Articles By Fred

As a small business owner, a dentist has many responsibilities to keep the business running smoothly; employing staff, maintaining the office equipment, marketing for patient flow to name a few. However, with all the careful planning and attention to detail, there is one aspect that the majority of dentists don't plan for, which is how to keep the business viable if the dentist is unable to practice. Every year a fellow practitioner may unexpectedly lose the ability to practice due to an unexpected injury or illness. Weeks or months of lost practice time will affect patients, staff and cash flow. Moreover, disability insurance has a waiting period before benefits will be paid, typically three months. In this article, I wish to share events that I have witnessed and ways in which they were handled in hopes that others may benefit through proper planning and organization.

Since 1983 when I first became involved in dentistry, I have worked in nine major metropolitan cities and served clients in countless others. During that time, numerous events occurred that were both sad and frustrating. Dental offices were left stranded without a practitioner for a variety of reasons including: a dentist needing time off for recuperation after emergency surgery, dentists with broken arms or hands, and unexpected death.
In these cases, the dentist wasn't able to treat patients, the employees in place didn't know what to do, and the spouse often did not have the business acumen to carry forth the business operations and therefore the business faltered. In the event of death, a practice's productivity would plummet until a potential buyer arrived with an offer far less than the previously thriving business was worth. Sad, but true, the estate of the deceased dentist may be left with little if any proceeds from the sale of an asset.

Most dentists carry disability insurance, but again the period of time until benefits begin may be far too long to wait for much needed funds. This can destroy a fine dental practice. An option to managing operating expenses when little income is being generated is to carry office overhead insurance. This policy protects the short-term financial needs of a practice with payments until the disabled dentist returns to work.

But even overhead insurance has limitations; will the proceeds from insurance enable the office to remain viable, keep the patient base intact, and continue to employ staff until the dentist is able to work again or the practice is sold? Most likely the answers to these posed questions are NO.
Rather than risking harm to a most valuable asset, dentists may consider becoming involved with a group of conscientious dentists in their community who would help preserve a practice if something unexpected happened to one in the group.

I have designed a successful program to help a 'fallen' dentist's practice remain viable. It is based on a simple premise, that the dental community is a caring one, willing to volunteer services for fellow comrades. The program is termed "Inter-Practice Protection", and it has worked successfully in Arizona since developed in 1997. The concept is straightforward: form groups of like dentists who agree to volunteer coverage for each other in times of illness, short-term disability, trauma, or death. This is not an insurance policy; rather, it is assurance that a practice, the team of employees, and patients will continue to be served. Inter-Practice Protection provides coverage for the practice during a dentist's absence to ensure that it does not lose production, the team continues to work, and patients continue to receive care.

Since its inception, nearly one hundred dentists in the greater Phoenix Metropolitan Area have formed six separate groups to cover for their practices should an untimely and unexpected mishap occur. These groups are well-structured and organized associations of private practicing dentists who have committed to volunteering a day of their time if a colleague within the group is unable to practice.

Members of the group operate their own private practices and collectively volunteer their time to care for patients and keep the fallen dentist's office functioning while the doctor rehabilitates, or until the practice is sold. Patient payments for treatment provided by the covering doctors are made to the practice being covered.

After activating groups for a variety of reasons, such as cardiac surgery, a broken arm, a broken hand, and even an untimely fatal heart attack, the coverage specifics have been fine-tuned, with the participating dentists input. In addition, the groups' dynamics have become stronger with each passing year. Following are guidelines for effective operation of the coverage groups.

• The groups are comprised of about 17 dentists.
• A Chairperson and Vice-Chairperson are elected by the group to function as administrators of group communications, manage annual meetings, and coordinate activation for a doctor needing coverage when necessary.
• The group provides coverage if a member is not capable of providing usual dental services due to non-intentional mishaps, illness, disability, or death. Normal maternity, without complications, substance abuse, and alcoholism shall not be considered a disability or illness.
• Upon the event of a disability, the member or family member promptly contacts the Chairperson to advise coverage is needed. The Chairperson then calls an activation meeting to be held at the disabled member's office within 24 hours and creates a coverage schedule with the members of the group.
• Coverage begins no later than 15 days after the date of disability, and continues for a maximum of 12 weeks. Coverage will cease when the disabled member returns to practice, or upon death when the practice is sold.
• Members covering a practice are not responsible for managing, administering, or directing the business of the disabled member's practice. A personal representative, family member, or other representative of the practice is responsible. Members may assist without any obligation to do so, but are not liable for any damages.
• The dental team should notify patients of the disability and make known the name of the covering dentist prior to the patient's appointment. The team will maintain all normal business operations, cooperate and assist the member who is providing coverage, and ensure there are adequate supplies and personnel for the practice of dentistry.
• Members are not obligated to cover more than their allotted number of days. After the entire roster of the group is contacted for coverage, any more additional days of coverage by a member is voluntary.
• Contact your malpractice insurance company and ask them specifically: "In the event of my untimely death, will my policy allow for patients to be treated in my office by my staff under the supervision of a dentist volunteering his time and still provide malpractice coverage?"
• Each member must review their personal information to be sure that the Power of Attorney is delegated to a significant other so that payments for accounts payable and payroll may be made without delay.
• If a member is contracted with an insurance company as a preferred provider, then the member must find out guidelines for each particular plan in the event another doctor, who may or may not be contracted with that insurance company in his or her own practice, treats patients during a covered period. This will ensure payments for treatment rendered to patients are made to the doctor's office receiving coverage.
• Members of the group agree that if a patient of the doctor who is receiving coverage wishes to pursue care from the volunteering dentist, the volunteering dentist will decline to accept the patient in his or her practice until a waiting period has passed. In the event of a disability or illness, one hundred and eighty (180) days shall pass. In the event of death, ninety (90) days shall pass.
• Attendance to an annual or biannual meeting is urged to reunite with fellow members, review past year's events, and demonstrate commitment to the group.
• Prior to covering at another practice, a schedule may be faxed so that the covering doctor may review the patient load and treatment mix. At that time, the covering doctor may consider bringing some of his or her own instruments.

Through careful planning and preparation, the groups here in Phoenix were well organized and ready to step in under any circumstances.

On the evening of July 31st, 2003 around 7 p.m., I received a call from a periodontist who is a member of the "Concerned Periodontists", an Inter-Practice protection group in Phoenix. He informed me that a fellow periodontist had passed away suddenly and unexpectedly of a heart attack at the age of 41 at his home that morning. By 7:30 a.m. the next day, the coverage group was activated and within a few hours a schedule was created in which eighteen periodontists had volunteered their time over the next sixty days to cover the practice.

I arrived at the deceased periodontist's practice at 10:30 a.m. and was met with an enormous amount of gratitude and appreciation by the team. To know that the doctor had thought ahead and aligned himself with a conscientious group of practitioners was such a relief to his staff, and to know the practice would be covered in this difficult time lifted a huge weight of concern off their shoulders. In the following weeks, patients were treated, the staff continued to work, and the business continued to operate while the surviving estate planned for the practice's sale.

No one really knows what tomorrow brings. We plan for our practices to grow, we plan to maintain a happy and productive team of employees, we plan for retirement, and we hope to have enough insurance coverage to provide financial help in catastrophic situations. Be prepared and have a plan in place so that your practice will continue to be productive when you're not there.

Question: One of my employees broke her ankle during a weekend skiing trip. She has a note from her physician excusing her from work for the next 10 weeks. Am I required by law to hold her job open?

The answer to this question, for most dental offices in Arizona, is no. Since Arizona is an "at will employment state," there are no rules governing job security regarding an injury that occurs away from the workplace. That being said, if your dental office employs more than 50 people then the employer may be required to follow Federal Mandates under the Family Medical Leave Act, or FMLA. Here, an employer may be required to give an employee, who has worked for the employer for at least 12 months or 1250 hours during the 12 months before the leave, up to 12 weeks of unpaid leave for certain family and medical reasons. The employee would return to the same or a similar position when the leave is over.

Although not required to hold a position for an employee, it may be prudent for an employer to do so anyway. The question that should immediately pop into an employer's mind in this situation is, "Is the injured employee worth holding open the position?"

An employer should immediately evaluate the injured employee's worth to the practice. Is the employee a star performer who will be difficult to replace? Is he or she the "model" employee who receives well deserved, excellent job reviews every year? Does he or she have such rapport with the patient base that a permanent absence will affect the practice? How will the rest of the dental team work without this person?

Most employers have a pretty good idea regarding the performance of each team member. There are some that are so well suited for their office that they cannot imagine working without them. There are other employees that do not seem to meld, may be inept in various situations, and the employer spends many hours thinking that it would be nice if a more competent worker could only replace them.

For the employee who is competent, and would be sorely missed, hold open the position until he or she is well enough to work again. For the employee who is not up to par, replace him or her.

In addition, because Arizona is an "at will employment state," it is possible for an employer to retain one employee and not another. Following the rules in Arizona, it does not matter if a precedent has been set within an office. For example, regarding the original question, two employees could have been on the same skiing excursion, both equally injured, but the employer has the option of retaining only one employee. However, managing this scenario in your office, is not recommended.

When an employee must take an unpaid Leave of Absence, whether it be for a broken ankle, maternity, or caring for a seriously sick child/family member, there are ways to diminish the financial hardship to your employee. Earned but unused paid time off in the form of sick pay and/or vacation pay should be used first. Some employers feel compelled to grant unearned, future vacation pay to an employee who is in good standing with the office (tenured, trustworthy) however this is not recommended. Not only may the employee never return to work and therefore the money is not "recouped", burn-out is high without some vacation/time away from the work environment if the employee does return to work.

In the event of an injury, one may consider asking for certification from the physician that details the date when the health condition started, the length of time the condition is likely to last, diagnosis of the condition, treatment prescribed, and whether inpatient treatment is required. You are free to decide when to ask for a certificate, but maintain a uniform policy; don't be selective concerning the event or the person, it may lead to discrimination issues later. Since most people are honest, the simplest and legally safest policy is an honor system in which you accept employee's statements at face value. Finally, ask for a final written statement from the physician that the employee is cleared for work and if there are any restrictions prior to commencing employment.

With this issue and others that may occur in the practice, double check the practice's Personnel Policy Manual and be sure a fair and sensible policy for a leave of absence is in place. Accidents happen, and we must be proactive in warding off problems that may result from such events.

Can I implement a personal cell phone use policy stating phones are to be shut off during business hours? If so, should that policy stipulate the use of personal cell phones is permitted only during break and lunch periods?

How in the world did we ever live without cell phones? How did we have the patience to sit by a land-line phone waiting for a call? How did we track down a friend at the stadium, or our teenager in the mall? How many of us remember trying desperately to find a pay phone, and then realizing we didn't have a dime or correct change to make a call?

Cell phones have become an important, beneficial part of society, I suppose it could be said that they are a necessity. As valuable as cell phones are in this day and age, they also have become an intrusive part of society. Twenty years ago, we weren't reminded to turn off our cell phones prior to a movie or performance. Twenty years ago we didn't take a phone call in the middle of a restaurant, and we weren't subjected to listening to one-sided conversations in most every environment.

Cell phones have their purpose, but also can be a bane to mankind. It is increasingly difficult for people to disconnect from their own personal worlds with its distractions and live in the here and now. For example; "I am glad I am enjoying an intimate luncheon date with you my friend, but please excuse me if I need to take an important business call."
Although cell phones can be considered a valued asset in some circumstances, they are not ALWAYS a necessity. In answer to the original question; yes by all means a dentist should have a policy requiring cell phones be turned off during the working day. Not only should cell phones be off, but also cell phones should be kept in the employee's purse or locker so as not to become a distraction such as in cases of text messaging or retrieving voicemail, both of which can be done silently. Even with the extenuating circumstance of an emergency, family members can always call the dentist's main office line to relay any concerns or urgent need to contact an employee. An employee should only have the benefit of cell phone use during lunch or break periods. The final judgment as to whether or not a call is an emergency lies with the dentist or employer.

If you do not have a policy in the manual regarding cell phones, I suggest you implement one immediately by issuing an addendum to your manual, educating all the employees regarding the new policy, having each employee sign the policy, and put this signed copy in their employee files as part of their permanent record. At this time it would also be prudent to make sure all your employees have read your office manual, and each employee has a signed statement in their file that they have read and understand the office policies and procedures. This is a safeguard not only for the employees, in that they understand what is expected of them, but also for the employer, in that expectations have been made known and adherence to policy is expected.

Say "goodbye" to unwanted interruptions during the work day. And Say "hello" to a higher level of patient services, where patients in your office leave after a positive experience, without a cell phone ringing!

What are we allowed to say when a prospective employer calls our office for a reference for one of our ex-employees who was dismissed or resigned?

This question certainly raises a dilemma, and in today's litigious society, one to carefully think through. According to the Arizona Industrial Commission and Labor Board, no laws govern this issue in our state. Following basic guidelines will help one decide how to disclose information about former employees and avoid litigation.

An employer may fear that if any negative statements are made one could be sued for libel (written) or slander (spoken). It is best to stick with the facts and lay aside personal feelings. Basic information that may be disclosed would be dates of employment, job title and description, rates of pay both at the beginning and end of employment, and if the employee resigned or was terminated.

In order to avoid defamation, a former employee must prove that information given out was false and that the information harmed his or her reputation. Proving the information given was true dismisses these types of lawsuits. For example, disclosing disciplinary action taken during the employment period is justified provided that documentation signed by the ex-employee is on record. Make sure personnel files reflect fairness, objectivity and honesty; free of unproven gossip.

My recommendation is to speak only to the doctor, or the owner of the practice. Ultimately, these people are responsible for hiring, training, reviewing performance, and dismissing employees.

It also pays to be discrete while attending informal gatherings. Don't speak freely at a meeting or other functions where social and/or business chatter may take place. Among colleagues and employees, disclose the reasons for firing strictly on a need-to-know basis. Limit the announcements to, "Sally has left the practice and we're seeking a replacement." Either 'speak well of the dead', or say nothing at all. For example, if one believes nothing positive can be said of a former employee, simply state that it is the policy of the practice not to comment on former employees with prospective employers. Airing grievances about someone will likely spread, potentially causing legal complications.

The "Crown Jewel" of all questions that will tell a person most all they need to know about a former or prospective employee is, "Given the opportunity, would you hire the employee again?" A "yes" or "no" answer speaks volumes. Take it from there.