Ep. 101: Q&A – Finding a Hygienist, Problematic Staff, and New Patients
This week we answer more listener questions with special guest Sabri Blumberg. You can also watch the filmed version of this episode on our YouTube Channel here: https://www.youtube.com/watch?v=DEzOvLsslf0
Topics:
:11 – I can’t find a hygienist.
9:54 – I have a problematic staff member but they’re very productive.
18:00 – How do I get more new patients?
Links:
The MGE New Patient Workshop - https://www.newpatients.net
Free Consultation - https://www.mgeonline.com/free-practice-analysis
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Questions From This Episode
What does Sabri recommend for a practice in a tight hygienist market, even when the schedule looks full right now?
She recommends always staying connected to prospective hygienists, through Facebook groups, ongoing interviews, and keeping applications on file, even when there's no current opening. That way, if a hygienist unexpectedly leaves, the practice already has a network to call instead of starting from scratch.
Why does Sabri say having the doctor personally take over hygiene patients is a bad solution to a hygienist shortage?
Once the doctor is doing hygiene, they inevitably limit how many hygiene patients the practice can see, which cuts into treatment presentations, since most outstanding treatment gets diagnosed and sold through hygiene visits. She recommends hiring an associate willing to cover hygiene instead, since in tight markets it's often easier to find an associate than a hygienist.
What's the first thing Sabri checks when a doctor says a staff member is "very productive" but a problem for the team?
She verifies the actual production numbers first, since a reputation for being productive can be exaggerated or based on a few visible wins while ten upset patients quietly never return. If a staff member treats coworkers badly, she says they're likely treating patients the same way, even if the numbers initially look strong.
If a staff member really is productive but keeps upsetting others, what does Sabri say to check next?
Whether the people complaining about that person are themselves productive, since underperforming staff sometimes try to undermine productive coworkers. If the complaints are legitimate, she recommends addressing it through written policy and direct correction through the manager, with replacement only as a last resort, something she says is genuinely rare.
What's Sabri's practical advice for getting more new patients, beyond running new marketing?
Assign one specific person to be accountable for new patients, since it's rarely anyone's actual job otherwise, and have that person actively ask every patient, referral, or even a vendor in the office (like a plumber) whether anyone in their household needs a dentist. She points out that practices often assume they're seeing whole families when the math, comparing unique households to total active patients, usually shows otherwise.
Episode Transcript
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Jeff: Welcome to this week's episode of Dental Business Rx. This is actually part two of a two-part series, last week's episode was episode 100, this is officially episode 101. For episode 100, we did two things we'd never done before. One, we filmed the episode, so if you're watching this on YouTube, you know we filmed it, since you're watching it. If you're listening on Spotify, Apple Podcasts, or Google Podcasts, you can also watch it on YouTube if you'd like. The second thing was taking listener questions, an amalgamation of what we've received since the podcast began. We isolated the top six, did the first three last week, and we're doing the other three this week. To answer them, I've got Sabri back. Hello, Sabri.
Sabri: Hello, Jeff.
Jeff: Many of you know Sabri if you've listened to the podcast before, she's our Deputy Chief Operating Officer here at MGE, in charge of all of MGE's technical delivery, and she's worked with thousands of clients. So I thought, who better to ask. You've seen the questions in advance, so I'm not putting you too much on the spot.
Sabri: No, that's good.
Jeff: Alright, here's our first question for this week. I can't find a hygienist, what should I do? Are you hearing that as much now as you were, say, in 2020 or 2021?
Sabri: Not as much. During that period, people couldn't find anybody, front desk staff, assistants, associates, it was a real crunch across the board. That's eased up a lot in certain areas of the country. I'm still hearing "I'm having trouble finding a hygienist" out of the older, more persistent complaints, hygienist is probably still the most common one.
Jeff: Has it gotten as good as it was before 2020?
Sabri: I'd say we've always had some trouble finding hygienists in certain areas, so it's become more of a regular, ongoing problem rather than a crisis-level one.
Jeff: One thing I noticed, and I'd heard this a fair amount too, was that if someone told me they couldn't find a hygienist, I'd look at Indeed for that area, how many ads there were and what was actually being offered. There was a real disconnect, salary.com would say the hygiene rate in a zip code was $42 an hour, and then Indeed listings were offering $60 to $65. And in the truly problematic areas, corporate offices were offering $4,000 signing bonuses on top of high salaries. I actually saw a client who couldn't find a hygienist and was offering $10 an hour less than every corporate chain in the area, which kind of answered his own question.
Sabri: Right, and I do see people hiring hygienists for far less than corporate is offering, simply because that hygienist wants to work in a private setting. Those tend to be your best hygienists, believe it or not, money isn't everything. But looking at those gaps helped me figure out whether the problem was real, an actual hygiene shortage in that zip code, or whether the client just wasn't good at hiring. Usually it's a combination of both.
Jeff: So let's take the worst case, I'm in a genuinely tight market and still having trouble. What would you do?
Sabri: First, if you're in a tight market and you know your hygiene department should always be expanding, you should always be looking for hygienists, even if your schedule's currently full. You're collecting names, building connections, and even if a specific person isn't available, they know people. Getting yourself connected through Facebook groups, continuous advertising, interviewing, and keeping applications on file means that when you're in a pinch, you already have people to call, which beats going through a temp agency.
Jeff: So if I know ten hygienists I've talked to at some point, and I suddenly need one, I can call those ten, and if they can't come themselves, they'll know someone who can pick up a few days while I figure out something permanent.
Sabri: Exactly, that's a preventative action.
Jeff: Okay, so let's say I haven't done any of that. I'm starting from scratch, my hygienist just moved out of state or quit, and I'm in a tight market. What now?
Sabri: First, get the word out to as many people as possible, though at that point you're doing it behind the eight ball, on an emergency basis. Call temp agencies, it's not a great solution, but it works. Post in Facebook groups. Place ads on Indeed, correctly. A lot of people don't use Indeed correctly, and it's a bit finicky. If you click that a position requires experience, or a certificate or license, even though the person genuinely needs a license to practice hygiene, for whatever reason, and I didn't write Indeed's algorithm, so I can't fully explain it, you suddenly stop getting applications from licensed hygienists. Maybe they forgot to check that box when uploading their application. Sometimes just removing all the filters on Indeed starts generating applications again.
Jeff: Interesting.
Sabri: In worst-case scenarios, the doctor often says, fine, I'll just take hygiene onto my own schedule. That's a terrible solution, because once the doctor starts seeing hygiene patients, they limit how many hygiene patients the practice can actually see, which isn't productive enough for the practice, and it limits how much treatment gets presented, since most treatment presentations and outstanding treatment plans get sold through hygiene, as we've discussed before. So limiting hygiene limits your sales, and your numbers start dropping.
Jeff: So it's almost better to hire an associate who likes doing hygiene. And believe it or not, some associates genuinely don't mind it, at least for a while.
Sabri: That's right, it's almost always better to hire an associate to cover hygiene than to have the doctor take it over, or to have no hygiene at all, purely from a numbers perspective.
Jeff: So if I truly can't find a hygienist no matter what I try, I should be looking for an associate willing to do it instead.
Sabri: Right, and in those markets it's usually easier to find an associate than a hygienist, go figure. So yes, these are sloppy, less-than-ideal solutions, but they work. Ultimately, the better solution is not waiting until the fire's already burning, prevent it through good hiring practices in that area ahead of time. But if you're already stuck, those are your options.
Jeff: Good answer. Alright, next question. This one was phrased a lot of different ways when we compiled them, but essentially: I have a problem staff member, they're a problem for me and for the rest of the team, but they're very productive. What do I do?
Sabri: Interesting question, because "productive" and "problem" don't usually go together, it's a bit of an oxymoron. The first thing I'd do is verify the actual production, since that could be exaggerated, or they could just look busy, or you're seeing the two sales they close and not the ten people they upset who never come back.
Jeff: That's interesting, because if a person doesn't keep real statistics or metrics, how would they even know if they're actually productive?
Sabri: Exactly right, that's when you end up managing by opinion instead, "we're hardly getting any new patients," or "all our new patients aren't great," these vague, all-inclusive statements. It might look like your hygienist is selling a lot, and then you actually check the hygiene production numbers and they're terrible, or you look at how many people are overdue on recall and never coming back. Because if someone's treating your staff badly, and has the nerve to treat you badly too, they're probably treating patients badly as well. And my favorite version of this is when someone says "everybody loves this hygienist." Who's saying that, the hygienist themselves, or someone else?
Jeff: I don't know, that's just what the doctor tells us.
Sabri: How is that even quantifiable? And usually that's exactly the kind of hygiene department that never expands, stuck at four days of hygiene for ten years straight while getting 40 new patients a month, which doesn't add up. The hygienist is a problem, but nobody wants to get rid of them because "everybody loves them," or because they're so productive, closing all these cases, even though half the patients they see never come back because they upset them.
Jeff: Have you seen cases where someone's, I don't know, over-prescribing or over-treating to inflate their numbers?
Sabri: I'm not trying to accuse anyone specifically, but yes, that general idea, whether it's a hygienist, front desk, or an assistant, it doesn't matter who. When I hear "this person is incredibly productive, yet everyone around them is upset," I get suspicious.
Jeff: So step one, verify they're actually productive. Then, if they genuinely are, and people around them are upset, what next?
Sabri: Then you look at why the people around them are upset. And this especially applies if, say, you're the doctor, and the office manager gets along fine with this hygienist, or the schedule coordinator does too, but the receptionist, the financial coordinator, and one of the assistants really don't like them. Often it's because the hygienist keeps getting upset that the schedule's messed up, or not confirmed properly, and yells about it, or tells a patient they need something and nobody ever actually collects for it, so she blows her stack, feeling like she's sitting there doing nothing while everyone else drops the ball, and it comes across as "the hygienist is being mean to me."
Jeff: Got it.
Sabri: So if the hygienist is genuinely, verifiably productive, and the people around them are upset, check whether those upset people are themselves productive. Your non-productive staff will often try to take down your productive staff. That's part of why managing by real statistics matters so much.
Jeff: So now let's say we do have a genuinely productive individual who, for whatever reason, keeps upsetting the staff, has poor social skills.
Sabri: At that point it usually comes back to policy. Everyone has a certain hat they wear as a staff member, meaning we treat each other courteously, we don't curse at each other, there are agreed-upon standards for how the team conducts itself. Make sure that's actual written policy, something you can use to correct the offending staff member, then actually correct them and see if it changes.
Jeff: And if nothing changes, the rest of the staff is productive, and this one person keeps upsetting the other productive people so the practice can never grow?
Sabri: Then you have to make a decision. But I'll tell you, the number of times I've genuinely run into that exact scenario, I can think of maybe one time in my whole career.
Jeff: I can't even think of one off the top of my head.
Sabri: I'll give you a hint without using names, this was a doctor and office manager, newer clients at the time, and the office manager was hyper-competent, genuinely excellent. She went and subbed for a friend's practice for a week when their office manager was out for a month, and they had their best day ever, the very first day she was there.
Jeff: Well, maybe that says something about their own staff too, since they also couldn't keep people. But I've seen people who are rough around the edges, and even then, that's usually workable.
Sabri: Exactly right. If someone's genuinely rough around the edges, and especially if they're productive, you may not have much patience for people who aren't, that happens, productive people are sometimes rough around the edges. But there's no reason someone can't still be courteous. You need a good manager who can manage these personalities well, and if the person is genuinely productive, they can usually change.
Jeff: So it's, you can't yell at the receptionist, she's crying right now because of this, that's not okay, even if the intent is to stop it from happening again.
Sabri: Right, but a problem like that should go through the manager, who addresses it properly, you don't want staff going directly at each other, that creates a toxic work environment. Usually a good manager can manage these personalities. If you truly do have that rare situation, worst case, you may have to let them go.
Jeff: But that's after real investigation first. So to summarize: verify they're actually productive, check whether the people complaining are themselves productive, then policy and correction, and only if that doesn't work, consider a change.
Sabri: That's right, but that last option is genuinely rare, I don't see it often, I can barely remember another instance besides that one.
Jeff: Makes sense. Alright, our last question, and this one was very general: how do I get more new patients?
Sabri: Oh boy, we run a whole seminar on this.
Jeff: We're not going to spend eight hours on it here. Give me some immediate tips. Say I'm getting 20 new patients a month and want 30 or 35, what would you tell me to do?
Sabri: First, give the target to someone in the office who's actually held responsible for it. It can't be everybody's job. One person accountable, because then that person is genuinely creating that part of the organization, taking real ownership of it. Usually that alone makes the number go up.
Jeff: Do you get that answer a lot when you ask? I don't do as many client interviews as you used to, but I know you'll ask a doctor and office manager who's responsible for production, and the doctor says, that's me. Collections, the office manager says, that's me. Then you ask who's responsible for new patients, and they just look at each other.
Sabri: All the time. Eventually one of them says, I guess me? So nobody's really responsible, it's usually a genuinely neglected area of the practice. At best, people say, oh, we have a marketing company that handles that, but nobody's actually accountable for the outcome, even if money's being spent on it or people are trying. We've seen clients go through the MGE New Patient Workshop, average about a 42 percent increase.
Jeff: I had to get that plug in.
Sabri: You did good. But even after the workshop, the doctor and staff go through it, and one of the things we now cover directly is who's actually going to be accountable for this ongoing. Because without that, nobody is. And if the answer is "the doctor," how realistic is it that the doctor is actually going to take new patient phone calls, make sure conversion is handled properly, build out a call log, all the things we already covered with the first question? The doctor isn't going to do that, they don't have the time or bandwidth, and very often the manager doesn't either. It's usually better to give it to one specific person.
Jeff: So say I have an office manager, a receptionist who also schedules, and someone handling insurance and finances up front. If the office manager is handling external marketing, Google, Facebook ads, mailers, I'd go to my scheduler slash receptionist and say, you're responsible for internal referrals.
Sabri: Exactly right, and it's about having someone actually thinking with it. I'll give a slightly silly example. I stopped by a client's office recently, and their plumber happened to be there fixing a shutoff valve that kept failing. The office manager was chatting with him while he worked, and I noticed he was missing a front tooth. So I asked him directly, do you have a dentist? He said he'd seen one, but the guy kept talking to him about expensive options and it felt like way too much money, he just wanted to be able to eat. So I said, why don't you schedule an exam, they have a new patient special, and they can take a look at what makes sense, the client actually does implants. Last I heard, he completed half his treatment plan and paid for it, and was getting the rest covered too.
Jeff: I've heard you tell clients this for years, and there's this whole formal approach people expect, sit down with the patient as the doctor and ask for a referral, "our best patients come from family and friends, we hope you loved your treatment," this whole slightly awkward, scripted conversation. But what you've actually told clients for years, if I can summarize, is much simpler: if you have a new patient special running as part of your marketing, and a new patient calls in, or the mailman walks in, just offer them the special. If someone calls saying they just moved to the area and wants to schedule a cleaning, a well-trained receptionist asks, is there anyone else in your household who needs a dentist? Since usually more than one person in a household needs one.
Sabri: Exactly, and the caller might say, well, my husband's actually been looking for a dentist too, and you say, great, we have a new patient special, can we get him scheduled too? It's simple, and you can do it with people already sitting in the practice too, ask if anyone in their household isn't currently seeing a dentist, and get them on the schedule right there. But that has to be someone actively thinking about it constantly, because it belongs to them, it's the game they're playing to flood the practice with new patients, and they take real pride in it. That's genuinely the simple answer on new patients.
Jeff: I've used the same numbers you've given me before as examples, and seen the same pattern. This is something you could literally start today, it doesn't have to be big or complex. We've covered this on prior episodes too, how to get more referrals specifically.
Sabri: If you're an average practice seeing 20 or 30 people a day, and a lot of practices assume they're already a "family practice," but I remember you pointing something out with a client where you had them pull the number of unique households versus the number of active charts, which you can do through the mailing list feature in most practice software, one mailing per household shows you the real difference.
Jeff: The last one you told me about was 800 households and a thousand patients, when if they'd truly been a family practice averaging out, that 800 households should have translated to closer to 2,400 patients.
Sabri: Exactly, so they weren't really seeing whole families the way they assumed. That doesn't mean you're not seeing plenty of family members, just not as many as people tend to think. It's one of those nebulous assumptions, it feels like you're a family practice, but are you actually seeing the whole family?
Jeff: I'm not saying you need to see kids if you don't want to, but husbands, wives, moms.
Sabri: Right, and you'd be surprised how often someone says, no, nobody else in my household needs an appointment, but you know, my mom's actually in the area and does need one, great, let's get her scheduled. So if you've got a new patient special, offer it to your plumber, your mail carrier, the person delivering water jugs, anyone. I saw one office that turned this into a genuine game, scheduling family members, the mailman, anyone, including people who called with a wrong number. Someone would call thinking they'd reached a different number, and the receptionist would just ask, do you have a dentist? And schedule them anyway. I thought it was brilliant.
Jeff: How far can you take this?
Sabri: As far as you're willing to communicate, and as long as the person has teeth. You need someone extroverted and comfortable with communication to really run with it, but more people should be doing this, it's genuinely simple. I'd challenge anyone listening to start trying it today, just with the patients already in your practice. Pull up a chart, see who else is in the household, check their emergency contact, see if that person's actually a patient. Chances are they're not. You could just ask directly, does your husband John have a dentist? We've got a new patient special right now, just mentioning it. Most people simply never get asked.
Jeff: That wraps up all six questions. Sabri, thank you so much for being on.
Sabri: You're so welcome.
Jeff: And folks, I hope this helped. If you have questions about MGE, or about the New Patient Workshop I mentioned earlier, that link is on the episode webpage if you're listening, or below if you're watching this on video. If you have any questions about MGE, you can visit us online at mgeonline.com, or call us at (800) 640-1140. Folks, have a great week, and we'll see you at the next episode.