Articles By Fred

What are "the rules" for paying my staff while we're traveling for continuing education, including my hygienist?

The issue regarding pay and travel for continuing education comes up quite a bit, and since there is no "rule" or industry standard, a dentist or employer should consider an approach based on what the business can afford financially, while being reasonable. Once a protocol or policy is formed, commit it to paper, have each member of the staff acknowledge and sign off on the policy. Finally, include it as part of the office's personnel policy manual.
A general "rule of thumb" to follow is if one requires an employee to attend a lecture, meeting or training seminar then expect to pay for that employee's time. Situations in which paying for the employee's time would be an option are if:

• The employee attends the event outside of his or her regular working hours.
• Attendance is voluntary.
• The instruction session isn't directly related to the employee's job.
• The employee doesn't perform any productive work during the instruction session.

With this background information, here are a few recommendations.
Continuing Education Rate of Pay
When the team is required to participate in continuing education during normal working hours or outside the normal schedule and they are not directly applying their skills, compensate employees at a Continuing Education, or CE, rate of 50% of their regular pay. Each employee will be responsible to note on his or her time log the hours that are accumulated for CE, and travel time if away from the office. This applies to all personnel except registered dental hygienists and employee dentists.
For hygienists, I suggest offering to help pay for courses they need to complete their requirements, but not compensate them for time worked while at the course. Require pre-approval of the course, and offer full tuition reimbursement of up to $200 annually. Here, one is assisting them with CE and licensure compliance, their responsibility, and in turn they accept the day off without pay.
Continuing Education Away from Home
For continuing education courses where travel outside of the immediate metropolitan area is necessary, and the course takes place outside the normal business schedule, consider these guidelines:
The employer will pay course tuition, travel expenses including airfare, ground transportation to and from the hotel, lodging, any meals sponsored by the employer, and a $40 per day allowance for incidental expenses to each employee, including hygienists. Transportation from home to and from the airport will be the responsibility of the employee. If group shuttle arrangements are more reasonable and accommodating, then the employer may elect to arrange and pay for group transportation. Under these circumstances, wages for hours worked will not be paid.
When a significant investment in continuing education and travel is made on the employee's behalf, I suggest considering a policy where the employee agrees to remain employed with the office for a period of one full year after the course is completed. If the employer terminates the employee because of a violation of company policy, or the employee resigns, then the employer may, at his or her sole discretion, require the employee to reimburse the cost of tuition, lodging, and airfare.
It is highly recommended that team members are aware that continuing education is an important part of career and practice development. State this in the personnel manual and make sure employees sign an acknowledgement form that they understand one aspect of their job will be time spent learning how to improve their own performance along with the entire team.
In summary, make sure employees understand the basis of the recommendations for this policy:
· The employee is engaging in a group session to educate the team on enhancing people and practice performance.
· They are not performing productive work during the session.
· It is an integral part of the businesses plan to support an educated and organized team.
· A significant investment has been made on their behalf to advance their knowledge and skills.

Continuing education is necessary in today's changing environment. Enhancing people and practice performance leads to enhanced patient services, and as a result, improved productivity and profit. Provide employees with a reasonable package for continuing education and travel so that the team is encouraged to advance their skills and to put forth their improved expertise.

Should I Conduct Background Checks For Potential Hires?
More often than not, I run across dentists complaining about their new hires' performance. When asked how the reference checks went prior to offering the new employees jobs, the dentist will respond sheepishly that this was not done. The reasons that reference checks were not done run the gamut of "the office was too busy and I needed someone immediately" to "the person seemed so sincere and trustworthy."
Reference checks should always be done on each applicant that one is considering hiring. With that said, we get to the more detailed investigation, that of background checks.
There will always be some dishonest people seeking employment. The job of the employer is to discover false or incomplete information given on the job application so that the dishonest person is not offered employment. The first step in securing a worthy employee is to have a thorough, well written job application. This application form can be useful not only in finding out the applicant's past experience, but can also serve as an informational tool that allows the applicant to understand the basic terms and conditions of the job he/she is seeking. The job application can also serve as a consent form in order to obtain reference checks and background information. When giving the person your application form, impress upon him/her the importance of being as accurate and truthful as possible. Application fraud, or resume fraud, is a serious offense, and dishonesty is justification for firing. In other words, discovering after the fact that a false application was submitted is cause for dismissal.
The need to investigate a potential hire is legitimate, but the employer must be careful not to infringe on the applicants legal right to privacy. The best way to circumvent privacy issues is to only pursue background information that is directly related to the person's job. Inform the applicant, within the job application, that part of the hiring process is to request information from a variety of sources that could include schools, former employers, credit reporting agencies and law enforcement agencies. Have the applicant sign a consent form as part of the hiring process. The consent form can be a part of the application or a separate form.
There is a federal law called the Fair Credit Reporting Act or FCRA that imposes strict rules on the use of "consumer reports" which includes background checks. The FCRA stipulates that in order to use a report, it must be prepared by a consumer reporting agency; meaning a business that assembles reports for other businesses.
For example, when hiring an office manager with fiduciary responsibilities, it may be prudent to perform a credit check. If the dentist uses a credit bureau to obtain the applicant's credit payment record, this would be covered under the FCRA. One might think that credit history is not relevant to employment, but when dealing with an employee who will be responsible for managing the dental office's finances, hiring an employee that has difficulty keeping personal finances in the black may not be the best choice for the job. Also, if a person is in debt, they may be more prone to skim money from the dental coffers. Embezzlement is an unfortunate, but fairly common problem that occurs in dental offices. I personally have known three dentists that unknowingly employed an embezzler.
Another background check that may be performed is the inquiry regarding criminal history. Be mindful that asking about an arrest record is a subtle form of discrimination since oftentimes arrest charges are found to be without merit and dropped. Conviction records however can be used to rule out applicants as long as the conviction has a correlation with the job being sought.
As said earlier, include written information with the application that notifies the potential hire of consumer report inquiries for employment purposes. Written permission is a requirement in obtaining consumer reports. Any agency that prepares a report for the employer will require that the dentist certifies that he/she is complying with the federal law and that the information received will not be used in violation of state and federal equal employment opportunity laws.
Upon receipt of the report, particular rules apply if the dentist decides not to hire the employee based on the report results. Before informing the employee that he/she will not be hired, a dentist must give disclosure regarding his/her decision. The disclosure should include a copy of the consumer report and a copy of "A Summary of Your Rights Under the Fair Credit Reporting Act." This is a publication written by the Federal Trade Commission (FTC). The dentist can obtain a copy of this publication either by visiting the FTC's website at www.ftc.gov/os/statutes/2summary.htm or by asking the business who prepared the consumer report to send a copy. Once both reports are given to the potential hire, or even an existing employee, the dentist can notify the person that he/she will not be hiring the applicant (or firing an existing employee). The notification can be written, verbal, or even by e-mail.
Also note, when informing the person that you will not be employing him/her, or terminating a current employee, a dentist must inform the person of the credit reporting agency (CRA), including name, address and phone number of the agency and also state that the CRA did not have any decision making abilities regarding the employee's hiring outcome as well as the CRA is unable to give specific reasons for the dentist's decision. The applicant, or employee, has the right to disagree with the accuracy of the report prepared by the CRA and an additional copy may be obtained from the CRA, at no additional charge within 60 days.
The employer must perform the above steps in order to avoid legal trouble.
This seems like a lot of work. And, as I've written in other articles, when the work performed up front during the hiring process is thorough, problem are few later. Performing a background check, although laborious, is an important, albeit optional, tool that protects the dental office from future problems with a dishonest person seeking employment.

I suspect one of my employees has a substance abuse problem. What are my options?

Each employer has the right to insist on a drug-free workplace. There are no laws preventing one from combating the use of drugs and alcohol in the workplace. There are, however, some limits on your ability to test employees for drug usage. Legally, you're free to prohibit the use of drugs and alcohol in the workplace, require that an employee not come to work or return from meals and/or breaks under the influence of alcohol or drugs, and require that all employees meet the same performance standards.
Employers needn't tolerate absenteeism, tardiness, poor job performance or accidents caused by alcohol or illegal drug use. Guard against these events with a good policy that is fair and within your legal rights.
One obstacle that gets in the way of drug testing is with workers' rights to privacy. Laws on drug testing vary widely from state to state, and legislators and judges struggle to strike a balance between workers' rights and the legitimate needs of businesses.
In our state, the Arizona Revised Statutes § 23-493 explains our limitations and legal parameters. Here is a summary to start things off.
· Employers with one or more full-time employees must abide by the statute.
· Employers must inform prospective hires that they will undergo drug testing as a condition of employment.
· Employees are subject to random and scheduled tests for any job-related purpose, to maintain productivity and safety, and upon reasonable suspicion.
· The drug-testing policy must inform employees of their right to explain positive results.
· Before conducting tests, the employer must give employees a copy of the written policy. The policy must state the consequences of a positive test or refusal to submit to testing.
So, in direct response to the question heading this article, "Reasonable Suspicion" is your key. However, be careful.
There's nothing wrong with firing an employee or rejecting an applicant who uses, possesses or distributes drugs illegally. This includes the use of illegal drugs and the illegal use of prescription drugs that are deemed controlled substances under federal drug laws.
Example, Quite Bright Smile Centers, a fictitious dental office, fires Hilda after determining that she takes amphetamines without a doctor's prescription. Amphetamines can be legally prescribed, but are classified as "controlled substances" because of their potential for abuse. If a doctor didn't prescribe amphetamines for Hilda, Quite Bright Smile Centers would be justified in firing her for illegal use of drugs.
How did Quite Bright Smile Centers know Hilda was using drugs? The most reliable way to determine that an employee is using drugs illegally is through a drug test.
Most businesses have a policy prohibiting employees' use of alcohol or illegal drugs in the workplace. In addition, some businesses offer employees help in dealing with abuse of these substances, often through an employee assistance program in which the business pays for professional counseling. In my personal experience, dental offices rarely have a written policy on drug testing. And, dental offices may not be prepared to handle the cost of providing help in this regard.
Once an applicant becomes an employee, drug testing gets stickier. Testing is usually permitted when employees have been in an accident or you've seen them bring illegal drugs to work. Your legal right to test at random without a solid written policy signed off by each and every employee is unclear, and questionable.
Recovering addicts are protected within the Americans with Disabilities Act. The Act prohibits you from discriminating against people because of past drug problems. This includes people who no longer use drugs illegally and those who are receiving treatment for drug addiction or who have been rehabilitated successfully.
Pre-employment testing is the safest type of testing from a legal standpoint. After an employee is hired, federal and state laws as well as court decisions control testing. If you decide to test, your primary motive should be to ensure the safety of workers, patients/customers, and members of the general public who frequent your office.

You're most likely to withstand a legal challenge if you limit testing of employees to three situations.
1. Safety and Security. Because a dental office provides hands on health care that carries a risk to the public's safety, you can require periodic testing of your employees.
2. Accidents. You can require testing of an employee who's been involved in an accident. For instance, an employee who accidentally causes injury to a patient or themselves.
3. Retesting. You can require periodic retesting of an employee who is currently in or has completed a drug rehabilitation program, or an employee to whom you've given a second chance. Example: one who tested positive for drugs after a personal injury accident, but was kept on the job anyway.
Even though you have a right in these situations to require a drug test as a condition of continued employment, you can't force an employee to submit to a test against his or her will. You can, however, fire an employee who refuses to be tested if it is in your written policy as a consequence of declining a test.
In general, avoid a policy of testing all employees. Not all of them will be in a position to cause harm through drug usage. Similarly, avoid a program of random drug testing. If you test all employees, test them randomly or test without a good reason, you may get sued for invasion of privacy or infliction of emotional harm.
To keep your drug testing program on a solid legal footing, use a test lab that's certified by the U.S. Department of Health and Human Services or accredited by the College of American Pathologists, keep the results of the drug test confidential, and be consistent in dealing with those who test positive. Also, keep good records documenting why and how tests are administered. Require employees to acknowledge in writing that he or she has been given a copy of the drug and alcohol policy, or include the policy in your employee handbook and obtain a written acknowledgement that the employee has read the handbook.
Alcoholism is treated somewhat differently. A person disabled by alcoholism is entitled to the same protection from job discrimination as any other person with a disability. But, you're not required to overlook the effects that this disability can have on job performance. Under the Americans with Disabilities Act (ADA), you can discipline, discharge or deny employment to an alcoholic if the person's job performance or conduct is so badly affected by alcohol usage that he or she isn't qualified to do the job.
Example: Quite Bright Smile Centers employs Gertrude who often is late for work and sometimes is unable to perform her job up to standards. The employer disciplines her because of her tardiness and poor performance. The company holds Gertrude to the same standards as its other employees and disciplines her in a like way. This doesn't violate the ADA.
Neither the ADA nor its regulations define alcoholic or alcoholism. The lack of definitions may have little practical effect, however, since the ADA allows you to judge the employee by his or her ability to do the job. People who have an alcohol problem aren't legally entitled to any special consideration.
Be proactive in handling the sensitive issue. My "Practice Pointer" today is to establish a written drug-testing policy and have each employee sign off on the written document. Provide this to each applicant so that they too are aware of your position. Follow the guidelines in this article so as to be fair and prudent within your practice.
Here's an example of what I would recommend:

Drug Testing

The aim of random and scheduled drug testing is to ensure a safe and drug-free workplace. The practice will treat all team members consistently and not single out any one person or group.

Prospective employees and team members currently employed may undergo random and scheduled drug testing as a condition of employment. These tests will be conducted for any job-related purpose, to maintain productivity and safety, and upon reasonable suspicion of substance abuse.

Employees have the right to explain positive results. And, before conducting tests, the employees will be given a copy of this written policy, along with the consequences of a positive test or refusal to submit to testing:
· Results of a positive test may lead to termination.
· Refusal to submit to a random or scheduled drug test will be grounds for immediate termination.

I understand the policy stated above, and the consequences of a positive test result and refusal to submit to a random or scheduled drug test.
{Provide lines for employee and employer signature dates of their signatures}

Federal laws on drug testing by and large cover employees who hold jobs in which drug abuse can affect public safety. For instance, the Drug-Free Workplace Act of 1998 requires all contractors with the federal government to certify that they will provide a drug-free workplace. However, the Act doesn't require employers to test employees.
For more information, contact the Center for Substance Abuse Prevention Workplace Helpline at
800-967-5752 during business hours 9 am to 5:30 pm weekdays. Or, go to their website at www.drugfreeworkplace.gov.

Also, for information specific to Arizona law, contact the Industrial Commission at the Arizona Department of Labor in Phoenix at 602-542-4411, or www.ica.state.az.us.

What is the General Trend With Regard to Policies on Office Romances?The general trend, in the past five to ten years, is for large companies to view office romances with a more lenient eye. The Employers Council reports that only 25% of companies nationwide have some sort of policy regarding workplace "relationships."

And, let's face it…having a policy prohibiting office romances won't stop love. Also, if a dentist did choose to initiate a policy prohibiting office romances, how is this relationship defined? Outside of the office, how reasonable is it to assume that this could even possibly be monitored and followed up on? The ideal office setting is one where everyone is amicable, willing to go above and beyond to lend assistance where needed.

This friendship may continue outside the office setting. Often, colleagues get together for social time outside the office, and this is considered friendship. Where does a boss draw the line on friendly gatherings versus dating? The ramifications of the inquiry could easily bring on a sexual harassment lawsuit…
"So, you spent the night at {you-know-who's} house?" (This line of questioning could be interpreted as a probing question regarding intimate relations and breach of privacy). "Yes, {you-know-who} was the designated driver, and I slept on the couch. What are you implying?"

Office romances are inevitable. It is easy to understand how such relationships develop; people spend a majority of their waking hours during the week at their job working side-by-side with others. Not only is there a common background and interest (workplace and skill sets), there is a lot of time spent getting to know each other in a non-threatening environment. The interested party has an idea of what the person is like after spending so many hours together. It is a wonderful feeling to find a soul mate so conveniently, no more searching. No more bar hopping or church single-socials, no more expensive dating services or Internet chat rooms. Ahh, bliss. As the saying goes, love can be blind. And blind it is in that there is much more involved regarding the work environment. It would be a wonderful thing if an office relationship came without hitches, but the hitches are aplenty, and they are called: additional fellow office workers; career advancements; job reviews; job requirements; terminations; rivalry; competition; jealousy; favoritism…to name a few.

Whenever advancement occurs, co-workers of equal status will try to determine why; "Why him/her and not me?" If there is a known "relationship" in the office, career advancement is even more carefully scrutinized. If the significant other was promoted, there is the risk of blame, "We know how he/she got that job!" The fallout from these thoughts and emotions causes less respect toward the person in the new job, as well as jealousy and resentment. It will be more difficult for the significant other to fulfill this new role to its full potential.

On the other hand, if a colleague of equal status was promoted, and not the significant other, jealousy and resentment may also arise. There will always be the internal office struggle regarding ulterior motives. Was an advancement based on a relationship, was the advancement of a colleague based on merit, or even, was the advancement of a co-worker based instead of the significant other due to a love squabble outside the office? In any of these scenarios, resentment and jealousy can easily arise within the office, and these emotions can easily be transferred into a case of sexual harassment/sexual discrimination.

Since office romances do occur, the best option for a dentist is to have an understanding of how people work together and how human emotions and relationships develop when people work in close proximity. It is also advisable to have a strong, enforceable policy prohibiting sexual harassment/sexual discrimination. This policy should be contained in the office's Policy Manual. And, as we all know, a signed acknowledgement form stating the employee has read and understands the office's policies should be included in each employee's personnel file. The policy should be explicit regarding what is considered sexual harassment/discrimination, and the ramifications of violating the policy; the employee is subject to disciplinary action including termination.

Below is a copy of the sexual harassment section that is included in the office manual of dentists that I provide consulting services for. It would be wise to check your policy for completeness, and have your employees sign the policy immediately if they haven't already done so.

Sexual Harassment
The employer is committed to providing a work environment free of discrimination. In keeping with this commitment, the employer maintains a strict policy prohibiting sexual harassment. This policy applies to all employer agents and employees, including management. Sexual harassment includes: flirtations, touching, propositions, verbal abuse of a sexual nature, graphic or suggestive comments about an individual's dress or body or actual or perceived sexual orientation, the display of sexually suggestive objects or pictures, including nude photographs.

Sexual harassment also includes, but is not limited to unwanted sexual advances and requests for sexual favors where either (1) submission to such conduct is made an explicit or implicit term or condition of employment; (2) submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual; or (3) such conduct has the purpose or effect of substantially interfering with an individual's work performance or creating an intimidating, hostile, or offensive working environment. Employees who violate this policy are subject to disciplinary action, including dismissal.

Any incident of harassment, including work-related harassment between employees, patients, or any other persons, should be reported immediately to the employer and/or to the designated individual. Employees will be given the name and or title of the individual so selected. A prompt investigation will be conducted as discreetly as possible. Obviously, no employee reporting any such harassment will be subject to any sort of retaliatory action. Any employee accused of prohibited conduct will have the opportunity to explain the conduct in question. In the case of our employees, if harassment is proven, the offender will be disciplined, up to and including termination. It is the responsibility of every employee to conscientiously follow this policy.

Conclusion
Romances between co-workers, employers & workers, vendors, and customers/patients may happen. Discuss with your team how you will handle this issue. Establish a policy that is professional, sensible, and in line with your dental practice's fundamental principles. Regardless of inter-office relationships, your team must know the expectations for job performance and behave in a responsible, professional manner within the work environment.