. You may not intend it, but the impact is there regardless. I know that many of us think we are doing what is best for our teams, and through some self-awareness and reflection, you can take these lessons to heart and work on your practice. It’s never too late!
Bonus Truth: You don’t give your team members feedback on their performance. I get it, reviews are tedious and painful. For most dentists, having to sit down and tell the person they spend 8 hours every day is more painful than getting a wedge stuck under their fingernails. But there’s really no other way to do it. People need to know where they stand when they work for you. People are not mind readers. Just give them the feedback they need, and if necessary, provide training for them so that they can improve! They need to know if they need to improve when they are falling short. And, what if they are not performing up to your standards and then you let them go? How would they have known to improve? That leaves you open for litigation. Bottom line, you are in the role of the
Bonus 2: You think punishment is going to improve their performance. I’m just going to come out and say it: if you are even considering punishing your employee, you have already lost. Why? Again, it comes down to motivation. Our employees are (with some exceptions) grown adults. They have long outgrown the “do this or else” frame of mind when they graduated high school. Cell phone usage is the most common complaint I hear. If you think that punishing them for this will deter it from happening, good luck finding their replacement because they’ll probably leave. This is where a reframe comes handy. Have the hard conversation by saying, “look I have noticed that you seem to be on your phone a lot. When you are on the phone, that takes away from your ability to deliver proper care to our patients. I know you want to do that, so can you please put the phone away while we are working.” Or something along those lines. Remove the personal attack from it and state the truth, because it is. Our devices are addictive, and many of us dentists are just as addicted to them. But placing a limitation on it from the beginning and reinforcing it for the whole team will go a lot longer than punishment. It becomes part of your office culture. The focus on the patient.