What Would You Do?

This case was submitted anonymously by a PAGD member. PAGD encourages members to participate in our online communities to get feedback from their colleagues regarding situations like these.

“Prior to the pandemic, our office had three hygienists that have been with the practice for three-plus years, and the dynamic with the entire team was working well. Upon our return to practice, one of the hygienists asked to have her workload reduced to three days per week from five. She has a medical history and was concerned for the potential of treating asymptomatic COVID patients, even with the full PPE that we provided. Considering our reduced capacity for hygiene at the time, I was pleased to grant this request.

That same hygienist has now asked to have her workload reduced further to one day per week. The problem is that our demand for hygiene services has resumed to near its prior capacity, and there have been grumblings from the other two hygienists that they are still working full-time under more difficult circumstances. One of the two remaining full-time hygienists is a cancer survivor, and has medical concerns too, but has opted to remain. Until this, there was no major divisiveness on the team. What would you recommend I do?”

Response #1

Ray Johnson, DMD, MAGD

This is a difficult situation that can be looked at from many different angles. As a business owner and a dentist we are often asked to wear many hats. This is a glaring example of that. A very simplistic approach would be to address strictly the office hygiene capacity/need. Hiring a new hygienist or going to assisted hygiene would be ways to solve this problem. By bringing on a new team member who is engaging and willing to work, this could help boost morale from the current employees who are feeling spiteful.

I would encourage those that are working hard given the circumstances. You must also consider if this person is still of value to your office. If the other employees are doing their best and complying, this other employee should be as well. If they choose not to, which this pandemic situation is allowing, then you can choose to no longer need them in their reduced capacity.

On the other hand, we are dealing with people. We cannot forget this fact. It is too easy to dismiss someone’s emotions, ideologies, health, etc. You must be caring and thoughtful at all times. If this employee wants to reduce their time for genuine reasons, that is their right to do so. You should be sympathetic to this. The pandemic has opened a new array of issues to deal with. These are not the normal problems that an office usually faces.

Response #2

Andrew Jeffers, DMD

As a dental practice owner I see that I have three prime responsibilities: to maintain a viable and stable business, to provide consistent and high-quality dental care to my community, and to give my staff a working environment that is equitable, safe, and professionally respectful. These responsibilities are like an equilateral triangle where each segment is connected to the other and the strength of the triangle is based on the stability of each of the three sides. If the focus on any one side becomes overly weighty the other two sides inevitably strain and the balance is severely threatened.

The past six months have been a hurricane of fear, anxiety, and ethical dilemmas due to the COVID-19 pandemic. As dentists, we have had to maneuver through an ever-changing barrage of advice, restrictions, closures, and sanctions. I, personally, often felt frustrated and worried about the future of my practice as well as the health of my patients and staff. But as the leader of my team, it is vital for me to be the voice of calm and reason and to provide guidance and reassurance that everything possible is being done to protect all involved from exposure and illness. That being said, as with every storm, there is some residual damage and there are no cut and dry solutions when dealing with human emotions.

I applaud the dentist mentioned for being flexible and empathetic to the needs of the hygienist. Yet, as we all move to a path of normalcy, nothing really is as it was. Apparently, this hygienist has concerns that strongly linger past the closures and sanctions. My first recourse would be to have a private meeting to discuss these concerns. I’ve found that a stated problem is often an avenue to many other obstacles that an employee is experiencing. Does this hygienist have children at home unsupervised due to hybrid school models? Is this person providing support or care to an elderly family member? Or is there another issue that’s causing additional stress? With a better understanding of what’s truly happening I would remind the hygienist of their value to the practice and that as a team member I would expect their commitment to the health and well-being of their patients and coworkers. Are there adjustments or compromises needed to make this happen without a loss of work time or productivity?

I keep thinking of that triangle, stable and balanced, when so much around me feels the opposite of this. So I hold the triangle together with whatever creative, out of the box, innovative methods needed not necessarily because I have the time or patience to do so; I do it because this is the potholed, unpaved path to our new normal.

Response #3

David Larson, DDS, FAGD

This is an interesting scenario because it lives in the gray and that is where most tough decisions lie. Several factors would have to be considered prior to taking any action. I would need to consider: Hygienist X skillset, her relations with patients, her relations with rest of team, relations with me, my ability to replace her if gone (local workforce issue) and her impact in moving our office towards its future goals. The scenario presented frames Hygienist X in a generally negative light but before an action is taken, a full measure of her value and potential should be evenly considered.

If this were me, I would take those factors into consideration and then have an answer to the one core question: Do I want to find a way to keep Hygienist X on the team understanding it that it will take more active management in order not to cause any unwanted distress with Hygienist A and Hygienist B and also may cause me to manage a new Hygienist C to fill in the needed care gap?

If yes, then I would seek to make it happen while both recognizing and addressing the concerns of the other team members. I would do this with the following steps:

  1. I would draft an employment agreement with Hygienist X that states she has requested a reduction in her work hours and understands that I may need to fill in the relinquished time with another hygiene team member. Hygienist X would further sign and agree the understanding that she has no entitlement or expectation to have any additional hours other than the one day per week as requested.
  2. I would have Hygienist X sign that she understands that she will no longer receive any benefits that are for full-time employees, such as vacation hours, paid holiday, medical insurance, CE hours, uniform allowance, etc. to the extent that it is already outlined the office manual.
  3. I would have a conversation with Hygienist A and Hygienist B, once Hygienist X signs the document, and let them know my appreciation for them picking up the slack, that Hygienist X is now part-time and I will be looking to fill in the need with a new team member. I would ask them for suggestions to allow them to be engaged in the process and have some ownership of the new team member.

    Caveat – Many quality hygienists want FT and benefits, so after a few weeks trial period, it may become necessary to let Hygienist X go and make Hygienist C full time if you want Hygienist C as part of your team. You have to be ready to make this decision prior to the start of this process.

    If no, I would seek to make it happen in such a way as to diminish any unemployment claims to my account. It sounds kind of mean to forge a path like this but as a business owner, I need to look out for my practice and the rest of my team’s best interests. Those do not align with Hygienist X’s interests at this time. I would seek to achieve this by:

  4. Request the work reduction request in writing from Hygienist X before you let her know of your intention to let her go. Once received, discuss with her your office needs and listen to hers. Respect her need set, but, plainly and honestly, thank her for her time with you, appreciate her care for the office patients, but then let her know her needs and your needs do not align and her services are no longer needed.

    Caveat A – You need to decide before this point if you will want to keep her on for one day a week until a new hire is found or just let her go. My suggestion would be to just let her go. From the scenario, she sounds grounded in self-interest and will be an energy sink and morale dumper while she remains. It is not worth it for one day a week. She will likely quit with short notice when it suits her desire so do not put yourself in that vulnerable position. Say goodbye.

    Caveat B – Decide in advance your answer if she relents and agrees to stay at two days a week. I would not keep as per the scenario she has already caused discontent among the team and it will not get any better. If you do keep her, you need to get her to sign to diminished hours with no expectation or guarantee or more hours, benefits shift to those of part-time, and if hours need to be cut, she would be the first to lose hours. I would not contort myself to make Hygienist X happy at the expense of Hygienist A and Hygienist B.

    From the given scenario, I would infer that Hygienist X has already mentally left the office. She is not interested in what the practice needs, not interested in the additional load her actions are placing on the other hygiene team members and is not likely to change. She is behaving in a selfish manner, which is her right, but also my right. I need to likewise act in a selfish manner on behalf of the practice and the rest of the team’s interests. I would protect my office, get her request in writing (ideally witnessed by a third party), seek to hire a new FT hygiene team member and then let Hygienist X go when indicated, either by work flow or her attitude.

    The unemployment liability costs should be reduced significantly or potentially eliminated, if it is viewed as a refusal to continue with work as hired, with her written request by her to reduce her hours. I think Hygienist X will, on balance, most likely be a negative energy if she stays in the office and she certainly will not move your practice forward as desired. Letting any team member go is a very hard step to take, especially if they are trying their best. This would be much easier as she is presented as no longer engaged and not being a team member.