Ep. 85: Building a Great Team Despite Recent Hiring Struggles
In this episode, Jeff discusses the current state of the hiring market, what it means for your practice, and four ways you should to adjust so you can fill your positions of need with highly productive new staff.
Topics:
:11 – Recent changes in the labor market and how they affect your practice
12:04 – 4 ways to be more successful at finding and onboarding great staff right now
Links:
Sample Hiring Ads - https://www.mgeonline.com/sample-hiring-ads-2
Statistics to Track - https://mgeonline.com/dental-office-statistics
Free Practice Analysis - https://www.mgeonline.com/free-practice-analysis
Listen to full episode :
Have a question for Jeff?
Fill out the form and he will get back to you.
Questions From This Episode
How has the labor market actually shifted according to recent data, even though unemployment itself has stayed low?
Unemployment has held steady near pre-pandemic levels around 3 percent, but job openings peaked at roughly 12 million in January 2022 and have since dropped below 10 million, and the ratio of unemployed people per job opening has climbed back up from about 0.5 in late 2021 toward 0.68 today. The market is still tight, but it's genuinely starting to loosen, even if it hasn't fully turned yet.
According to a recent NFIB small business survey, what displaced inflation as the number one problem facing small business owners?
Labor quality, cited by 23 percent of small business owners as their top operating problem, overtaking inflation, which had been the top answer just the month before. This matches what a lot of newer and prospective clients describe, the issue usually isn't just being unable to find or hire people, it's that the people they do hire often can't actually perform the job.
What's the actual definition of labor quality, and how does it apply to a dental practice?
A formula from a 1964 National Bureau of Economic Research paper defines labor quality as labor input divided by man hours, essentially how much genuinely correct, valuable work someone produces in a given amount of time. In a dental practice, that might mean a reactivation caller who books 10 appointments off 20 calls an hour versus one who books none, or a treatment coordinator who closes 80 percent of cases versus one who closes 30 percent.
Why is searching for the perfect hire actually the wrong approach, and what should a practice look for instead?
Genuinely ready-made, fully proven hires are rare, and holding out for one means most positions stay open far too long while nobody ever quite measures up to an undefined ideal. Interview performance also doesn't reliably predict job performance, someone can interview beautifully and still fail on the job, so the real approach is bringing in a good fit candidate, training them, and judging them by how they actually perform once they're doing the work.
What's the biggest mistake owners make when a new hire's numbers start slipping, and why does it matter so much?
Accepting the employee's own explanation for the underperformance, no one wants to schedule right now, nobody wants to pay, instead of looking at whether the underlying problem is actually that specific person. Jeff describes a doctor who overhauled an entire scheduling policy because one scheduler claimed nobody would come in for morning appointments, when in reality it was that scheduler, not patients in general, who couldn't make it work.
Episode Transcript
-
Once a year here at MGE, we hold what we call the Owners Conference, a four day event for MGE Power clients, past and present, including new graduates, covering advanced management and clinical training. Usually at this conference, I dedicate part of my presentation to the state of the dental profession, a snapshot of industry growth, economic and employment conditions, where the industry stands now and where it's heading. That presentation requires a considerable amount of research, pouring over graphs, statistics, studies, white papers, genuinely the fun stuff.
As I was recently wrapping up my presentation, focusing specifically on employment and the labor market, I noticed a few new trends starting to take shape around staffing. Staffing has always been a challenge in dentistry, as long as I can remember, but over the last three years these problems have grown considerably, between a lack of qualified candidates and rising salaries. It's hard to find a new client who doesn't have some complaint about staffing, or who feels fully and satisfactorily staffed. That makes sense given how tight the employment market has been.
So the real question, especially in a service business, is what should you actually do about all this so your office is properly staffed and your team's production quality is at a level that genuinely works for your business. That's what I want to talk about in this week's episode. My name is Jeff Blumberg, and I'm your host.
Let's start with a quick update on current hiring conditions. I'll put the source links on the episode webpage, but I want to walk through three specific statistics: unemployment, job openings, and jobs available per unemployed person, along with a couple of other relevant metrics.
First, the US unemployment rate. Looking at data from July 2018 through March 2023, unemployment stayed fairly constant, dropping to its lowest point since the pandemic in early 2022, and it's remained roughly static since then, sitting around 3 percent and change, essentially back at pre-pandemic levels.
Next, job openings in the United States, meaning employers actively advertising for staff. This is where the trend starts shifting. Openings peaked in the first quarter of 2022 at around 12 million, meaning 12 million positions needed filling nationwide. Since then, that number has dropped off, fairly sharply over the last month or two, and now sits at or just below 10 million.
Now compare unemployment against job openings, specifically the number of unemployed people per job opening. If there are two job openings for every one person looking for work, that's a genuinely tight labor market, since that person effectively has their choice of options. This ratio spiked during the early pandemic when unemployment was high, then dropped to roughly 0.5, meaning two openings for every one person looking, starting in late 2021 and holding steady for a while. Over the last couple of months, that number has started climbing again, now sitting around 0.68 people per job opening. The last time it was a genuine one-to-one ratio was back in 2018. So this ratio is trending upward, more people are now available relative to the number of openings, though we're not back to a loose labor market yet, it's still fairly tight, but it is beginning to shift.
There's one more relevant data source worth mentioning, from the National Federation of Independent Businesses, a group whose surveys of small business owners I've referenced before. They track something called the Hard to Fill Index, essentially asking small businesses whether they can hire enough workers, specifically what percentage of surveyed businesses went an entire month with an unfilled position. That figure peaked back in 2021 at roughly half of all businesses surveyed. It's since been dropping and now sits in the low 40 percent range, meaning the majority of businesses surveyed did not go through the month with an unfilled position. That's a good sign on the surface, though it could also mean some businesses simply aren't actively hiring at all, which isn't necessarily good either.
So what does all this add up to? We still have a genuinely tight employment market, still a lot of openings relative to the number of people looking, but that market is starting to loosen. Whether that trend continues, I honestly don't know, but it is loosening. Keep in mind too, like real estate, this varies considerably by region. Here in the Tampa Bay area, for instance, the job market feels even tighter than the national picture, while other regions may have more people looking for work relative to openings. What I've walked through here reflects the national picture specifically.
Here's the part I found genuinely interesting. The NFIB survey also asks small business owners directly what their single biggest operating problem is right now. Last month, the top answer was inflation. This past month, in the March 2023 survey, the answer changed. I'll read it directly: owners reporting labor quality as their top small business operating problem remained elevated at 23 percent. Labor quality was the number one answer, according to the NFIB's own jobs report.
This tracks closely with what I hear constantly from newer and prospective clients. The problem usually isn't simply I can't find or hire anyone, it's that the people who do get hired often can't actually perform once they're on the job. So what does labor quality even mean? There are a number of definitions out there, but the one I like best comes from a paper published by the National Bureau of Economic Research back in 1964, called Productivity Trends in the Goods and Services Sector. After acknowledging the term is genuinely difficult to define precisely, the paper lands on a simple formula: labor quality equals labor input divided by man hours.
Here's what that actually means in practice. Say you and another bricklayer are both laying brick today, working in comparable conditions, nothing unusual like laying brick on a ceiling. If you can lay 60 bricks at an acceptable level of quality in the time it takes the other person to lay 30, you have a meaningfully higher level of labor quality. Translate that into a dental practice, and it comes down to how much someone genuinely produces, correctly, in a given period of time. If those bricks were laid sloppily, without proper cement, badly out of alignment, that wouldn't actually count, even if there were more of them, since quality is the first requirement, and volume within a given time frame is the second.
Say you hire two people to do patient reactivation calls, since you want to see who performs best. One averages 20 calls an hour and books two appointments from them, while another also averages 20 calls an hour but books ten appointments, or say a third only manages ten calls an hour and books nothing at all. The person booking ten appointments off twenty calls is clearly the more productive employee, the one with the higher labor quality. Or say you have two treatment coordinators, one closes 80 percent of the cases you hand them, the other closes 30 percent. In that same amount of time, the coordinator closing 80 percent is collecting roughly twice as much, simply because they're more effective within the same working hours.
Now, some positions in a dental practice require licensure or certification, an x-ray license, a hygienist's credentials, a doctor's own license. But even there, this same concept, how much someone genuinely accomplishes in a set period of time, still applies directly. For a doctor, that might mean production per hour. For a dental assistant, how long it takes them to properly fabricate a temporary crown. For a hygienist, how much they get done within their allotted time. Say two hygienists are both doing scaling on one quadrant, and it takes one of them an hour while it takes the other two hours, assuming both did the work correctly, the hygienist finishing in an hour has the higher labor quality. And with certain roles, you might also expect additional contributions, a hygienist helping support case acceptance, or an associate expected to present treatment themselves, all of which factor into this same overall concept.
So if you boil labor quality down to something genuinely usable day to day, it really comes down to performance and statistics. Every example I've given, the reactivation caller, the treatment coordinator, the bricklayer, can be measured. When you're looking for high labor quality, you're really looking for someone genuinely productive, who accomplishes a lot within whatever time and standard you've established as necessary.
Here's the problem though. When you're in the hiring process looking specifically for that ideal reactivation caller who books ten appointments an hour, or that treatment coordinator closing 80 percent, you interview thirty or forty applicants and none of them seem to fit the picture you've built in your head. You're essentially hunting for a perfect employee, and that's the wrong approach, for a couple of reasons.
First, that perfect, fully ready-made employee genuinely doesn't exist in any reliable, repeatable way. Occasionally you get lucky, a fully trained office manager relocating to your area because their spouse's job moved them there, someone who's already proven themselves successful elsewhere and can step directly into your practice. But how often does that actually happen? Rarely. If you build the expectation in your head that you need someone flawless, with some vague, undefined standard of perfect, you'll never find anyone who measures up, and every hire will feel like you're settling.
The other risk with hunting for perfection is getting fooled by a strong interview. Say I interview beautifully for a treatment coordinator role, answering every question confidently, describing exactly what I've closed before, how quickly I respond to objections, all of it. You come away thinking I'm going to be fantastic. Then you actually put me to work, and I completely fall apart, unable to deliver anything close to what I described. How often has this happened to you, someone interviews wonderfully and then seems to become an entirely different person once they're actually on the job? People naturally put their best foot forward in an interview, but that performance doesn't reliably predict how they'll actually perform in the role.
So you have to let go of the idea of finding a perfect hire. What you're actually looking for is someone who's a good fit for your team, someone you'll likely need to train, and someone you genuinely don't know much about yet since you haven't worked together before. You can hope they'll succeed, and you should, but you won't really know until they're actually doing the job. I've hired people I wasn't sure about who turned out excellent, and I've hired people I was genuinely excited about who turned out to be a real letdown, that happens.
I've seen this play out repeatedly with executives I've worked with over the years too. Someone's area is overloaded, a new hire is coming in, and the excitement builds, this person used to do this, they used to do that, this is going to be amazing, almost like anticipating a great movie. Then the person actually starts, and it falls flat, nothing like what was pictured, and two or three months later they're gone. I'm not suggesting you shouldn't feel hopeful about new hires, I certainly do. But I'm never genuinely sold on someone until I've actually seen them work and confirmed they can get the job done. That matters far more to me than where they went to school, how long they've been doing this work, or how many other practices they've worked in, it comes down to whether they can actually do the job. Licensure requirements still apply where relevant, obviously, but even a licensed hygienist you were confident about can simply turn out not to be a strong fit once they're actually working.
So how do you actually address this labor quality problem, since it's clearly significant? There's a lot that could be said here, but let's cover four practical, big-picture steps.
Number one: keep your hiring lines continuously open. You should always be on the lookout for good talent, and if a role requires licensure, obviously you're only hiring licensed candidates, you've probably had the experience of getting a response to a hygienist posting from someone with no license who'd simply like to get one eventually. But for administrative roles, and dental assisting in some states, you can bring in someone with zero prior experience. The goal is simply generating a healthy volume of prospects, giving yourself real options, and then hiring the person who seems eager to work and genuinely become part of your team. From there, you put them to work and see how they actually perform, which I'll get into shortly.
Part of what trips people up here is treating a new hire almost like a marriage, some permanent, weighty commitment. I'm not diminishing the real relationship that develops between you and your team, but with any brand new hire, you genuinely don't have that connection yet, and if they don't work out after two or three days, or even a week, you need to be willing to move on. People sometimes attach a real stigma to this, as if losing a new hire who didn't work out is some kind of personal failure. But you actually fail in two different ways here: first, by leaving a position unfilled for months while endlessly searching for someone perfect, and second, by keeping someone in place who's genuinely doing a poor job simply because letting them go feels uncomfortable. Both are real failure points. Keep your hiring lines open, generate plenty of options, and if someone meets your basic qualifications and seems like a potential fit, give them a genuine try. If it doesn't work out, you simply move on to the next candidate. I've included sample hiring ads for various positions as a download on the episode webpage if that's helpful.
Number two: your practice has to be capable of at least rudimentary training, now more than ever. I know this can feel like one of those pieces of advice everyone nods along to without actually acting on, similar to being told you should exercise more and not quite getting around to it. I hear the same hesitation from newer clients specifically around staff training, when am I supposed to find the time, I don't have time to put together training materials, shouldn't people already know how to do this when they walk in the door?
A couple of things worth considering here. If you're hiring people with little or no experience, they genuinely won't know what to do without being shown. And beyond that, education itself has changed. Here's a simple example: our own staff at MGE regularly sends out business letters, and I'd bet your practice does something similar, a thank you note to a referring doctor, a letter to a patient. On average, the younger candidates coming through our own hiring process don't know how to properly format a business letter. I'm not talking about grammar, I mean the basic structure most of us learned in grade school, To Whom It May Concern, a colon rather than a comma after the greeting. If you're around my age or a bit younger, you probably remember learning this directly. Today's younger candidates have largely grown up communicating through text and email instead, and that specific convention often just was never taught.
That's something genuinely simple to teach someone who's eager and willing to learn, this is the format we use for a business letter, and it takes about fifteen minutes to walk through. There may be small things like this you need to teach that you never had to learn yourself, purely because educational norms have shifted. Don't get frustrated by that gap, it's not a reflection on the person, nobody ever taught them. If they're capable of picking it up quickly, it's an easy fix.
You'll need some form of genuine training infrastructure to get people functional, and as your practice grows, your training capability should grow right alongside it. Think of it like building up to distance running, you don't start with a marathon on day one, you build from a mile, to two, to five, and eventually further. In a smaller practice, the people you bring in may need to already come with a bit more built-in skill, simply because your training materials aren't fully developed yet. As your training improves over time, you'll be able to successfully bring in people with less and less prior experience. You may not have needed formal training materials in the past, but you likely need them now if you want to consistently build a strong team.
Number three: you need statistics to actually know whether a new hire is working out. This is really how you measure labor quality in practice, statistics exist to measure productivity. If you bring on someone for reactivation calls, you can track how many calls they make, how many actual contacts result, how many appointments they set, and how many of those patients actually show up. That gives you a genuine measure of their productivity. If those numbers are climbing, that's a good sign. If they're not, that's worth addressing directly.
Picture it as a graph, you'd expect to see that person's numbers climb steadily, and if you don't add additional staff, growth may eventually plateau at a genuinely solid, acceptable level of productivity, that's fine. But without tracking statistics in the first place, you have no real way of knowing whether someone is actually productive at all. A meaningful part of what we teach clients is managing by statistics, both keeping them consistently, and knowing what to actually do once you see them trending a certain way. Without statistics, you're essentially driving a car with every gauge hidden in the trunk, no idea how fast you're going, whether you're low on fuel, or what your engine temperature looks like. You simply can't run a business that way, and the same logic applies directly to your practice.
This is exactly why statistics matter so much with newer hires specifically. Say you're an established practice with three or four administrative staff already, and you're bringing on a new receptionist while your current scheduler is handling the phones in the meantime. I wouldn't put a brand new hire straight onto the phones right away, since whoever answers your phone is the very first impression of your practice, and effectively your partner in every dollar of marketing you're spending. If they're genuinely poor at it, they're quietly wasting your entire marketing budget.
So instead, test them somewhere lower stakes first. Say you have a batch of inactive patients, have the new hire start there, making reactivation calls. That's a genuinely easy skill to teach, showing them how to schedule a hygiene visit, how long to block for someone overdue for a new initial exam after several years away, since the basic concept of visiting the dentist for a routine checkup is already familiar to virtually everyone, unlike explaining something like an implant for the first time. Walk them through it, role play it together, you play the patient, then a slightly more difficult patient, and then put them on the phone for real. Make sure they at least know your practice name and enough basic information not to embarrass the practice, but you don't need them fully polished before this first test.
Once they're actually making calls, if they're not producing any appointments fairly quickly, they're probably not going to succeed in any other role in the practice either, since the underlying issue is that they simply can't produce a result. I'm looking for at least a genuine promise of labor quality here. Can I make this person more effective over time, teach them to communicate better, sell more persuasively? Absolutely, that's entirely possible. But I first want to see whether they can produce any result at all. There's no reason to keep someone around for months producing nothing while you continue paying them. If they're on the job for a week or two and genuinely booking appointments that patients actually show up for, that's a real signal, good, this is a promising hire, worth investing further training into other areas of the practice. If instead they can't book appointments, or tell you outright they simply don't enjoy being on the phone, and yes, I've genuinely seen schedulers hired who don't like phone work, that tells you something important early, before you've invested significant time and cost.
So that's the statistics piece, measuring actual productivity rather than relying purely on gut feeling or opinion. If you're bringing on new hires, you want to see whether they can perform at all before handing them more responsibility, since there's nothing worse than someone who's already underperforming being handed even more things they won't get done. I've also put together a simple statistics tracking handout, available as a download on the episode webpage, showing core statistics worth keeping regularly in your own practice.
Which brings us to number four: don't rationalize away underperformance. Most of what I've described here is genuinely straightforward to put into practice, put someone on reactivation calls and measure the result, but you have to actually follow through and not talk yourself out of what the numbers are telling you.
Say you hire a scheduling coordinator with some prior experience, train them on your specific systems, and a few months in you notice the schedule sitting empty with a lot of unfilled openings, and production sliding as a result. When you ask what's going on, in my experience, they're rarely going to say something like, honestly, I'm not making enough calls, or I don't know how to handle a patient who resists scheduling, or I've been spending too much time chatting with other staff instead of working the phones. What you'll typically hear instead are explanations pointing outward, people just don't want to schedule appointments right now, the economy's rough, you can't expect anyone to come in during the morning since that's when people are at work. In other words, the responsibility gets assigned elsewhere rather than owned directly.
Don't accept that at face value. I've seen this play out before, a scheduler insists nobody wants morning appointments because of work schedules, and the doctor ends up rewriting their entire scheduling policy around it, when the actual truth was simply that this particular scheduler couldn't make morning scheduling work. Other people schedule morning appointments successfully all the time. Don't restructure your entire practice around what turns out to be one person's individual limitation. The same principle applies with a treatment coordinator who isn't closing cases, blaming financing approvals or claiming patients only want what insurance covers. Sometimes there's a kernel of truth worth examining, but you have to verify that honestly for yourself rather than simply accepting the explanation and changing your whole approach as a result. That's exactly when real problems start.
So: don't rationalize. Put someone in a role, see whether they can genuinely produce, track the statistic, and watch whether their area is actually growing. If it isn't, either find someone who can grow that area, or work directly with that employee to improve their specific performance so growth resumes. And naturally, as the person running the practice, you're responsible for providing a clear mission, a genuine division of labor with specific roles and responsibilities, real room for growth, and solid leadership. You can't hold your team accountable if you're not holding yourself to the same standard, showing up late, or doing things you wouldn't tolerate from your own staff simply doesn't work. You have to lead by example, not just by what you say.
There's a great deal more depth to each of these points, but this covers the fundamentals. This is genuinely how you improve labor quality, currently the single biggest problem facing small business owners according to their own survey data, and it's a fixable problem, it simply takes real, consistent work. There's really no reason to remain understaffed or improperly staffed indefinitely from this point forward.
If you're listening to this thinking it sounds right but you're not sure where to actually start, we offer a free practice evaluation, I'll put a link on the episode webpage. We'll take a look at what's happening in your specific practice and help identify your next move toward the goals you're setting for yourself. Or if you have questions about anything covered in this episode, you can always email me directly at jeffb@mgeonline.com.
I hope this helps. I've included links on the episode webpage for the sample employment ads, the statistics tracking handout, and the free practice evaluation. And to everyone listening, I genuinely appreciate you taking the time. If you haven't already, consider following or subscribing wherever you listen, and feel free to leave feedback. If you have any questions, you can reach us here at MGE at (800) 640-1140, or find us online at mgeonline.com. Folks, have a great week, and I'll see you at the next episode.