Ep. 71: Four Ways to Reduce Staff Turnover
Staff turnover is a fact of life and you can entirely avoid it, but if you don’t keep it to a minimum, it can become highly expensive and stressful. So this week, Jeff shares the four most important factors in reducing turnover and building a solid long-term team!
Topics:
2:16 – Why holding on too hard to employees can actually make turnover worse
11:10 – Causes of a stressful (or toxic) work environment
18:26 – Getting started on the right foot
26:38 – Giving your employees a real future
Links:
Sample Employee Checklists - https://www.mgeonline.com/sample-employee-checklists/
Learn more about MGE - https://www.mgeonline.com
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Questions From This Episode
How does keeping a genuinely bad fit employee too long actually create more turnover?
It puts real strain on the rest of the team, since someone else usually ends up quietly picking up the slack, and the longer that person stays, the more entrenched and harder to move on from they become. Letting go of someone after only a week or two of clear underperformance isn't really turnover at all, turnover is losing someone who was actually good at the job.
What's a reliable way to tell whether a new hire is a good fit within the first couple of weeks?
Give them pieces of the job in increasing complexity and see whether they're actually executing those tasks repeatedly and correctly, not just once. If someone still isn't handling the basics of what they were specifically hired to do after a couple of weeks of real training, that's usually a genuine signal, regardless of how nice or apologetic they are about it.
Why does tolerating a toxic employee or a rude patient actually drive good employees away?
It quietly tells the rest of the team that behavior is acceptable, even without saying so directly, since the team can see exactly what's being tolerated. That creates a stressful, unsafe feeling work environment, and a genuinely good employee who's picking up someone else's slack while being treated poorly will eventually take the next opportunity that comes along.
How much can good onboarding and training actually affect retention?
One study found that good onboarding can increase employee retention by up to 69 percent over three years. Onboarding isn't just paperwork, it's making sure a new hire genuinely understands the job's expectations, the company culture, and what success actually looks like, ideally starting during the interview itself rather than after they're already hired.
What's the fourth major factor behind staff turnover, and why does it matter so much?
Whether the practice actually offers people a real future. Employees are individuals with their own goals and ambitions, not interchangeable parts, and if someone genuinely ambitious is stuck in a role with no real path to grow, they'll eventually leave for somewhere that offers it, no matter how well they're treated otherwise.
Episode Transcript
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Whether we like it or not, staff turnover is a fact of life for every business owner and manager, and that includes dental professionals. No matter how ideal your setup is with regard to staff, people are still going to move, change careers, or have their lives change in some way. There's not much you can do to prevent that entirely, so at some point you're going to lose some employees. The real question is how you keep that turnover percentage as low as possible. The ideal level of turnover is generally considered to be 10 percent or less, yet you often see it considerably higher, especially in other industries, but in dentistry too.
So the question is how we keep that number as low as we can, and that's what I want to talk about in this week's episode. My name is Jeff Blumberg, and I'm your host. We know that turning over staff costs real money, there have been various estimates on this, and one of the better ones I've seen puts it at roughly 33 percent of an employee's annual salary, though that could vary considerably depending on the specific role and person. Either way, we know it costs money, that's not exactly breaking news. The reason I bring it up is that this should simply be treated as part of normal business operations, an expectation you plan for. We want to keep that expectation as low as possible, but it is something that's going to happen, and you have to be prepared for it.
In a lot of cases, when people don't want to look at something, confront something, or think about something, they simply don't prepare for it, and then they end up caught flat-footed with a much bigger problem on their hands. So you want to make sure your hiring and onboarding infrastructure is actually in place, so that when turnover does happen, you're ready for it.
Let's look at a few ways to improve on this. I could genuinely talk about this subject for hours, we do a lot of training on it with clients, but I've boiled it down to four basic areas that affect turnover, along with specific things you can do to improve each one.
The first area has to do with whether someone is simply a bad fit for the role. You might wonder how keeping a bad fit employee actually affects turnover, but I'll explain. If you keep somebody who's a bad fit for too long, that actually creates more turnover in your practice. So if you want to prevent turnover, the fix is straightforward: don't keep people who are a bad fit.
How do you know if someone's a bad fit? I'm not an employment attorney, so this isn't legal advice, and you'll want to seek your own counsel on specifics, but for me, a reliable measuring stick has always been this: if I hire someone to do a specific job, say their responsibilities are A, B, and C, I'll know whether they're a good or bad fit by whether they're actually doing A, B, and C. Think about what you're actually hiring someone to do, you're hiring them to handle something so you don't have to, and in exchange, they become part of your team and get paid. If someone isn't doing the things you hired them to do, they might be a genuinely nice person, someone you'd happily grab lunch with, but they're simply not a good fit for the business, because you hired them to do A, B, and C, and they're not doing it.
How long should you wait to find out? Not very long. If I've shown someone how to do A, B, and C and they're not showing real signs of being able to handle it after a couple of weeks, they're probably not a good fit. Say you've hired a new receptionist, and in your office that role means answering the phone and scheduling patients. You've trained them on the basics, feeding them pieces of the job, starting with the simpler parts and building toward more complex responsibilities over time. If after a couple of weeks they're executing most of what you've asked, repeatedly and correctly, with the occasional understandable mistake, they're probably going to work out.
On the other hand, if after a week or two they're still not handling the basic things you've asked of them, even if they're genuinely apologetic and pleasant about it, they're probably still not a good fit. This assumes, of course, that you've actually done some real training, not simply handed them a phone and the practice name and walked away.
You might wonder how keeping this person on actually creates more turnover rather than firing them creating it. Here's why: a couple of things go wrong when you keep someone who genuinely isn't a good fit. First, it negatively affects the business directly, the job isn't getting done properly, and you'll likely see dips or sags in productivity. Second, if you have other staff, say three people at the front desk and this new receptionist isn't handling their share, who's picking up that slack? Almost certainly the other people up front, which creates real stress on those positions and can lower their performance too.
The other thing that tends to happen is that the longer you keep someone on, the more entrenched they become in the business and the harder it gets to actually move on from them. Here's an important distinction: say you had an excellent employee who had to leave abruptly, a family emergency requiring an out of state move for a couple of years. You hire a replacement, and within a week or two it's clear they're not going to work out, so you move on and hire someone else. That's not turnover. I don't consider letting someone go after a week or two of clear underperformance to be turnover at all, the actual turnover happened when your original excellent employee left. Turnover is losing someone who was genuinely good at the job and had been there a while, not parting ways quickly with someone who was never actually the right fit to begin with, so there's no need to agonize over that kind of quick separation.
So keeping a bad fit around puts stress on the rest of your team, and it puts stress on you too. Here's the simplest way to actually handle this, and I've seen what not to do plenty of times. Say you hire someone for tasks A, B, and C, and they're not doing them. I've seen owners respond by discovering the person doesn't like doing A or C but is fine with B, so instead of finding someone who can genuinely handle all three, they reassign A and C to other people and let this person just do B. Why would you do that? I've seen this happen with a schedule coordinator who didn't enjoy calling patients, so the owner had them file insurance instead, essentially paying schedule coordinator wages for insurance filing work. Why not simply find someone who can actually do the job you're paying for? If there's a genuinely different role in the practice that matches what they're actually good at and worth that same pay, fine, reassign them there. But if you hired someone for a specific job and they're not doing it, find someone who can.
So what would I actually do if a new hire isn't cutting it? It's simple: I'd tell them directly. If we've worked on something and they're still getting it wrong after a couple of weeks, I'm not going to vilify them or make them feel like a terrible person, since in most cases they genuinely want to do a good job, they're just not managing it yet. I'd tell them plainly that I need to see specific changes, or I'll likely need to replace them. Some people might think that sounds harsh, but I'd actually call it kind, because in a lot of cases, if you never tell someone, they may genuinely believe they're doing fine, they just see you looking frustrated and have no idea why. If you don't tell them, how are they supposed to know? They don't have ESP.
In plenty of cases, if you point out specifically what's going wrong, people will fix it, or at least genuinely try, and you may end up with a great employee as a result. I've seen that happen many times over my career. Other times, they'll admit they actually dislike the job, in which case you can part ways on good terms right then, why keep them around at that point? They're already looking elsewhere, so you might as well start looking for a replacement too.
So talk to the person, honestly and factually, without being unkind about it. What I wouldn't do is quietly let someone skip the parts of the job they don't enjoy without ever addressing it, and I definitely wouldn't do what I've seen happen elsewhere: an underperforming employee gets replaced, and the outgoing employee is asked to train their own replacement without ever being told they're being let go. Why would you want someone who's doing a poor job passing all their bad habits on to the next person? Instead, I'd simply have them keep doing the job I hired them for, or find a genuinely better fitting role in the practice if one exists. But for the most part, if someone's a bad fit, I move on, and counterintuitively, that actually reduces turnover in the long run.
The second thing that tends to drive turnover, and that you can nip in the bud, is tolerating a toxic or problem employee, or letting a problem patient run roughshod over your team. If I have a negative employee who's rude to the rest of the staff and genuinely underperforming, people sometimes assume time alone will fix it, that if they just leave the person there long enough, some big realization will eventually kick in and things will improve. That very rarely happens. It's a bit like a dentist finding a pit in my tooth and me saying, don't worry doc, if we just leave it alone it'll heal on its own. Obviously that's ridiculous. If you let a problem employee who's rude to coworkers and underperforming stay in the practice unaddressed, it affects the entire office culture and mood, and it isn't good for the rest of the team.
The same applies to a problem patient. Say a patient is rude to your staff, mean to the hygienist, and nothing is ever done about it. That kind of unaddressed behavior, whether from a coworker or a patient, creates a genuinely stressful working environment. If I have a coworker who's negative and unproductive and I'm quietly doing half their job on top of my own, I don't want to go to work. So if another opportunity comes along where I don't have to deal with that stress, that starts sounding pretty appealing.
The same goes for patients treating staff poorly with no response from management. That's not a physically unsafe environment necessarily, but it isn't a mentally safe one either. And the reason it's stressful is precisely because nobody's doing anything about it. Say I'm your receptionist and your financial coordinator is a genuine problem, late constantly, mean, underperforming. I can't do anything about that, I'm not the boss, and I don't want to run to the office manager every single time they're negative toward me, since that starts to feel like tattling. It's just stressful. Sunday night rolls around and I'm already dreading going in Monday morning.
This is really a failure at the executive level, the office manager and doctor positions, since nobody is maintaining any real order in the business, and that silence sends the wrong message to the whole team. If I'm the receptionist trying to show up on time and do everything asked of me, while this financial coordinator does none of that and I'm quietly covering for them, what message does that send? You're demonstrating, without ever having to say it, that this behavior is acceptable here. The same applies if you let a toxic patient treat staff like garbage, it tells your team they're simply not that important. I don't fully agree that the customer is always right, and while patients certainly matter, they're not so important that we let them trash the team. We're a team too, working toward the same mission, and yes, you'll hit speed bumps occasionally, but you shouldn't have to subject yourself or your staff to that kind of treatment. And honestly, the number of patients who are genuinely like that is usually small enough to count on one hand.
So if you're allowing that kind of behavior to run unchecked, from an employee or a patient, that's going to generate real turnover, since it creates ongoing drama, almost always traceable back to just one or two people, occasionally a handful of patients.
The fix here is the same as with a bad fit hire: the behavior needs to change, and I'll tell someone directly, without embroidering it, exactly what's going on and what they're doing wrong, because I want to give them a real chance to correct it. Early in my career, I witnessed someone get fired who was genuinely shocked it was happening, purely because nobody had ever told them they were doing a poor job until the decision had already been made. I decided right then that I would never let someone be blindsided like that. I've hired and fired plenty of people over my career, and I've always made sure they saw it coming.
So I'll tell someone directly that we're having issues with specific things and that they need to be corrected. If they do correct it, that's often the end of the problem entirely, and sometimes there's a real, fixable reason behind it, they didn't know how to do something, or didn't understand an expectation. But if a pattern of genuinely unacceptable behavior continues, I'll tell them clearly that it needs to change or I'll likely need to let them go. That way, if it eventually does happen, it's never a shock, they've already had real chances to turn things around, and it's a far easier, more amicable separation as a result.
The same principle applies to a toxic patient. I cover this in our seminars too: if a patient is rude to my receptionist, I'll address it directly, and if their response is essentially I'm the customer and I'm always right, they should simply find care elsewhere. I don't need to subject myself or my team to that. We have a mission we're trying to accomplish here.
So that's the second major factor: a bad fit employee left in place too long, or a toxic employee or patient allowed to run unchecked.
The third factor has to do with training, onboarding, and management. I read an article recently, I'll put a copy on the episode webpage, pointing out that good onboarding can increase employee retention by up to 69 percent over a three year period. Onboarding is a big deal. It isn't just signing tax paperwork, it's genuinely learning how the business operates, what the company culture is, and what's actually expected in the role. I'd start that process as early as the hiring conversation itself, since I've seen plenty of cases where someone gets hired without a clear understanding of what's actually expected of them. I'm not going to spend an hour and a half explaining a job during an interview, but I'll cover the major points, hours, pay, incentives, the core objective of the role. I want candidates to fully understand what they're getting into, because if it isn't something they actually want, I don't have to hire them, and they don't have to take the job. That alone avoids a lot of headaches. If someone can only work Tuesday through Saturday and the job is Monday through Friday, that's simply a mismatch, and it should be identified before hiring, not worked around afterward.
Once someone's actually hired, the topic of training materials and manuals often gets an interesting reaction, especially from newer clients. There's usually broad agreement that having them is important, but the idea of actually building them out feels overwhelming enough that it never quite happens. Here's the thing about training materials though: something is genuinely better than nothing. A basic job description beats no job description at all. A simple policy on how you want money collected beats no policy at all. You have to start somewhere, keep it simple, and build from there over time.
You're also living in an era where audio and video tools are cheaper and easier to use than ever, and easier to actually get in front of your staff. If you want your team to understand your practice's mission statement, record a short video. Phone camera quality today is genuinely excellent, grab an inexpensive tripod, and that alone beats having nothing at all.
So you want reasonable onboarding to orient someone into the practice, and simple training materials to bring them up to speed on what's actually expected of them. And that expectation isn't just how do I schedule a patient or how do I use the software, it's the bigger picture: here's what success in this role actually looks like. You might tell someone, we're currently collecting and producing $80,000 a month, and I don't have a dedicated scheduler yet, so once you're in that role, I expect that number to climb to $120,000 because the schedule is running more efficiently. From there you can teach them how to actually achieve that. But stating the expectation itself matters enormously, because if you don't give people clear guidance, they'll simply assume what you want, and since most staff genuinely want to do a good job, they'll act on their own best guess, which may not actually be what you had in mind.
So expectations need to be genuinely clear from the moment you hire someone, and they should be reinforced consistently as part of your ongoing management approach. When you're actually training someone into a role, pay close attention throughout. If I'm the office manager handing off scheduling responsibilities to a new coordinator, I'm still ultimately responsible for that function, so I hand off pieces of it gradually, correcting mistakes as they come up and showing them how to do it right the next time. If the mistakes stay minor and improve over time, great. If they become large, repeated, and genuinely unfixable, that may simply mean this person isn't the right fit after all.
I've also read plenty of advice along the lines of you just have to trust your team. I do trust some people on my team enormously, genuinely with a great deal, and I'd hope they feel the same about me. But that trust was never automatically granted the moment I met them, some people are simply more trustworthy than others, and trust generally has to be earned. I might trust someone to drive my car who I wouldn't trust to go collect $50,000 from a patient. There are levels to it. Trust gets built by watching someone consistently do what they're actually supposed to do.
Say you have a treatment coordinator. You'd first show them the basics of the role, then have them sit in with you, gradually handing over more responsibility over time, having them work through financing applications while you're still nearby to confirm things get done correctly, sitting in on larger cases, then eventually just popping in near the end. Eventually they'll tell you they've got it handled, and you can genuinely step back, shifting into more of an oversight role, checking in on goals and performance rather than managing every detail.
That's not really a trust issue in either direction. The opposite extreme, someone who's constantly paranoid and micromanaging everything, is just as unproductive. But hiring a brand new receptionist with zero dental experience and immediately handing them all your new patient calls, worth real marketing dollars each, without any oversight simply because you've decided to trust them, isn't smart either. Trust is earned the same way an employee earns your trust, by consistently doing what they say they'll do and by you setting a good example yourself. I do think the word trust gets used a bit loosely here, knowing someone will reliably do something is earned over time, but giving someone a genuine chance and reasonable benefit of the doubt when they're new is simply good management. At the same time, once someone's clearly proven they know how to do something well, say two dental assistants who've been with you for eight years, there's no need to keep double-checking every single room setup, that's simply excessive.
So: solid onboarding, simple but real training materials, and correcting people when they make mistakes are all genuinely important pieces of reducing turnover.
Which brings us to the fourth and final factor, and this is where I see people go wrong most often: giving people a genuine future. It's tempting to think of your practice purely as a machine, with parts, scheduling, financial, production, hygiene, and if a part breaks, you simply swap it out, the way you'd replace a car alternator, a computer mouse, or even a hard drive. But people aren't parts. People are individuals, with goals, dreams, ideas, and their own sense of where they'd like their career to go. Some are more ambitious than others, and if you want people to stay with you long term, what they're trying to build for themselves has to align, at least to some degree, with what you're trying to build.
Say you run a modest, comfortable practice, you work 25 hours a week, you're not especially interested in growing it further, and you're paying $15 an hour for someone to answer the phones, but that person happens to be genuinely ambitious and wants to build a real career. They're not going to stay long, your practice is simply a stepping stone toward wherever they're actually headed. I like to understand what my team's career goals actually are, because it tells me whether they genuinely fit with what I'm trying to build. If I ask a candidate applying as a dental assistant what their career goals look like, and they tell me they only plan to assist for another six months before moving into a completely different profession, that tells me two things right away: they're not staying past six months, and that may simply not align with what I need. I'm not expecting someone brand new to promise they'll work for me for the rest of their career, they don't know that yet, and neither do I, but I do need to be able to offer real upward mobility, which means I need some kind of long-term growth strategy of my own.
People carry very different levels of ambition, and that's fine. I might have someone who's genuinely happy and fulfilled as a financial coordinator, earning steady incremental raises, participating in an incentive plan, working a comfortable 38 hours a week, confident and content in that role, and I love having them there. I might have someone else who started as a dental assistant, moved into a junior management role because they wanted more responsibility and income, and eventually became a regional manager helping run a second or third location as the practice expanded. You have to leave real room for that kind of growth. I don't love the term dead end job, but if someone genuinely ambitious is stuck at $15 an hour with no path forward, that's simply not a long-term fit for them.
I like knowing what my team members are actually trying to build for themselves, because it lets me find the right long-term players for whatever I'm building too. This is actually one of the better ways to expand into multiple practices, which I've discussed in other episodes. It happens naturally with hungry associates: they come work for you, eventually want their own practice, and leave to open one. Why not instead set things up so you help them open that second location as a genuine partner, and then a third together, bringing in other associates along the way? You end up building a real team of future partners rather than losing good people to that same ambition elsewhere.
So I like to understand what the people I work with are actually aiming for, and whether that aligns with what I'm trying to build, what role they want to play, how big a role, and whether I can genuinely accommodate that. If I can, they're likely to stick around for a long time. That's the fourth thing you can do to reduce turnover, and I know I covered a lot of ground here, this could easily have run twice as long.
I hope this helps, and that these are things you can start applying in your practice right away. Again, I'm not an employment attorney, so if specific questions come up, it's genuinely worth having one you can call. I also have a set of employee checklists available as a download, they help you onboard new employees more quickly, and they come from our online platform, DDS Success, which I've mentioned before. I'll put the link on the episode webpage. There are checklists for scheduling, collections, and other roles, all customizable, genuinely useful if you're bringing on newer staff.
I hope this helps. If you have any questions, you can find us online at mgeonline.com, or call us at (800) 640-1140. You can also email me directly at jeffb@mgeonline.com. Folks, have a great week, and we'll see you at the next episode.