Ep. 65: Listener Q&A about Finding & Hiring Employees
Over the last few months, we’ve received a lot of questions about hiring and staffing issues, so we figured it was time for another listener Q&A episode! This week, Jeff answers your questions about finding and hiring qualified employees.
Topics:
1:00 – Finding qualified (and skilled) employees
9:45 – Finding hygienists & associates
17:49 – Taking rising salaries into consideration
26:34 – Conducting interviews
Links:
Sample Hiring Ads – https://www.mgeonline.com/sample-hiring-ads-2
PPO Exit Strategy – https://www.mgeonline.com/ppo-exit-strategy
Group Interviews – https://www.mgeonline.com/group-interviews-download
Listen to full episode :
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Questions From This Episode
Why does Jeff recommend removing filters, like "must have a license," from job postings on sites like Indeed?
MGE's Power Client Managers found that Indeed's filters, for reasons that aren't entirely clear, end up screening out qualified applicants along with unqualified ones. Jeff says clients who removed the "must have a license" filter for hygienist and associate postings actually received more responses from properly licensed candidates, not more unqualified ones, so filtering is better done once candidates actually respond, not before.
How does Jeff say a practice should figure out what to actually pay for a position, rather than relying on a site like salary.com?
He found a real gap between benchmarking sites and reality, one Southern California example showed salary.com's high end for hygienists around $48 an hour, while actual local job ads ran $60 to $65. His recommendation is to check what similar positions are actually advertising for in your specific area, and generally aim for the top third, or at least above the 50th percentile, to attract genuinely motivated candidates.
What options does Jeff suggest for practices in areas with very limited hygienist or associate availability?
Beyond removing filters and pricing competitively, he recommends expanding the geographic radius of your advertising, covering relocation costs for a strong out-of-area candidate, or advertising through professional associations like the ADHA, ADA, or AGD, which maintain email lists reachable for a few thousand dollars, often far cheaper than a headhunter.
Why does Jeff say heavy PPO participation makes rising salary costs even harder to absorb?
He walks through the math: if a practice's average PPO write-off is 30 percent, then having a third of the practice on PPO plans creates roughly a 10 percent effective fee reduction across the whole business, two-thirds creates a 20 percent reduction, and being fully in-network creates the full 30 percent. Layered on top of rising wages, he says that combination is what eventually prices a practice out of being able to afford the staff it needs.
What two changes does Jeff recommend for practices seeing a lot of interview no-shows?
First, contact every promising lead almost instantly, since a genuinely in-demand candidate won't wait around and may already have other interviews lined up by the time a slower office calls back. Second, for high-response roles like receptionist, consider a group interview format, explaining pay, duties, and hours upfront to quickly filter out mismatches before investing time in individual interviews with the strongest candidates.
Episode Transcript
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This week's episode is a listener Q&A about hiring. I get a lot of questions on staff-related issues, everything from hiring to onboarding to training, to how do I know if this person's going to work out long term, how do I manage my staff, and so on. To keep the episodes manageable, I figured we'd start at the beginning of the process, hiring, and pick up with the other subjects in future episodes. My name is Jeff Blumberg, and I'm your host. I'm taking the questions I get most frequently, worded differently each time, but generally asking the same underlying thing, and we'll just work through them.
Question number one, and this is the one I get asked the most: I'm having trouble finding qualified employees. When I advertise for front desk positions, I either get people with no experience and few job skills, or I get little to no response at all.
Let's start with the "not enough prospects" half of that. Say I place an ad on Indeed and get almost no responses. What could be wrong? It could be the venue, maybe you're advertising somewhere that just doesn't reach people, a local newspaper or a niche site. But assuming you're using a platform that should generate responses, Indeed is what most people use these days, though it used to be Monster.com or CareerBuilder, and Craigslist still works in some areas, there are a couple of likely culprits.
First, the ad itself might be the problem, too complex, too wordy, not attention-grabbing. Think about what you're actually doing when you place a hiring ad: you're marketing. It's the same as advertising for new patients, if I run new patient marketing and expect phone calls, I know it's working when the phone rings. If I'm advertising in a place that should generate responses and I'm getting nothing, there's probably something wrong with the ad itself. So look at it honestly: is it descriptive of the job, sure, but is it actually attractive? Would you, as a job seeker, respond to it, or does it read like assembly instructions? We have sample ad templates for different positions that you can download from the episode webpage if that helps.
The next thing to check, especially on a platform like Indeed, is filtering. Our Power Client Managers have consistently found that Indeed's filtering system isn't necessarily working in your favor. Say you're advertising for an expanded-functions assistant, a hygienist, or an associate, and you've got filters turned on, like "must have a license." For whatever reason, maybe something in how applicants submit their resumes doesn't align with those filters, turning that filter on ends up screening out a lot of genuinely qualified prospects. We've had clients unclick the "must have a license" filter for hygienist and associate postings and actually get more responses from licensed hygienists and associates, not more unlicensed people, more of the people you actually want. So our recommendation with Indeed is: don't use filters at all when placing the ad. Do your filtering once candidates actually reach out or come in, not before you've even seen who's interested. Another thing worth trying on Indeed is running some free, unsponsored ads alongside sponsored ones, you might get more responses than you'd expect.
So that covers ad quality and removing filters. Sure, without filters you'll get some noise, we've all had the call where someone says "I'm calling about the hygienist position," and you ask if they're licensed, and they say "no, but I'd love to be one." That's going to happen. But if going filter-free takes you from four hygienist responses to twenty, even if five of those twenty aren't actually licensed, I'd rather have the twenty.
Last point on placing ads: if you're going to list pay in the ad, do your homework first, because getting it wrong can quietly filter out a lot of your best prospects. There's a real disconnect right now between what salary benchmarking sites report and what the actual market is paying. I looked into this a few episodes back specifically for hygienists in Southern California, Chicago, New York, and Miami, comparing real job ads to what salary.com listed as the low, median, and high range for each area. I've been a fan of salary.com for a long time, you pick a position, it tells you the range for that zip code, but in one Southern California example, salary.com listed the high end around $48 an hour, while actual job ads in that same area were running $60 to $65, and a client practicing in that exact zip code told me hygienists were actually asking for $65 to $70. So there's a genuine gap right now, salaries haven't fully settled after all the disruption of the last few years, it's still shaking out like a wave moving through a cracked whip.
Given that, the way to figure out what to actually pay is to look at what your local market is advertising for that specific position, not what a benchmarking site says. If you see a handful of receptionist ads offering $14 to $18 or $16 to $20 an hour, that tells you roughly where you need to be. Generally, you want to aim for the top third, at least above the 50th percentile, if you want to attract genuinely motivated candidates. Should you offer more than what others are advertising? Not necessarily, if the going rate for a treatment coordinator in your area is clustering around $20 an hour, advertising at $20 puts you on equal footing with everyone else. But if you're advertising $16 to $18 while three other offices are offering $20, you're likely going to be the last ad anyone responds to. So do the homework: check Indeed and similar sites for comparable positions in your area and price accordingly.
Question number two: I can't seem to find a hygienist or an associate. Hygienist and associate availability is genuinely regional, some areas it's easy, some it's much harder. First, apply what we just covered, remove filters, that alone will get you more resumes. Second, look at what your specific market is paying. Going back to that same salary research, Southern California, Chicago, and New York all showed limited hygienist availability, with average salaries over $50 an hour in New York and similarly high in Chicago, and corporate offices in those markets offering $4,000 to $5,000 signing bonuses. Miami, by contrast, showed average salaries in the thirties, with no signing bonuses mentioned at all, private or corporate. That tells you Miami simply has more available hygienists relative to demand. This regional pattern also shows up between urban and rural areas within the same state, a busy metro versus somewhere more rural nearby, say upstate New York versus New York City, or areas near Lake Okeechobee versus Miami here in Florida.
So here's the progression I'd actually follow if I were in Tampa Bay, where hygienists are genuinely at a premium. Start with normal advertising, filters off. If that's still not generating enough responses, expand your geographic reach, advertise in Central or South Florida too, with the understanding that if you find someone great, you may need to cover relocation costs. That sounds expensive, but it often isn't, flying someone in for a few weeks and putting them up at a Residence Inn to see if the fit works is a lot cheaper than you'd think, especially since they're already licensed to practice anywhere in the state. If it works out, you can pay for relocation and have your attorney draft an agreement, say, a two-year commitment with a reimbursement clause if they leave early. The same expand-your-radius approach works for associates too, we saw clients successfully recruit associate doctors from busier parts of their state during and after the pandemic, including doctors leaving big cities who wanted more space.
If conventional job boards like Indeed or DentalPost aren't cutting it, you can go further. Professional associations, like the ADHA for hygienists, or the ADA and AGD for dentists, along with various dental trade publications, maintain email lists. You can't buy these lists outright, but you can advertise through them, and it's often more affordable than expected, sometimes just $3,000 to $5,000 to reach essentially every relevant provider in the country, and some services let you localize it to a specific state. State dental associations, like the Florida Dental Association, which operates under the ADA, often have their own publications and websites where you can run banner ads too. There's really no shortage of channels, and it tends to cost far less than hiring a headhunter, which can run you thousands of dollars per placement, with the added benefit of keeping more control over the process yourself. I had one client, a husband-and-wife team where the wife was the dentist and the husband ran the practice as office manager, who couldn't find an associate through normal channels, so he literally got on the phone and started cold-calling other dental offices in the area alphabetically, back when people still used phone books. He got through to the "C"s before finding a lead, because dentists know other dentists, even if the office he called wasn't hiring, they often knew someone who was looking to relocate. The point is, if you put enough feelers out, you'll get a response eventually.
If you've expanded your reach and you're still not finding candidates, you can look outside your state entirely. Licensing reciprocity varies a lot, some states make it very difficult, Florida, for instance, generally requires retaking boards, while others have much simpler reciprocity, sometimes just an application or a jurisprudence exam for an already-licensed, practicing dentist. So advertising in neighboring states, or going as broad as a national email campaign, is entirely viable if local options are exhausted. There's always going to be somebody reachable if you're willing to widen the net. This is obviously a US-centric explanation, but the underlying approach should adapt to wherever you're practicing.
Question number three: salaries in my area are getting too high across the board, any suggestions? This ties back to the same salary disconnect. There's been substantial inflation over the past year and a half, I first covered this back in a video and episode last August, and it's hitting your practice from every direction, marketing costs, lab costs, supply costs, and staff wages. I've also covered salary as a percentage of revenue before, generally you don't want total staff salaries, excluding the doctor and associates, to exceed about 22.5 percent of practice revenue. But the real question is how your internal numbers relate to what's happening externally.
Say you used to pay a receptionist $14 an hour back in 2019, and now good receptionists in your area are asking $17 to $18, which isn't unusual at all given what's happened since 2020. You could get upset about that, but there's a reason it's happening, either that's genuinely what the market is willing to pay, which you can confirm by looking at current ads, or it isn't, and you're seeing outlier asks. If people are genuinely asking 20 percent more than they were three years ago, your fees need to move commensurately, otherwise you'll eventually get priced out of being able to hire anyone at all, robots aside.
So get smart about the revenue side specifically. Have you actually raised your fees over the past three years, in step with inflation? You should have seen at least a 10 percent fee increase since 2020, if you were charging $1,200 for a crown in 2019, you should be at roughly $1,320 or higher today. Fee-setting is often fairly arbitrary to begin with, most doctors set initial fees based on whatever the previous owner charged, or what a colleague charges, sometimes a formal fee survey, there's no universal standard, which means fees that were reasonable at the time often don't get revisited as consistently as they should. We see this constantly with new clients, their most common procedures often sit at the 40th percentile or lower on fee surveys like the Wasserman Guide, which I'll link on the episode webpage, we have no commercial relationship with them, it's a bit old-school but still the most comprehensive source I've found for localized fee data by zip code. These percentile figures mean exactly what they sound like, if you're in the 50th percentile for an adult prophy, half the practices in your area charge the same or less, and half charge more. If you want to sit in the 60th to 70th percentile instead, you need to raise your fee accordingly. I'd recommend running a thorough fee survey now, focused on your most commonly performed procedures, since that's where the revenue impact is greatest. If a given fee is significantly under where it should be, you can phase in the increase incrementally rather than shocking everyone at once, but during a period of active inflation like this, you want to be reviewing fees more frequently than usual, quarterly or even every other month, until things stabilize. And keep in mind, most published fee guides lag behind real-time inflation, if a guide was compiled at the end of 2021, it hasn't caught up with 2022 pricing, so you may need to adjust beyond what it shows.
The other major factor behind rising salary pressure is heavy insurance participation, which I've covered at length elsewhere and won't turn into a full tangent here, but briefly: my core objection to having an insurance company effectively set your fees isn't just that the fee is too low, it's that an outside company with no stake in your practice's success, and no on-the-ground understanding of what your business actually needs, is controlling what you're allowed to charge. That's not a sustainable way to run a business. Ideally, the market, not an external contract, should set your pricing. There's an upper bound too, obviously, if the going rate for a crown in your area is $1,400 and you decide to charge $4,000, you're likely pricing yourself out regardless of demand. But on the other end, when your true market fee for a crown is $1,400 and your PPO contract caps your reimbursement at $850, that gap ripples through the entire practice. If your average PPO write-off is 30 percent, and that's often optimistic, plenty run worse, then once a third of your practice is PPO patients, you've effectively created a 10 percent across-the-board fee reduction for your business. Two-thirds PPO gets you a 20 percent reduction. Fully in-network gets you the full 30 percent. Compare that against rising salaries and expenses: yes, wages are climbing, but if you're not charging what you should be, on top of that pressure, the math simply doesn't work, and you'll eventually price yourself out of being able to afford the staff you need to handle your own patient volume, which just means the practice contracts.
So my suggestion is straightforward: check your fees against a proper survey, and if you're heavily in PPOs, start working on getting out, it takes time, especially with a lot of managed care in your mix, so start now. We offer a PPO exit strategy session if you'd like help working through that, I'll put a link on the episode webpage. With a new year coming up, this is a genuinely good resolution to commit to, because left unaddressed, salary pressure as a percentage of revenue is only going to keep climbing.
Last question before I run out of time: more than half the people who respond to my ads blow off their scheduled interview, some don't show at all, others say they took another job. What am I doing wrong? This has always happened occasionally, but it's become noticeably more common since 2020. I can't pinpoint one universal cause, and it seems to touch nearly every position, I rarely hear about it with associate doctors, sometimes with hygienists, but much more with dental assistants and administrative staff. I have two pieces of advice here.
First: speed, and I don't mean how fast the interview itself moves, I mean how quickly you get the candidate into one in the first place. This is a basic, very common mistake, especially among newer clients: someone responds to your ad on a Monday, but you're busy, already short-staffed, and figure you'll get to it in a couple of days. By Wednesday or Thursday, some of those candidates already have other offers, some you can't reach anymore, and you end up with no-shows. A genuinely motivated, in-demand candidate isn't going to sit around waiting for your callback, they don't know you yet. So respond as close to instantly as possible, if I get a response Monday at 11:00, I'm calling or emailing back by 11:05, and getting them in fast, that same day or the next. This is essentially marketing, and slow response times are one of the biggest personnel mistakes we see, the candidates who are genuinely motivated are moving fast, and if you're not matching that pace, you lose them to someone who already scheduled four other interviews before you even called back.
Second: consider a group interview, a tool that was heavily used before 2019 and still has real value, even though large gatherings obviously weren't possible for a stretch in 2020 and 2021. A group interview isn't appropriate for provider positions, dental assistants, hygienists, associates should always be interviewed individually, but for something like a receptionist role where you've received a large number of responses, say a hundred applicants, you can bring a group in together. There's a full process for running one, and we have a handout on it available on the episode webpage. In short, it filters candidates quickly: everyone signs in, and you open by clearly explaining the job, pay, duties, and hours, right up front, which I'd recommend in any interview format, since it immediately filters out anyone who can't work the hours or doesn't want the actual job. I'd apply the same principle one-on-one too, if you sit down with a hygienist and explain that you expect them to help with case presentations, and they tell you they're comfortable with hygiene and patient education but genuinely dislike talking about treatment and don't want any part of sales, that's worth finding out immediately, because if that's a real dealbreaker for them, hiring them just sets up disappointment on both sides from day one.
In a group interview specifically, after explaining the role, the doctor typically comes in to speak briefly, and then whoever's running it, often the office manager, administers a short quiz to see who was actually paying attention. It's all laid out in our group interview handout, and even during the height of the pandemic, when in-person gatherings weren't possible, some clients ran this same format over Zoom successfully. I'd genuinely recommend it whenever you're dealing with a large volume of responses for a single position. Once you've narrowed the group down, you move into individual interviews with your top candidates from there, also covered in the handout. Just remember, it's really only useful when you already have a large pool of responses, and it's not a fit for provider-level hiring.
I think I've actually beaten my usual half hour this time, so I'll wrap up here. We'll cover onboarding, training, and management in future listener Q&A episodes, along with marketing and other practice management topics. That's all I have for you this week. Don't forget the downloads on the episode webpage: the sample employee ads, the PPO exit strategy session link, and the group interview handout, all available if you'd like to check them out. If you want more information about MGE, you can find 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.