The art of hiring and firing for your dental practice

Kristin Tauras, JD, discusses how to establish a detailed hiring process and how to fire staff that are detrimental to your practice

There is a common saying in employment law: hire slowly, fire quickly. While in a perfect world, the employer would have the luxury of slowly sorting through a dozen applications, there is a shortage of workers capable and willing to work in a dental practice. The tendency is to hire quickly before the candidate gets away and a hesitation to terminate a poorly performing employee, which is the opposite of the spirit of the legal employment practices.

Despite the seemingly limited job market, the rule of hire slowly and fire quickly is vitally important, especially for private dental providers. The decision goes beyond dental capabilities to who you want to work with you, who you trust to greet and treat your patients, who will be a good fit for your practice, and who will be around in the future.<

Hire slowly

You want to make sure the candidate has the qualifications (licenses or skills) that you need, fits well into your dental office environment, and will be around long enough to be of value to you. A rushed decision could mean hiring someone who has the desired technical expertise, but lacks the interpersonal skills needed to work in a small office environment or engage with patients. Or, a rushed decision could mean hiring someone that has fantastic people skills, but is unable to remain focused on the job, lacks the needed skills, cuts corners, and does not work well in stressful situations or confined spaces.

The hiring slowly principle does not mean to spend weeks or months before deciding to hire a candidate. It means to be both intentional and thorough in your hiring practices.

“Use the interview as a time to observe the person’s demeanor, interest level, interactions with others, and how they fit within your office dynamics.”

Posting

The hiring slowly process begins with recruiting talent. Whether you are posting an opening or responding to inquiries regarding hiring, make sure that you understand what you are looking for in a candidate and clearly convey that message. If you do not have a job description of the role you are attempting fill, now is a good time to create a written description.

You should post every license and skill that individual must have along with other job requirements and consider posting every desired quality the individual should have. Obviously, you want your dental professionals to have the license or certification required in your state, and your office personnel to have basic computer knowledge, but also consider what other qualifications you want the individual to have. Some examples include, prior experience, ability to work with children, experience working with the elderly and disabled, experience in a medical or dental office, ability to work in small confined spaces, ability to take direction, experience with charting, and experience with submitting insurance documents.

Applications

You should check with an attorney in your state to verify that your application process complies with your state laws. Do not assume that the application you used for the last several years complies with today’s employment laws. The laws are continuously evolving.<

At a minimum, your application should include a place for providing information regarding the following:

1. name and contact information
2. the position the applicant is seeking
3. prior employment history
4. work-related experience
5. education
6. licenses
7. computer/charting proficiency

Your application should also provide a signature line for a verification, stating that the applicant attests that the information they are providing is true and accurate. This will make it easier to withdraw an offer or terminate a person if the information is found to be false.

What you should not ask is more complicated.

More than half the states now have a “ban the box” law, which are laws that prohibit requesting information on an application regarding criminal arrests and convictions.¹ Many states also have laws regarding salary history as a means to remediate discrimination in wages.² The Equal Pay Act (EPA) is another federal employment law giving employees a private right to action for discriminatory pay.

You should also avoid questions that may reveal whether an applicant is a member of a protected class under federal and state equal employment opportunity laws. Many states have laws against disclosing a disability, race, or other historically discriminating categories on a job application. Even in states that do not specifically prohibit this inquiry on the job application, the inquiry into protected classifications may be used as evidence of discrimination. See for example, Title VII of the Civil Rights Act of 1964 (Title VII) (a federal law that prohibits employment discrimination based on race, color, religion, sex, or national origin); The Americans with Disabilities Act (ADA) (a federal law prohibiting discrimination on the basis of actual or perceived disability), and Age Discrimination in Employment Act (ADEA) (a federal law prohibiting discrimination against people over the age of 40).

Interviewing

The interviewing process is vitally important. The inclination is to leave hiring to the office manager, but you should be involved in the interview. Today, most initial screening interviews are done over the phone or through Zoom to determine if the person meets the initial criteria for the job. At this point, you should know enough about the candidates: their educational level, whether they are credentialed, years of experience, and whether they have an interest to work in the location for the hours/days required and the salary range.

Use the interview as a time to observe the person’s demeanor, interest level, interactions with others, and how they fit within your office dynamics.

If the applicants are for a dental professional, ask about the history of their license, whether they have had any disciplinary actions and the status of the actions, lawsuits and claims, whether they currently have insurance and who their current provider is, and whether there is any reason they would not be insurable. Pay close attention to someone who has had several jobs over a short time period or someone who was until recently practicing in a different state. There may be legitimate reasons for the changes, but this could be a red flag that the person is no longer licensed in another state, has had issues in that state, or has a history of job jumping.

If the applicant is an office professional, ask about their experience working in a dental or medical office. You will also want to gauge their understanding of HIPAA and the need to maintain medical and financial privacy. Asking open-ended questions such as, “what was the least pleasant dental experience you have had” and watching the person’s reactions as well as words will disclose information about the person who you are hiring. The same details are important to find out about your office staff as well. Your receptionist may be the first and last contact any patient has with your office; you want it to a positive one.

During the interview, you should make it known if an offer of employment is conditioned on drug screening, criminal back ground check, or financial background check. This will give the applicant the opportunity to front any issues and decide whether they want to move forward in the hiring process, which may save you from the time and cost associated with background checks.

Working interview versus skills assessment

The working interview is tricky, but may be necessary. You can ask a dental professional to demonstrate their technique, but if you receive compensation for their work, or if they spend time doing actual work, then you may be required to compensate them for their work.³ (Some dentists find working interviews beneficial because they offer the opportunity to assess the candidate’s technical and interpersonal skills.) Negotiate this in advance if you are asking them to work. You should also check with your malpractice provider and workers compensation provider to verify that the “working interview” is covered by insurance.

References

You should ask for references, but recognize that most people will only provide references from individuals who they know will give a positive reference. Pay attention to what references are not there — especially if none of the references are from recent employers. You should contact the references listed. You should also verify that the references are true references.

Background checks/drug testing

If you use background checks and drug testing, make sure that the candidate knows up front that any job offer will be pro-visional on a background check and drug test.

Criminal background check: Many states require a written authorization prior to doing a background check. You should follow your state laws before conducting any criminal background check and in determining how to use the information. It is a violation of civil rights to request a background check because of someone’s race.⁴

Financial background check: Under the Federal Fair Credit Reporting Act (FCRA), the applicant must sign an authorization, and the FCRA notice must be provided on a stand-alone document (not part of the employment application). There are several nuances to this law that should be discussed with an attorney before deciding whether you need this information.

Licensing check: Most states have websites where the public can find information related to licensing renewals and disciplinary actions, such as suspensions and revocation of license. You should never forgo reviewing the licensing information available. If anything is flagged during the search, you should make an inquiry regarding the issues prior to offering employment. You should also inquire about whether there have been any pending investigations, findings, and suspensions of the professional’s Drug Enforcement Administration (DEA) license.

Drug screening: States have different laws related to drug screening. It is vitally important to check with your state’s laws prior to requesting that the applicant submit to a drug screening. This is especially true in states that have legalized the use of cannabis. Where drug screening is permitted, you should use the state-specific drug screening authorization form and follow the state-specific protocol for responses if the drug screening it positive.

Internet and social media: A Google search should not be your only review of an applicant, but it may provide useful infor-mation. You may see red flags, such as the sharing of offensive comments or conduct. You may see that there were employers the applicant left off. It may also disclose a person’s tendency to post negative reviews of employers. Or, it may show a person that has a professional footprint.

Decision

When you have all the information, you still need to make the decision whether to hire the applicant. Be thorough in the reasons you want that person to be your employee or not.

Your considerations should include considering both the individual and your needs.

First, does the candidate have the skills and level of experience you need? If the employee has the skills, but lacks the experience, will you be in a position to train the employee while still maintaining office efficiency while the employee gains the experience? Do you have the time and patience to train a newer professional? Be realistic. A recent graduate from a prestigious university may seem appealing, but a person from an established practice may be a better fit for your office. Then again, even a person with years of experience would not be a good fit if you do not agree with their approach to patients or treatment.

Second, does the candidate have a personality that fits well with the office? Does the person interact well with others? Does the person seem like someone you and your patients can communicate with? Most dental and medical offices strive to have a calm environment, beginning with the person who greets the patients, to the professionals who perform the work, to the per-son who ultimately schedules the follow-up visits and billing. You do not want the environment to be disrupted by having someone join who is caustic, negative, or standoffish. Assume that the person who came to the interview is that person on the best day. Try to imagine how that person will fit in with your vision for the office.

Third, will the candidate stay? If you follow the hire-slowly principle, you will have already invested time in this candidate. Is there anything in their work history or personality that would lead you to believe that the individual is viewing this position as a stepping stone? You will want to have an employee whom you believe will be around in the long run to make your time and efforts pay off.

Fire quickly

Firing quickly means to take swift action when it is apparent that the employment relationship is not working. For most, it is a difficult decision to fire someone. You have invested time into hiring and training the employee. It is hard to admit that you made a mistake or that it is not working out, especially if you have grown fond of the employee. It is not an easy decision, but if you are considering it, it is probably a necessary decision.

Do not delay in terminating once the reason is apparent.

There are several reasons why this should be done swiftly.

Productivity

If an employee is not performing up to your standard, it will negatively impact productivity for both that employee as well as those around the office. It may be that the individual did not have the level of training or experience you believed they had, or needs more training and guidance than you have the time to give. Mistakes can be costly for you and your patients.

Office Culture

It is often said that one bad apple can ruin the bunch. The same is true of one toxic employee. Most dental practices are small enough that one employee can adversely affect office culture. If an employee is not fitting in well to the office culture or is unintentionally or intentionally sabotaging the office dynamics, it makes sense to act swiftly. Similarly, although more subtle, a person who is not pulling their own weight, arriving late, and making errors, will also negatively affect the office dynamics.

Cost

It is expensive to hire, train, and retain good employees. But, it is expensive to have a non-performing or disruptive person in the office. You should not spend time and money on further training someone who is not a good fit for your practice. The money, time, and energy spent trying to train and develop an underperforming employee diverts resources and attention from those who are, and may cause you to lose valuable employees and patients.

Reputation

Most dental offices rely upon repeat business and referrals. Most people do not take the time to research their dental practitioner, but will rely upon their dentist or neighbor in determining who to see. You cannot afford to have your reputation tainted by one poor employee.

Malpractice

Most obviously, you should terminate someone who is not meeting the appropriate standard of care. This could cause you both financial and reputation harm. But you should also terminate someone who does not meet the standard of decency in their interactions with patients. Someone who is unhappy with the dental procedure performed may sue, but someone who was also treated poorly by the person performing that service is more likely to sue.⁵ Anyone can make a mistake, but not everyone will know when a mistake was made, how to correct the mistake, and how to treat others.

Other liability

Employers may be held liable for the sexual harassment, discriminatory acts and, in some cases, the criminal acts of its employee. See Title VII, 42 U.S.C. 2000e, employer liability. This liability may extend to liability for acts against co-employees, venders, and patients. Terminating the offending employee may avoid or lessen civil liability.^6,7,8

One caveat to the fire quickly rule: If you have a contract or the employee is a member of a union, you need to make sure you follow the steps set forth in the contract prior to termination (such as notice requirements or termination for cause provisions). In those situations, you should contact your attorney for guidance for how to best terminate.

Best practice

Hire with intention people who meet the criteria and fit within the office’s needs and culture. Do not be afraid to fire if the employee is unable to meet the standards or does not work well within your office. Making good choices and following the guidance as discussed above can avoid possible legal risks and lead to a more positive office environment and a stronger practice team.