It’s not getting any easier to find and hire good team members. In fact, it may have gotten even harder for small businesses over the last few months! So in this week’s episode, Jeff outlines six changes you should make in your hiring process to succeed in this new reality.
Topics:
1:11 – How the dental hiring landscape has been impacted recently
11:59 – Six changes you need to make in your hiring process
Links:
PPO Exit Strategy Session – https://www.mgeonline.com/ppo-exit-strategy
Sample Hiring Ads – https://www.mgeonline.com/sample-hiring-ads-2
DDS Success – https://ddssuccess.com
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Questions From This Episode
What did Jeff find when he compared hygienist salary benchmarks to actual job ads in Southern California?
Salary.com listed the median hygienist wage in a San Fernando-area zip code at $42.50 an hour, but real job listings in that same market ranged from $55 to $65 an hour, with corporate offices layering on $4,000 to $5,000 signing bonuses on top. Jeff points to this kind of gap as evidence that standard salary benchmarks were badly lagging behind what practices actually needed to offer to compete.
Why does Jeff say a job ad shouldn't be entirely focused on pay and benefits?
He says candidates who open an interview purely asking what they'll get, pay, perks, benefits, without any interest in what they'd actually contribute, tend to signal the wrong priorities. His recommendation is to balance the ad: list compensation, but also describe what the practice expects from the role, since the relationship runs both directions.
Why does Jeff say job leads need to be contacted "instantly" in the current hiring market?
With far more competition for the same limited pool of qualified candidates, a strong applicant is likely fielding multiple offers at once, so a slow response can mean losing them entirely. Jeff recommends calling, texting, or emailing a lead within minutes and getting them in for an interview as soon as possible, rather than waiting days to start reaching out.
How does Jeff structure interviews to avoid burning out on hiring?
He splits interviews into two informal stages: a quick first pass covering hours, pay, and core expectations, and only continuing into a deeper conversation if the candidate clears that initial bar. If something is a clear deal-breaker, like a hygienist candidate who won't participate in case presentation when that's a requirement of the role, Jeff ends the interview there rather than spending a full hour hoping to talk himself into a bad fit.
Why does Jeff recommend cutting ties with a new hire within two weeks if it's clearly not working out?
He argues that keeping a struggling new hire longer only compounds the cost: it drags down the practice's productivity while they're there, quietly frustrates coworkers picking up the slack, and still requires the same replacement and retraining effort later, just delayed and more expensive. He also frames it as better for the employee themselves, since they can move on to a role that's genuinely a better fit sooner.
Episode Transcript
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Having trouble finding personnel, having trouble keeping personnel. Maybe you can't find a hygienist, a dental assistant, front desk staff, or maybe you're setting up interviews only to have people not show. If you're running into problems like this, any of them, or ones I haven't even mentioned, you're not alone. We're in a new environment when it comes to hiring. This has always been one of the top three problems dentists face, but the events of the past three years have magnified it to the point where it comes up constantly.
The question is, what should you actually be doing in this environment? What changes ensure you maintain an edge, and that your team stays fully staffed so you can properly service your patients and grow your practice? That's what I want to talk about in this week's episode of Dental Business Rx. My name is Jeff Blumberg, and I'm your host, and I want to start by painting a picture of where things actually stand, since it helps to understand the context behind the changes I'm going to suggest.
Let's look at the national labor market picture first. I've covered this before, but let's revisit it briefly. Unemployment, according to the Bureau of Labor Statistics, sat at 3.5 percent for September, after moving from 3.5 in July to 3.7 in August and back to 3.5 in September. The last time unemployment was this low was February 2020, right before the pandemic began.
Here's where it gets interesting: job openings, which I've also covered before, were higher than they'd ever been, but they're actually down. Job openings hit 11.2 million in August and dropped to 10.6 million, down about 600,000. Except, and I want to read this verbatim from the Bureau of Labor Statistics report, it says the job openings rate decreased in all establishment size classes except those with nine or fewer employees, which changed little. And while plenty of our clients have more than nine employees, the average dental practice probably sits at or below that number. So for the average small dental practice, job openings are still running just as high as before.
The report also notes that both the layoffs and discharges rate and the total separations rate, people who quit or were fired, decreased in establishments with 250 to 999 employees, while the quits rate actually increased in establishments with 1,000 to 4,999 employees. So smaller businesses, under 10 employees, are looking for roughly the same number of people they were looking for in prior months, while the increase in quitting is really concentrated in large companies with over a thousand employees.
Breaking it down further by sector, and I don't want to bore you with this, but I found it genuinely insightful: looking at the 22 private-sector categories the BLS tracks, logging, hospitality, healthcare, and so on, nearly every sector showed a net increase in employees for the September report, which makes sense given that job openings are down overall. The two exceptions were leisure and hospitality, and food services, both of which showed a net decrease, meaning more people quit than were hired. Every other sector had more hires than quits. So essentially, more people got jobs last month, which further tightened up the labor market. We're still sitting at that 3.5 percent unemployment figure, I genuinely expected it to ease off a bit by now, but we're still in a tight labor market.
What makes this even more confusing is everything that's happened over the past three years, stimulus checks, extended paid unemployment, people switching jobs and changing careers entirely. I've covered those statistics in prior episodes. Combine all of that demand, including from big business, with inflation on top of it, last month's figure was 8.3 percent year over year, and you get this completely distorted labor market, at least in my view.
Let me show you what I mean by that using the hygienist position specifically, since that's the role I hear the most complaints about. I pulled job listings from a few major metro areas on services like Indeed to see just how wide the variance really is, and it's more distorted than I've ever seen.
Take the New York City metro area. Hygienist salaries advertised ranged from a little over $30 an hour up to $60, a hundred percent variance. I saw ads offering $32.50 in one listing and $60-something in another, different offices entirely, but that kind of spread is genuinely unusual for a labor market.
Southern California gets even more interesting. I looked at the San Fernando area, just north of LA, using salary.com, a resource I've recommended for years to get a sense of the low, median, and high pay range for a given area, useful for making sure you're not overpaying or underpaying relative to the market. Salary.com listed the average hygienist wage there at $42.50 an hour. But I have clients in that exact area hearing $60 to $65 an hour from hygienists. Pulling up actual job ads for the area, I saw offices offering $55, $60, and $60 to $65 an hour, plus corporate offices layering on $4,000 to $5,000 signing bonuses on top of benefits like a 401k, along with that $60 to $65 hourly rate. So you've got a benchmark service saying $42.50 at the median, while actual ads cluster in the sixties, and offices advertising in the mid-fifties are probably struggling to find anyone.
Chicago, by comparison, showed a much tighter range: 45 to 55, 42 to 52, and 45 to 50 dollars an hour, nothing like the spread elsewhere. Dallas ranged all the way from 37 to 60, with a number of corporate offices advertising that you could make six figures a year, which is possible if it's production-based. Interestingly, the one area that didn't seem to have a hygiene shortage was Miami, where I saw salaries in the range of 30 to 36, 32.50, 28 to 35, and 29 to 35 dollars an hour, and I didn't come across nearly as many corporate signing bonuses there. Why would they need to offer one? Apparently there are simply more hygienists available in that market relative to demand, even though Miami itself is an expensive city to live in.
So you've got the overall national labor picture, plus a real scarcity effect that varies dramatically by locality, and the result is this wide variance in salary that's distorting the whole hiring process. Nobody can quite decide what they should actually be paying, and it's easy to look at what corporate is offering and think you simply can't compete, which I'd never recommend as a mindset, but it's created real confusion around hiring.
How you handle this depends a lot on your starting point. If hiring was already difficult for you before the pandemic, 2019 and earlier, you're going to need to work a bit harder at this. If hiring used to be relatively easy for you and has only recently become difficult, a few smaller adjustments can produce real, fairly immediate improvement. What I'm about to cover will help either way, but if hiring or team-building has always been a struggle for your practice specifically, there's more ground to cover than I can fit into a podcast episode, that's genuinely what full seminars are for. Still, I want to hit the key points, the major areas that have shifted as a result of everything I just described.
Here's the mindset shift worth having: you're looking for a genuinely good prospective employee, someone who could become a real asset to your team. Imagine that, purely as an analogy, where you might have once interviewed 10 people and found five good candidates, now you might only find two. That doesn't mean the other three would've been bad hires, it might just mean they had six other offers on the table, or some other circumstance pulled them away. You simply have to look a bit harder. But don't let that become an excuse to leave positions unfilled, or to settle for hiring someone you know you shouldn't. The fact that it's harder to find and onboard the right person doesn't excuse you from actually doing it. It's not a crutch for leaving positions empty.
I've got six points I want to run through here. Let's start with the hiring process itself. When you're hiring, one of the first things to nail down is what position you're filling and how much you'll pay. This is exactly where the market distortion I just described creates confusion. The truth is, you're going to have to pay more than you were three years ago, for no reason beyond inflation alone. If your revenue hasn't kept pace, that's worth examining on its own, but you'll still need to raise starting compensation regardless. We had to raise our own starting salaries for administrative roles by roughly 20 to 25 percent over the last three years, or we simply wouldn't have had administrative staff. It's not that people are suddenly only interested in money, prices have gone up across the board, so wages have to follow.
If you're struggling to pay more because your practice isn't growing, that's a separate problem worth addressing directly, maybe you haven't raised your fees, or you're heavily tied up in PPOs. We covered the process of actually getting out of plans in a recent episode with Sabri, walking through the steps in detail. Here's the short version: if you haven't gotten out of plans yet, you need to, because you're not just competing with the practice down the street, some of whom may have already left their plans, you're also competing with corporate dentistry, and corporate can absorb a lot more financial pressure than you can, since you're not really up against one office's budget, you're up against the entire corporation behind it. Eventually a chronically underperforming corporate location gets shut down, I've seen it happen, but they can absorb a lot more punishment along the way than an independent practice can, and frankly, you don't want to be competing on those terms anyway. If your fees haven't kept pace with where they should realistically be today, or you're still heavily in-network, you're going to keep getting priced out of the labor market. I predicted this two years ago, and it's playing out now. We offer a PPO exit strategy consultation if you want help with this, I'll put a link on the episode webpage. This can take time, so if it's going to take two years, start now, that gets you out by roughly 2024 instead of 2025, and the market isn't necessarily going to get easier while you wait.
The second point has to do with your job ads. I wouldn't necessarily follow the herd here. Plenty of the ads I see are extremely benefit-heavy, and sure, you should absolutely list pay and benefits, but that shouldn't be the entire ad. Have you ever interviewed someone whose first three questions were entirely about what they'd get, pay, perks, what's in it for them? If that's ever struck you as a bit off-putting, here's why: their primary interest should be in what they're going to contribute to your practice as a team member, not purely in what your practice is going to do for them. If an ad is entirely about the candidate's benefits with nothing about what's expected of them, that's a problem. Find a balance, list the pay and perks, sure, but also describe what your office is like and what you expect from the role. We have sample job ad templates for every position in a dental practice that I can put on the episode webpage if you'd like to download them. The core idea is the ad shouldn't be entirely one-sided, you're hiring someone to do something for your practice, and yes, you'll compensate them fairly for it, but the relationship goes both directions.
Once you've got ads out and responses coming in, whether through Indeed, DentalPost, iHireDental, or wherever you're advertising, you'll have actual prospects. One quick aside: I've noticed Indeed's filters can behave strangely, if you're hiring a hygienist and stack on a lot of filters, it can narrow your candidate pool down to almost nothing. I understand not wanting unqualified applicants, "hi, I'm calling about the hygiene position, are you a hygienist? No, but I'd like to be one," we've all gotten those calls, but for whatever reason, removing the filters tends to surface a lot more genuine prospects than you'd expect. Worth checking.
Which brings us to where the biggest mistake tends to happen: once someone expresses interest in a position, we've always recommended contacting them quickly, since an upbeat candidate is going to land a job fast regardless of where. In this market, that urgency needs to be magnified even further. If you get a lead, that person needs to be contacted essentially instantly, called, texted, emailed back within minutes, and brought in as soon as possible, because your candidate pool now has far more competition looking to hire the same people. Don't make the mistake I've seen repeatedly: someone gets a batch of responses on Monday, gets busy, and doesn't start calling until Friday, then concludes the ad didn't work, or that all the candidates were bad. No, you just waited too long. Call them right away.
Once you've got someone in for an interview, here's what's genuinely different from three years ago: if I want to hire this person, I'm hiring them essentially on the spot. I still run through a standard interview process, past performance, whether they can actually do the job, whether they meet the criteria, whether they can work the required hours, whether they're planning to stick around rather than relocate in six months, the usual things you'd want to know. But if this person checks the boxes and I'm offering fair, competitive pay for the area, I'm going to do whatever I can to hire them immediately. That includes background checks, which we run through a proper service, don't use something like Instant Checkmate, which is actually illegal for this purpose, use a legitimate service like ADP or similar, where the candidate signs off on the check. Some states require you to extend the offer before running a background check, so check with your employment attorney on that. We also check references. So if I think you're a good fit, I'll ask you to hang around for a few minutes while I run through that process, and then extend an offer before you leave, while you're still drinking your coffee. If I let you walk out the door without doing that, there's a real chance you accept an offer somewhere else in the meantime, and I lose you entirely.
Here's something else worth thinking about, since running a lot of interviews can genuinely burn you out over time: I run mine in two stages, sort of a level-one and level-two structure. Level one covers the basics, I explain the position and requirements, watch how the candidate reacts, and ask a set of standard questions we teach all our clients to use. If someone doesn't make it past level one, hours don't work for them, the pay isn't right, some other clear deal-breaker, there's no need to move into a deeper, level-two conversation, since they're already not a fit. That means I can cycle through prospective candidates quickly. I don't personally do this hiring anymore, we have an HR department for it now, but the process moves fast: the initial interview quickly determines whether it's even worth continuing, it's less a separate "second interview" and more a natural extension of the same conversation once it's clear someone's worth investing more time in.
You've probably had the experience of interviewing someone for a full hour, knowing within the first ten minutes it was never going to work, and then spending the remaining fifty minutes trying to talk yourself into it anyway. That burns you out, because you've just spent an hour on someone you were never going to hire, and now you have to start the whole process over again hoping to find the right person. If instead you move through the basics quickly, hours, pay, expectations, and something clearly doesn't fit early on, end the interview there. Say you're interviewing a hygienist, you explain the hours, the pay, and that the doctor expects the hygienist to help with case presentation or at least patient education around it, and they respond that they're happy to clean teeth and do hygiene instruction, but don't want to be involved in case acceptance at all. You can learn that in the first fifteen minutes. If that's a genuine requirement of the role, that's simply not a fit, no matter how badly you need a hygienist right now, because hiring the wrong fit just creates a different problem down the road. Spending fifteen or twenty minutes on people who clearly aren't a fit frees up more time to genuinely invest in the candidates who are, and keeps you from burning out on hiring altogether. Decide quickly, and don't settle. If there's a real deal-breaker, end the interview, don't hire them, you'll regret it later, especially in this environment.
That brings us to onboarding, something we've talked about for years and I still think most practices underinvest in, not for lack of wanting to, but because building out real training materials feels like a huge undertaking. Here's the basic truth: something is always better than nothing. A basic job description beats no job description. A couple of written policies beat none at all. But you need to take this more seriously now, because of what I'm about to say next.
I mentioned not wanting to spend a full hour interviewing someone you already know isn't going to work, moving fast and cutting losses early. The same principle applies once someone's actually hired, since job-hopping and turnover are both meaningfully higher in this environment than they were three years ago. If I can tell after a week and a half or two weeks that a new hire genuinely isn't going to work out, despite real effort on my part to make it work, I end it there rather than continuing to hope something changes. There are a few reasons for this. First, watching someone consistently underperform is upsetting, not just to you, but to their coworkers who end up quietly picking up the slack, even if nobody says anything out loud, it creates real friction, ask your own team sometime and you'll likely hear it confirmed. Second, turnover is always costly, and the longer you keep a non-performing employee, the more expensive it becomes. Every hour your office manager spends interviewing a replacement candidate is an hour they're not doing something else, treatment coordination, covering an overflow appointment, whatever it might be, on top of the direct cost of their time. And keeping someone who isn't performing in the role actively drags down the practice's production and statistics the whole time they're there. So the longer you wait, the more it costs you twice over: while they're underperforming, and again once you replace them and retrain someone new.
It's also not doing the underperforming employee any favors. Say you hire someone for scheduling and after two or three weeks it's clear they're not engaged or cutting it, and if it were entirely up to you, you'd have already replaced them, except there's no one else lined up, so you keep them on as a warm body, better than nobody, which is a genuinely false premise. You're already planning to let them go eventually, yet you're leaving them in place. If you let them go now, they have a real chance to go find a role that's actually right for them. And whether you say anything or not, people can feel when you're unhappy with their performance, they know. If you're putting on a face to avoid an uncomfortable conversation in your own practice, it's better for everyone, them included, to just move on. But you need to make that call quickly in this environment, both to protect yourself from sinking more time and training investment into a mismatch, and because the person deserves the chance to find the right fit sooner rather than later.
That said, you do need at least some basic training materials to get people up to speed quickly. With how accessible video has become over the last decade, you can grab a phone and a tripod and record simple walkthroughs, how to check a patient out, how to schedule a recall appointment, whatever it might be, and have new hires watch them. We also have an online training platform, DDS Success, with positional training built out for different roles in a practice, I'll put a link on the episode webpage. You can also make your own videos specific to your office, your mission statement, your own procedures, just start somewhere. The last thing you want in this environment is onboarding that requires someone standing over a new hire constantly, since that eats up valuable time from whoever's doing the training too. Some hands-on guidance will always be necessary, but you want to minimize how much of it is required compared to the past.
Speed is really the name of the game here, you don't want to overinvest time upfront, but you also want to make a clear call quickly on whether someone's going to work out. One thing I've noticed over the years: smaller organizations tend to have far fewer training materials, since everyone there is usually already trained and busy doing the actual work. As an organization grows, and I've watched this happen here at MGE too, the earliest people you bring on really have to be self-sufficient, since there's not much structure to lean on yet, they largely have to figure things out themselves. As the practice grows, you gain the time and resources to build out more structured training materials, which means someone who might not have made it ten years earlier, simply because they needed more support to get up to speed, can succeed now because that support finally exists. The flip side, though, is you don't want to swing too far the other way either, telling yourself someone who's been genuinely incompetent for a month and a half just needs more training. Someone still has to be able to pull their own weight to a reasonable standard. But you need to make that determination fast.
Last point, and this one's especially relevant in this environment: outsourcing. There are far more outsourcing options now than there were five or ten years ago, or even three years ago, and I've seen it work well in some areas and poorly in others. Let's start with what I wouldn't outsource: scheduling, whether that's the doctor's schedule or the day-to-day hygiene schedule, anything involving case presentation or treatment coordination, and answering the phone, I want a live person handling that, not a recording. Basically, anything integral to the day-to-day functioning of the office stays in-house.
What can you outsource? Marketing has always been a common one, your website, postcards, digital marketing, that's fine. You can outsource insurance verification and insurance filing. In some cases, you can outsource reactivation, say you have three or four thousand patients without a scheduled hygiene appointment, ideally that gets handled in-house, but there are legitimate services that specialize in reactivating patients on your behalf, and that can work too. Whatever you outsource, though, hold it to the same performance standard you'd hold any team member to. If a vendor isn't performing, don't assume they must know what they're doing simply because you're paying them and don't fully understand their specialty yourself. If they're not delivering, find someone who will.
So yes, the environment has genuinely changed, and there are real adjustments worth making to stay on top of it. But there's no reason you can't come out of this just as successful, if not more so, than you were a few years ago. The number of practicing dentists in the US isn't growing dramatically, while the population keeps growing every single day, meaning demand keeps climbing too. If you're genuinely on top of your game here, there's no reason you can't do extremely well.
I hope this helps. Don't forget the downloads on the episode webpage, including the sample employee ads if you'd like to check them out. If you want more information on anything I covered today, you can email me directly at jeffb@mgeonline.com, visit us online at mgeonline.com, or call us at (800) 640-1140. Have a great week, and we'll see you at the next episode.