Navigating Tough Times: Firing Patients and Staff in Dental Practices

RunninThis episode tackles the tough topic of firing patients and staff in dental practices.

Announcer:
Hello everyone. Welcome to the Millionaire Dentist podcast, brought to you by Four Quadrants Advisory. On this podcast, we break down the world of dentistry finances and business practices to help you become the millionaire dentist you deserve to be. Please be advised, we do speak with an honest tongue, and may not be safe for work.

Casey Hiers:
Hello and welcome. This is Casey Hiers back at the Millionaire Dentist podcast in studio with co-host Jarrod Bridgeman.

Jarrod Bridgeman:
Casey, good morning. How are you?

Casey Hiers:
Doing great.

Jarrod Bridgeman:
Listen, yesterday you and I went out to lunch for my work anniversary, and we went to a really nice place. And I kind of mentioned it to you, but it was really funny. I was on Instagram messing around last night, and on one of the stories I realized that my cousin, who I'm actually pretty close to, was sitting right behind us. But our backs were to each other and didn't notice.

Casey Hiers:
Your awareness is impressive. Connected those dots.

Jarrod Bridgeman:
I was so focused on my artichoke and crab, grilled cheese sandwich, that nothing else mattered.

Casey Hiers:
That was damn good.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Plus the eight martinis.

Jarrod Bridgeman:
Yes.

Casey Hiers:
Just kidding.

Jarrod Bridgeman:
It was seven, okay?

Casey Hiers:
Oh my.

Jarrod Bridgeman:
But yeah, thanks again for taking me out. That was great. I had a really good time.

Casey Hiers:
Yeah, that was a lot of fun.

Jarrod Bridgeman:
Best date I had in a while.

Casey Hiers:
Thank you. I hear that all the time. Or used to. But it never gets old. So do you remember that show, the Apprentice?

Jarrod Bridgeman:
Oh yeah.

Casey Hiers:
What was the line? "You're fired."

Jarrod Bridgeman:
"You're fired." Yeah.

Casey Hiers:
Yeah.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
And then now-

Jarrod Bridgeman:
Didn't somebody famous host that show?

Casey Hiers:
He's one of your favorite political... So for our listeners, Jared and I get along well, but political views, I tend to be a touch more conservative. Jared may be a little more progressive. Is that a good way to put it?

Jarrod Bridgeman:
I'd say so. Yeah.

Casey Hiers:
Yeah.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
I mean, I call it wrong, but-

Jarrod Bridgeman:
I'm progressive for Indiana. Yes.

Casey Hiers:
Yes. But the nice thing is we don't let political views divide us.

Jarrod Bridgeman:
Yeah, we work across the aisle.

Casey Hiers:
That's right.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Yeah. We're going to get into "You're fired.".

Jarrod Bridgeman:
'You're fired."

Casey Hiers:
Yeah. It's a fun line, right?

Jarrod Bridgeman:
I like that. Yeah.

Casey Hiers:
I was young when that show was on.

Jarrod Bridgeman:
I mean, it's fun until it's you.

Casey Hiers:
But fair. I used to call to buy merchandise from the apprentice shop or something. And then I would go through my order and then I would go, "You're fired." And I thought that was hilarious, but we do it on speakerphone. Yeah, bad sense of humor.

Jarrod Bridgeman:
That's so funny.

Casey Hiers:
But a lot of our ideas, they don't just come from Jared and I. It comes from talking to practice owners, and we were talking to some new clients recently from the East coast, and we're getting into this topic, so we thought, you know what? Let's talk about it on a podcast, because I think a lot of practice owners can struggle with firing. And first off, firing who? How about rude patients?

Jarrod Bridgeman:
Yeah, yeah. Rude patients can definitely be up there, and that's a tough pill to swallow sometimes, because it's a walking money bag.

Casey Hiers:
Potentially.

Jarrod Bridgeman:
Yeah, potentially. Yeah.

Casey Hiers:
Sometimes the rude patients also don't want to pay.

Jarrod Bridgeman:
That's true.

Casey Hiers:
They want to argue about payments.

Jarrod Bridgeman:
That's true.

Casey Hiers:
But we were joking about how really you just want to tell them to screw off. But you might need to make sure it's a professional dismissal.

Jarrod Bridgeman:
Sure. A professional screw off.

Casey Hiers:
Keep the high road as you recommend, "You know what? There's someone down the road," and maybe it's your competitor that you don't care for.

Jarrod Bridgeman:
Sure. Yeah. Yeah.

Casey Hiers:
Send them a glowing reference and recommendation to send them on. But one interesting point came out of this. It's a double-edged sword, but if you give your staff autonomy, because a lot of times the patients are nice to dentists, but they're rude to staff. And giving your staff the autonomy to, "Listen, if majority of you vote that this person is rude and you have good examples," that can empower a staff, dentist or a specialist has to have final approval of that. But that can be a really interesting-

Jarrod Bridgeman:
Well, let me ask you, what can a jerk patient do to the practice and do to the employees? What's the fallout from that?

Casey Hiers:
Well, what do you mean fallout?

Jarrod Bridgeman:
What could come of keeping a shitty patient on?

Casey Hiers:
Well, somebody gets ass hurt and sends a bad review. And of course, there's going to be some blowback, but the counterpoint is if truly somebody is a bad patient and they're terrible to staff and they're rude to staff, and all those things, it can be a net positive by doing that. But that was sort of the Appetizer, if you will, of the conversation of firing staff. And sometimes it can be therapeutic to just give them the proverbial bird and tell them to kick rocks and all that stuff. I would say each owner has to find their footing with that and be careful.

Jarrod Bridgeman:
Again, find, as you said, a professional way to do it.

Casey Hiers:
Yeah, that's probably recommended. But I thought it was interesting that, again, if somebody is really rude to hygienist or office manager, or employees, that them having some power or say, psychologically can really be a good thing in an office, because again, it gives people that feeling of autonomy and control and power, which I think can be good.

Jarrod Bridgeman:
Now let me ask, what happens if they run with that a little too far? What if they start firing patients on their own or something along those lines?

Casey Hiers:
Yeah, you've got a set in protocol. Nobody can do that just whatever. And-

Jarrod Bridgeman:
willy nilly.

Casey Hiers:
Yeah, and there's got to be, "Here's the criteria when this happens." But I think there could be some power there. And when I've talked to people who had to fire patients, ultimately they felt good about it. And it got to the point where they said, "Listen, if somebody wants to write a bad review and hang that over my head, I have a good enough practice, I'm a good enough... We're going to overcome that. Because there's more benefit to it.

Jarrod Bridgeman:
I was going to say, so what else? There's the obvious. What else falls into the realm of firing?

Casey Hiers:
Well, I think the more applicable one is with your staff and team. And we've talked about this for close to four years now. There's a supply and demand problem with staff and team.

Jarrod Bridgeman:
Correct.

Casey Hiers:
Finding good hygienists, finding good people. That's really, really hard. And so the whole, getting rid of mediocre people has been harder.

Jarrod Bridgeman:
I can see that. And especially if they're doing their job just well enough. But some of it too, like here at our company, we focus highly on not only very talented people but are they going to fit within our company culture. You might have found a hygienist who's really, really good technically but is a big drama queen.

Casey Hiers:
Yeah. I mean, when you talk about bad team members, anytime there's a negativity regarding office culture, if they're stirring up drama within the office, and there's that vibe, that is a huge blinking code red.

Jarrod Bridgeman:
Right. Because that's not only her or him. That affects the entire team. [inaudible 00:06:46].

Casey Hiers:
Yeah. But the conversation we had. If your hygiene department is not running optimally and you need more hygienists, you've got to be real strategic. But boy, if you know "I need to get rid of this person," then actively be working to find the right people to fill this, so then you're in a position-

Jarrod Bridgeman:
Well, and that one person may be preventing you from keeping a spot filled for a long time.

Casey Hiers:
More times than not, they're mediocre at their job, they try to boss their peers around, they try to almost take a superior, like, "I've been here longer."

Jarrod Bridgeman:
Like an unofficial managerial role that they don't have.

Casey Hiers:
Yeah. "I'm louder, I'm the alpha, I'm going to be the boss." That drama that stirs it up, they're not that great at their job, they're bossing around others. Typically, they're demanding a raise.

Jarrod Bridgeman:
Right, right, right.

Casey Hiers:
And you have a choice as a practice owner. You can lead or you can be led. There's not a lot of gray area.

Jarrod Bridgeman:
No, and the tough part with that too, is it's not always a learned skill. I mean, if you want to lead, you can push yourself to do that. But if you're a really maybe meek type of personality, it's going to be kind of hard for some people to do that. But then you're finding out, you've said this before, you're letting the tail wag the dog at that point.

Casey Hiers:
Mm-hmm. A lot of practice owners, we know they are nice. They are sweet people. They want to do dentistry, and they want to treat their employees well at heart, and they don't want to fire people. But again, you're going to make your decision. And if you don't have the ability to take charge of your practice and lead your practice, your team and staff will seek or smell weakness, and that's when you're going to get people to try to run your office. I see, unfortunately, too many times an office manager or an assistant, they think they run the office, and they kind of do. That's not good for culture. You need to be a strong leader. But you have to make your choice. Either be led, let the tail wag the dog and be okay with it because confrontation is too scary, or take charge of it. And sometimes you've got to take a shot across the bow, if you will, and make a big, "Hey, this person's been here for a long time, and all these reasons why I shouldn't fire him." But in reality, that would be the best thing to do.

Jarrod Bridgeman:
And you're right, confrontation's really never a fun thing. But it's something that needs to be done from time to time. A big part of it is removing the personal feelings out of it. Everything we talk about, especially when it comes to business, is remove the feelings, remove the emotions in a situation.

Casey Hiers:
The hardest firings are the ones where you like them as a person, you like them as a human, but they're not maybe doing their job, but they're also not stirring up trauma. Those are probably the hardest ones that we hear from practice owners. But yeah, it's a fascinating topic, and we're having this conversation with some people that they are strong leaders and they don't mind a little confrontation, but you still have to be very strategic.

Jarrod Bridgeman:
Do you ever do a pro-con list? You know? With the-

Casey Hiers:
Pros and cons?

Jarrod Bridgeman:
Uh-huh.

Casey Hiers:
Pro-con.

Jarrod Bridgeman:
Pro-con. Pro-con.

Casey Hiers:
Yeah, no, that's something I've done since I was probably-

Jarrod Bridgeman:
I'm was kind of wondering, it's like, okay, what are we paying them, how good are they at their job, versus how are they fitting in here, whatever the cases may be.

Casey Hiers:
In my personal life, there's been a lot of things where if I just sit down and actually do the hokey pros and cons on a piece of paper, all of a sudden things become a lot more clear. Because in your mind, you're running through so many RPMs in your mind of, what if, and this and that and the other. Where if you just list, "Here's what I like, here's what I don't like," it can be a glaring, either indictment on the person that needs to be fired. Or realize, "You know what? I need to be a better leader and coach them up." Because you can't just fire everybody that...

Jarrod Bridgeman:
Correct.

Casey Hiers:
... isn't awesome.

Jarrod Bridgeman:
They may just need that leadership to really blossom to what they could be.

Casey Hiers:
Yeah, "Here's the expectation, you're missing it here." But this is a really challenging topic for a lot of practice owners, and again, in a season where some hygiene departments are maybe understaffed or they can't find one, or they're paying a fortune for these temps, and they're in a real bad place. There's strategy around everything. Do not be led into the false narrative of, "Well, it's just where I live, well, it's just this. There's nothing that can be done." That's incorrect. Because we have a lot of people who are...

Jarrod Bridgeman:
We've got people all over.

Casey Hiers:
... staffed properly, with the right people, and they've had to make some tough decisions. But ultimately, what's the addition by subtraction, right?

Jarrod Bridgeman:
Right, right.

Casey Hiers:
They've made these tough decisions, they look up and six or nine months later and go, "My God, I should have done that three years ago."

Jarrod Bridgeman:
100%.

Casey Hiers:
And again, with the patient, but more importantly probably with your team and staff. But I thought that the firing of the patient, we've talked about that before.

Jarrod Bridgeman:
We have, we have. And that's a tough thing, but I mean, I've done it in my own personal life back when I was in a different business. And I had to tell a client, I was like, "You know what? Maybe I'm not the right fit for you. This guy will do what you're asking." I hated that guy. I was very professional, for me.

Casey Hiers:
Well, you just touched on another thing, that if you strongly dislike somebody, don't let personal emotion cause you to make a mistake.

Jarrod Bridgeman:
Correct.

Casey Hiers:
When I said double-edged sword, this is tricky. This is not a just straightforward topic like, "Oh yeah, just fire somebody and everything's better." no, I mean, you-

Jarrod Bridgeman:
You got to think about it a little bit.

Casey Hiers:
There's got to be some strategy. It's funny, our clients will go, "Hey, do you guys help with this or that?" And we always say, if it's a $5,000 decision or more, then get us involved. We'll help talk through it, strategy, timing, pace, all of those things. And it's always fascinating, the deep breath, like, "Okay, wow, I can have somebody at a bounce this off of? That's great." Because so many people make these decisions on-

Jarrod Bridgeman:
In their own vacuum of their life and have only their limited scope to base things off of.

Casey Hiers:
Yeah. When you're producing dentistry six, seven hours a day, and you've got a life...

Jarrod Bridgeman:
It's rough.

Casey Hiers:
... there's not a lot of time to sometimes strategize on all of this.

Jarrod Bridgeman:
No. And at the end of the day, how often do you go home and you're just kind of mentally exhausted too? You know what I mean? For me, I turn on the TV for about 20 minutes just to kind of decompress for a minute, before I can even do anything else with my evening.

Casey Hiers:
I'm getting into vinyl records. I just-

Jarrod Bridgeman:
You are?

Casey Hiers:
Yeah. I just got-

Jarrod Bridgeman:
I collect records.

Casey Hiers:
We just started. It was like some charity event, my wife wanted this record player, and it was pretty sweet, and we probably paid double what it cost. It was freaking costly. Well, it came with Taylor Swift, Michael Jackson...

Jarrod Bridgeman:
Nice.

Casey Hiers:
... The Beatles, and Bruno Mars.

Jarrod Bridgeman:
That's good. That's a little collection.

Casey Hiers:
I just added Johnny Cash and Foo Fighters.

Jarrod Bridgeman:
Oh, nice.

Casey Hiers:
But here's my point, talking about when you're tired at the end of the day. I'll go down to the basement and put on the record, and I can't toggle through 18 songs in five minutes, I actually have to listen. It's very relaxing.

Jarrod Bridgeman:
It's very different. It's the same as back when we only had the three TV channels. You kind of just got to watch what's on.

Casey Hiers:
Yeah. There was a real serenity to listening to a vinyl record. Not exactly knowing what the next song was, but just listening to it for a period of time.

Jarrod Bridgeman:
I really enjoy doing that.

Casey Hiers:
Yeah. It was nice. And I think as a practice owner, there's so much thrown, thrown at you, you've got to find your outlet. A lot of people tell us they'll hit the treadmill and listen to podcasts. A lot of times...

Jarrod Bridgeman:
This one's special.

Casey Hiers:
... we're on that shortlist.

Jarrod Bridgeman:
That's right.

Casey Hiers:
That's why we try to keep it to a nice two-and-a-half-mile run.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Right? What should that be, done in, about...

Jarrod Bridgeman:
For a normal person or me?

Casey Hiers:
... 16 to 20 minutes, right?

Jarrod Bridgeman:
Yes, yes.

Casey Hiers:
But you've got to find your outlet, because there's so many practice owners that just bitch about the same four things, and five years later they go meet up with their classmates from dental school, and they're all about the same things. Do something about it or stop complaining. Lead or be led.

Jarrod Bridgeman:
Shit or get off the pot.

Casey Hiers:
But you just can't be the victim, "Oh, woe is me.".

Jarrod Bridgeman:
Right.

Casey Hiers:
Because we have a lot of people in challenging areas, with limited hiring pools, that have great hygiene departments, they have good staff, they're happy, there's harmony. It can be done.

Jarrod Bridgeman:
That's right.

Casey Hiers:
Don't fall into the trap of...

Jarrod Bridgeman:
What was me.

Casey Hiers:
... victim to circumstance.

Jarrod Bridgeman:
Yes, yes.

Casey Hiers:
There's always one-offs, there's always unique situations.

Jarrod Bridgeman:
For sure, for sure.

Casey Hiers:
Yeah. Yeah, just start firing people.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Kidding.

Jarrod Bridgeman:
Just get rid of everybody.

Casey Hiers:
Kidding.

Jarrod Bridgeman:
Speaking of firing, Casey, I forgot to mention-

Casey Hiers:
Got some bad news for me?

Jarrod Bridgeman:
Got some bad news for you. Casey, this week in fact, we're going to be in the DC area. That's going to be really exciting.

Casey Hiers:
The swamp?

Jarrod Bridgeman:
The swamp, yeah.

Casey Hiers:
You and I should go in a bipartisan manner and really unite everybody.

Jarrod Bridgeman:
We should. You know what? I've never actually been to DC, ever.

Casey Hiers:
Yeah?

Jarrod Bridgeman:
I wouldn't mind going at least once just to kind of check out the standards.

Casey Hiers:
I did a tour of the White House as a kid during the Clinton administration. I was a kid in puberty though, So...

Jarrod Bridgeman:
So you and Bill are good friends.

Casey Hiers:
... I was looking for Chelsea. You know?

Jarrod Bridgeman:
So we're going to be there on Thursday and Friday as of this recording. I mean, we're almost sold out of our tasting event in Tyson's Corner.

Casey Hiers:
But had to get a bigger room.

Jarrod Bridgeman:
We had to get a bigger room.

Casey Hiers:
But need to get a bigger room...

Jarrod Bridgeman:
Yeah, that's crazy.

Casey Hiers:
... and up the numbers. So that's good.

Jarrod Bridgeman:
We're going to be heading towards Huntington Beach in Calabasas, California, we're going to be in the San Francisco area, we're going to be in a couple places. We're going to be in Grand Rapids and Detroit, up there in Michigan.

Casey Hiers:
Motown.

Jarrod Bridgeman:
Motown. Listen, I'm really excited about all the places that we're reaching out to and all the docs that we're going to be talking to. I think it's going to be a really cool thing to do and a really interesting thing, because we come back and we're like, okay, well, the doc in Detroit is having... It may not be the same issues as the doc out in Calabasas, California. It's so similar.

Casey Hiers:
Very true.

Jarrod Bridgeman:
Even though completely different areas of the country.

Casey Hiers:
I get excited when 45 people look at our subject matter and are honest with themselves and go, "Yeah, I could probably improve on something."

Jarrod Bridgeman:
Yeah. Yeah.

Casey Hiers:
And if you don't think you can, you're wrong. We talk to people that produce three and a half million dollars, they make a 1.2, their fee for service. I mean, you can go on and on and on. Well, those are the things a lot of people complain about, thinking they can never get out of insurance. But those people that are crushing it still have challenges. People with 55% overhead still have challenges.

Jarrod Bridgeman:
I mean, there's always room for improvement. After a certain level, it can be a little bit more and a little bit more and a little bit more. I mean, I know I'm perfect, but for most people it, I get it.

Casey Hiers:
But no, we've got a lot of good events to close out the year. Share some really important subject matter with a lot of people from around the country. And get different views. And ultimately that leads to our topics. We let the dental industry basically determine what our topics are, what conversations we have, things to get brought up.

Jarrod Bridgeman:
Yep. So, yeah.

Casey Hiers:
And unfortunately, firing patients, and staff, and team, it's part of being a practice owner, it's part of being a leader. Really not a lot of ways to get around it.

Jarrod Bridgeman:
So Casey, don't forget. If anybody wants to check out where we are going to be, fourquadrantsadvisory.com/events. You can sign up for the event right then and there.

Casey Hiers:
Check us out.

Jarrod Bridgeman:
Check us out and check us out and give us a like and a review and a rating on wherever you listen to our podcast. Thanks, Casey.

Announcer:
Hello everyone. Welcome to the Millionaire Dentist podcast, brought to you by Four Quadrants Advisory. On this podcast, we break down the world of dentistry, finances, and business practices to help you become the millionaire dentist you deserve to be. Please be advised, we do speak with an honest tongue and may not be safe for work.