Articles By Fred

“I’m still trying to configure a budget for 2009. I wonder which expenses I should really focus on to create a healthy profit. One of my first thoughts is to consider how to pay staff for attending Continuing Education courses, especially since the Western Regional Dental Convention is coming up. What is your recommendation?”

Believe it or not, I have come across dentists who want to save money by eliminating all C.E. course benefits for their staff. In my opinion, this is not a wise move to create more profit. The argument that was brought up by one particular dentist was that since hygienists have a requirement for a certain number of C.E. hours to keep their licenses current, the cost factor should fall on their shoulders. It is their responsibility to fulfill requirements in order to remain valid practitioners.

Sure, it’s true that employees need to be responsible for keeping licenses current, but what example does not assisting with C.E. costs set? I feel it shows that “doing the bare minimum, just to squeak by license requirements is fine by me.” A better example for all employees is “I believe in your talents, and I want to make an investment in all of you to not only better and empower yourselves, but to also benefit our patients. Attending continuing education courses helps to assure that we are providing care and service to the best of our abilities.”

Team members must be made aware that continuing education is an important part of career and practice development. It is also an important investment in time on their part and resources on the part of the practice. Together, the employer and team will benefit from C.E. when approached sensibly.

All this being said, there are some tips I can share regarding expectations not only about C.E. reimbursement, hourly pay for staff to attend, but also expectations for employees.

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 and what philosophy the owner has regarding C.E., while being fair and reasonable. Once a protocol or policy is formed, commit it to paper and 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.

How much should I compensate my employees for Continuing Education?

When the team is required to participate in continuing education either during regular working hours or outside the normal schedule and they are not utilizing their core competencies and not creating revenue, compensate employees at a Continuing Education, or C.E., rate of 50% of their regular pay. Each employee will be responsible to note on his/her time log the hours that are accumulated for C.E., and travel time if away from the office. If an employee is salaried, the compensation remains the same, regardless of when the continuing education course is in session.

For hygienists and employee dentists, I suggest offering to help pay for courses they need to complete their requirements, but not compensate them for time spent while at the course. Require pre-approval of the course, and offer tuition reimbursement for hygienists; say up to $200 annually. Use your own discretion as to how much reimbursement you wish to make available for employee dentists. Again, this is optional, and is dependent upon the employer, his or her philosophy, and budget. In reality, the employer is assisting in keeping employee dentists and hygienists up to date with CE and licensure compliance, which is ultimately the responsibility of these professionals, and in turn they accept the day off without pay.

How should I handle continuing education away from home, especially when travel is involved?

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.

When a significant investment in continuing education and travel is made and the employee’s are reasonable and cooperative, then the employer may elect to 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 supplementary expenses to each employee, including hygienists. The per-day allowance will also help cover gas to and from the airport. Under these circumstances, wages for hours worked will not be paid.

The employee will be responsible for travel to and from the airport. If group shuttle arrangements can be made, then encourage employees to car pool to and from either the airport or the course venue.

How would I handle a “Hands On” course when I consider one of my employees as my patient for the restorative dentistry?

On occasion, doctors have taken employees to courses and provided them with a significant amount of restorative dentistry; even “Smile Designs” in some instances. The employee becomes a great spokesperson for restorative and cosmetic dentistry and patients take well to witnessing the excellent results from the doctor’s work. Unfortunately, I witnessed an occurrence where after a short period of time, an employee decided, “The commute to the office is too far” and quit because she “found an office closer to home”. <>

Without any prior formal arrangement, the employee is certainly free to go; but it’s discouraging to know a person would be selfish enough to take advantage of the generosity of the employer by leaving shortly after major restorative work was done for free. Strange, the employee had no qualms making the commute prior to the course (and major restorative treatment provided) and didn’t mention any concern over travel time to and from the work place.

To ensure employees stay on board after a significant investment in continuing education is made, 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 part of or the entire cost of tuition, lodging, and airfare.

Prepare this policy in clear terms and in writing ahead of time, prior to leaving for the course. Supplement your employee manual with the new policy. Make sure employees acknowledge and sign off that they understand the policy.

I’m not trying to overstate the obvious, but one aspect of the employee’s job is time spent learning how to improve his/her own performance so that the business will grow and develop along with the entire team’s performance.

What if an employee chooses not to participate in a continuing education “trip” away from home?

It may occur that an employee chooses not to participate in a continuing education trip away from home. Certainly, family issues, health issues, or personal reasons may result in the employee choosing not to attend. In this case, the employee must take time off from work if the course is during normal working hours. They may choose to use their accrued and unused paid time off to receive pay, or not work and not be paid.

An alternative is to allow the employee to work in the office, if the course takes place during the normal work schedule, and receive the regular rate of pay. However, be precise as to what is required of the employee, make a list of tasks that must be completed, and require the employee to be accountable for completing the tasks. A good idea is to have a briefing of what is to be accomplished prior to leaving, and what was accomplished on the first business day back from the course. If the tasks were completed, “Hooray!” Recognize the employee for a job well done. If the tasks were not completed, discuss this with the employee and find out why the work was not completed as required. The privilege to work unsupervised should not be offered to this individual in the future.

I trust my staff to go to courses, be responsible adults and not duck out early while claiming they attended the entire course. Am I being naive?

I have to play the devil’s advocate, and hopefully this does not pertain to any employee in your office! We all want to believe in staff honesty, but let’s face it; unless there are stipulations in place to show attendance, time spent at conferences can be iffy. If the dentist and staff travel to each event together, there of course is no question, but if the staff members are off on their own, then steps can be taken to get the most out of your continuing education dollars.

After the convention, meeting, or C.E. course, require a short presentation from each person and each course attended. The presentations could be the focus of an office meeting pre-scheduled the week following the course or convention. Allow each team member adequate time to present their portion, say five to ten minutes, and allow time for discussion, questions and answers. Use the material from the team’s presentations to initiate new policies or procedures to help better the practice and apply them as soon as possible.

In addition, if it is expected that the staff circulate among the booths at the convention, have a “shopping list” for items and require business cards to be brought back, with names of the representatives at the booths that they spoke to, even requiring the staff to explain what was unique about each company and how each company could benefit the practice. Make sure that the staff understands the importance of company representation at dental conventions by showing good taste and exercising good manners

To sum up, examine your own practice in regards to continuing education benefits. Consider your philosophy of practice and how it can be supported with useful C.E. and what courses would help make your business plan come to fruition. Consider your financial resources and prepare a budget for how much money the practice will invest in 2009 and beyond for C.E. Construct clear policies regarding C.E. and how the team is compensated. If courses require a significant investment in time and resources, prepare a policy ahead of time and obtain the acknowledgement of the team, so there are no surprises. Have a meeting shortly after the course or convention and put into action recommendations that will help better your business.

Here’s to seeing you at the 2009 Western Regional Dental Convention!

“My business has been doing quite well over the last several years. But now, I’m not alone in finding times are tough. I thought I could weather the storm, but the down economy is hitting me, like it is other dentists, I’m sure. What do you recommend a dentist do in a down economy to boost his or her business?”

Let me take you back in time, for a moment…

In the not too distant past, dental practices were beyond thriving. There was an abundance of new patients, who along with the existing patient base, were willing to follow through on recommended major restorative work as well as opting for elective cosmetic procedures. These patients either had the money or were willing to utilize third party financing and pay the balance off “interest free” over time.

The first storm that dentists had to weather occurred after 9/11. This catastrophic event created uncertainty in the minds of many, and as a result made patients more reluctant to go forward with major treatment, or jump on the cosmetic “smile makeover” bandwagon, as did their friends. But even as the trouble in the Middle East continued to brew, there was a small but not too significant drop in production for some dental offices. It became apparent that these events had an impact on the dental industry.

Ahh, but then dateline 2004: Our home values are climbing; Arizona is one of the most sought after locations in the country to live in; people are flocking to our state to enjoy the riches this land can offer. People are buying homes left and right! Dentists are setting up “scratch start” practices in communities destined to bring thousands of new homes and people with teeth to work on! Even though dental offices worked diligently to keep patients’ teeth healthy, it became much easier to rest on one’s laurels without having production slump.

Fast-forward to 2007: The beginning of the housing market decline. The bubble burst! Thankfully, not as big a burst as some other areas in the country, but it happened here in our own back yard. As a result, patients who “would have been” aren’t coming to the dentist’s door because mortgages have gone sour, over time their home isn’t built; sometimes foundations haven’t even been poured. Consequently, new dental practices in the anticipated high growth areas of the state began to dry up. Unfortunately, we haven’t recovered and the economy is setting records for being the direst in decades.

Sorry, this is reliving the nightmares that have been keeping us awake. But, reality is that we are facing a very unique series of events, which requires action on the part of dental practices in order to maintain previous profit levels or even to recover. Something must be done to keep the business vibrant, growing, and profitable, but what?

Staying afloat and even growing your practice in an economic slump can be accomplished, but you must realize you can’t go on doing the same things and expect to achieve different results. Change is necessary in that people who run a business must be willing to adapt to new concepts as well as re-committing to fundamental management principles and proven systems in order to bring themselves back up to previous productive levels.

The preeminent “Practice Pointer” in a down economy is, DON’T ASSUME! Don’t assume that the economy is affecting every patient across the board and “nobody can afford anything.” How do you know what the patient will say ahead of time? You don’t. Sure, there may be plenty of patients that will say something to the tune of, “Oh, times are tough, I can’t afford it.” But there are others willing to go ahead with treatment, including complete dentistry, and even smile designs. Know that patients may say “no”, but keep them engaged in the practice; don’t lose them long term. Leave the door open with an approach such as, “We’re here for you; when you’re ready (resources have rebounded, time is right, pain won’t go away, etc.) Call us. We’ll make room for you right away.”

Several of my management consulting client dentists in the Greater Phoenix area are keeping steady or have demonstrated better numbers this year than last year; …in a down economy! Proof positive that patients are saying, “Yes” to treatment even today.

The next thing to remember is obvious; continue doing what you do best, which is diagnosing disease conditions and recommending treatment that will solve the problem and make the patient well. Don’t compromise complete diagnosis and complete care. The doctor and entire team must continue with patient education and compelling case presentations for each patient. Are you confident that your staff members are skilled and even excel at case presentations? If the answer is no, now is not the time to save money and throttle back on continuing education. Keeping staff at peak performance levels can only enhance and advance the practice.

The backbone of general practice is the hygiene department. Without a Periodontal Maintenance system that is well organized and diligently orchestrated, an office will witness a decline in patient visits resulting in a decline in income. Moreover, in uncertain economic times, it’s very important to advance prevention as a method to keep patients in the practice. Consider the difficulty in trying to convince someone to come in for extensive treatment that they have already said, “No, I don’t have the money, the economy is terrible, …”. Re-direct the energy into encouraging them to maintain their current state of health with a routine (prophy, periodontal maintenance/exam/call-it-what-you-will) visit. It goes without saying, do not turn a blinds eye to the treatment that is still pending, keep encouraging the patient to remedy their dental malady albeit in a friendly, professional manner.

During these times, a meticulous inspection of the program in your office must commence immediately. First, don’t assume each and every patient in your practice has been contacted for his or her preventive care or periodontal maintenance visit. Inspect each patient’s history either through the physical chart or computer record to be sure they haven’t “slipped through the cracks”. Next, establish a program that will contact each patient and ensure an appointment is made to keep him or her on a maintenance schedule.

In my travels, I have found practice management software systems that have a recall program that assists the office in managing patient continuing care. I have also found that these systems are not watertight and patients slip through the cracks at times perhaps because people are running the software. Further, team members may leave the practice for one reason or another only to leave a system that was orchestrated properly in the hands of someone who doesn’t know it as well, used a different software program, or has a different way of running recall. Don’t Assume! Learn your software program and how it manages recall, inside and out. And if that means hiring an experienced trainer to come in and seal up the cracks, then do so. Then, be certain all patients are included in the database with their correct maintenance interval. If this means a physical chart audit to confirm the database is complete, so be it. You said your office had slowed down, right? What else is your team doing?

The next step is where the rubber hits the road. The old adage rings true today,

“Ideas are a dime a dozen; people who put them into action are priceless”!

Direct your team to contact each patient who is not yet scheduled encouraging them to maintain their current state of dental health and make an appointment! Begin with a phone call first; and consider calling at a time of day that stands the best chance of reaching the patient. Yes, that means late afternoon and early evening. Have the right dialogue in place, rehearsed, so that the telephone contact has impact and positive results. A written script is handy, one that is encouraging without being too overly zealous. Second step is a postcard, sent two days after the first phone call. Third is another phone call made no more than one week after the postcard. Last contact is a nice letter that asks the patient to contact the office when they are able to confirm contact information and active status. Send this letter out the week following the second phone call.

Make a commitment to this project and be sure to follow a tight schedule. Don’t let a lot of time pass between phone calls and written correspondence. Additionally, depending on the size of the practice it may be prudent to begin with a block of patients and work through 50 or so at a time.

I trust the thought behind this is obvious to you. You are investing in time, which you certainly have on your hands. And, patients are more willing to come to the office for a routine “cleaning and check-up” since their out-of-pocket investment in these services is less than it would be for major treatment. Wouldn’t you agree it’s more difficult to get people today to come in for six implants and 14 units of crown and bridge than it is for a cleaning?

Lastly, in today’s uncertain economic times, non-productive use of time is not allowed, and not an option! Heck, this should apply whether the economy is down or not! Dental team members are getting an hourly salary to work, not read magazines or make personal phone calls. If you have a “Morning Huddle” spend time discussing what needs to be done during down time in the schedule. The dentist or office manager should keep a list of work items that could be accomplished so that jobs can be directed right away.

Supply use, if not monitored correctly, can be a drain on a practice. Having the staff be frugal in what is used can be a money saver. Designate one employee who is responsible not only for ordering supplies, but also in overseeing usage over the course of the ordering period. Taking note of the inventory of supplies already on the shelves so as not to over-order is important too.

Re-visit Internal Marketing

The dental team must be diligent in core internal marketing techniques. Three mainstays are asking for referrals, re-visiting previously diagnosed conditions that require treatment, and performing care-calls. Here is a helpful guide on these three to make sure the techniques pay off right away.

When asking for referrals, have an idea of what you will say so that when the occasion presents itself, it’s not foreign. Try to formulate your own style behind these sample scripts:

“Mrs. Herbert, thank you for the trust and confidence you place in us for your care. Please know that we always welcome new faces in our practice. If there is anyone you know that may benefit from modern dentistry, please direct them our way. We will take great care of them.”

Or,

“Mrs. Herbert, I’d like to ask your help. As you know, our goal is to help as many people become as healthy as possible. Sadly, the American Dental Association reports that 50% of the adult population does not visit the dentist regularly. If you happen to know someone that could benefit from modern dentistry, please send them our way. We will take great care of them. Thanks for your help”

Also, after a patient has completed treatment, use the occasion to praise their commitment and parlay that into a marketing opportunity:

“Mrs. Herbert, now that we have completed treatment, let me commend you for making a commitment to your health. It would be great to help other people like you. We always welcome new patients to the practice, feel free to refer our office to your friends and neighbors, we’ll take great care of them.”

Lastly, look for an opportunity to suggest referring patients to the practice. Have you ever had a patient who compliments you, a team member, or commented positively on their experience in the practice? If so, turn it into an opportunity,

“That’s so nice of you, thanks very much. And if you know of anyone who is looking for a great dentist, send them our way and make sure they tell us you sent them, we’ll take great care of them.”

When patients return to the office, for any reason, be it for periodontal maintenance, for completion of treatment in progress, or for further treatment as planned, re-visit previous treatment by following this guide:

1. 1. Ask the patient specifically about the treatment performed on their last visit.
2. “Mr. Smith, last time you were in, we took care of that tooth that was bothering you on the lower left side; how’s that feeling today?”
3. 2. Clarify that the treatment performed was satisfactory and the patient is pleased with the outcome: “Oh, my, yes, I totally forgot that you put a crown on that tooth; it feels great!”
4. 3. Document this conversation in the patient’s record to show the treatment was successful.

In most cases, the patient will be happy and indicate they are satisfied with the work. Use this as an opportunity to recommend referring someone to the practice. Then, continue the appointment. In the unlikely event the patient is not happy, spend whatever time is necessary to ensure their concerns are documented and understood. Then, work immediately to resolve the issue before beginning any further treatment.

By far, the most successful form of internal marketing is calling patients on the evening of treatment, or placing care-calls. Call any patient who has received an injection in your office on the evening of their treatment. This is a 30 second public relations phone conversation that must be made by the doctor:

“Mrs. Jones, this is Dr. Herbert calling. It was nice to see you today; how are you feeling?”

Harvey Mackay, who wrote “How To Swim With The Sharks Without Being Eaten Alive”, and “Beware the Naked Man Who Tries To Sell You His Shirt”, said it best,

“People don’t care how much you know, until they know how much you care about them.”

The entire purpose of this call is to demonstrate to patients that you care about them. Don’t consider calling only difficult treatment patients; I strongly recommend calling any patient who has received an injection. Most patients will be very pleasantly surprised by the call. Most likely, their doctor before has never called them! The obvious message is that you care about them.

To sum up, there is camaraderie amongst dentists, so don’t hesitate to talk to fellow practitioners; you may be able to pick up on some worthwhile tips and good advice can be shared between offices. It is also important to keep abreast of the news to keep yourself and the staff on their toes. But don’t stress too much, worrying about the news and the daily stock report will do nothing to change it. Put the energy that you would have spent worrying into action instead.

“Recently I came across a colleague who was dealing with a complaint regarding a breach in privacy among a patient in his practice. How can I be sure that all of the HIPAA Guidelines are being followed in my office? What systems do I have in place that could jeopardize the Privacy Act?”

This is a timely question, as Susan and I had the opportunity to visit healthcare facilities including hospitals, emergency clinics, specialty physicians, and physical therapy clinics for both our daughters this past summer (Rose’s split-open knee has healed nicely, and Mary’s torn ankle ligament is on the mend). During our visits, we witnessed multiple violations of HIPAA, and wondered how often this is occurring in dental offices.

The Health Insurance Portability and Accountability Act of 1996, the privacy provisions of the federal law, applies to health information created or maintained by health care providers. This Act went into effect on April 14, 2001, with a Rule of Compliance deadline on April 14, 2003.

In dental and medical offices, back in 2002-2003, there were analyses and well thought out plans in order to become compliant with the new HIPAA regulations. Five years later, how sure are you that your office has remained compliant? Sure, it is easy to push the Notice of Privacy Practice Sheet and Acknowledgement Form under the rest of the new patient paperwork, make sure the form is signed and dated, and clip it into the chart. But what happens beyond this initial step? How careful is the office to keep faithful to the rest of the privacy stipulations? Has your office become lax in following the “letter of the law” or have policies been instituted in your office that make patient privacy turnkey?

Dental offices that transmit any health information in electronic form, either directly or indirectly through a vendor or billing service, need to appropriately safeguard and disclose protected health information in compliance with federal requirements.

Failure to comply with the Privacy Rule can subject dentists to severe sanctions for violations, including both civil (fines) and criminal penalties. Civil penalties are $100 per violation, up to $25,000 per person, per year for each requirement or prohibition violated. Federal criminal penalties are up to $50,000 and one year in prison for obtaining or disclosing protected health information; up to $100,000 and up to five years in prison for obtaining protected health information under “false pretenses”; and up to $250,000 and up to 10 years in prison for obtaining or disclosing protected health information with the intent to sell, transfer or use it for commercial advantage, personal gain or malicious harm.

What should my office be doing?

•  Be vigilant that privacy practice policies and procedures are being followed
• Have in place a privacy compliance program that includes internal auditing of privacy procedures, with training of new employees so that the staff understands the practice’s privacy procedures
• Designate a “Privacy Officer” (can be the office manager or a spouse) to be responsible for overseeing that privacy procedures are adopted and followed
• Maintain reasonable and appropriate administrative, technical and physical safeguards to ensure the integrity and confidentiality of patient health information
• Protect against reasonably anticipated threats to the security or integrity of patient health information
• Protect against unauthorized uses of disclosures of patient health information
• Make sure that patients cannot see each other’s health information
• Ensure that only those employees who need to see patients’ health information in the course of their jobs can do so
• Take “reasonable precautions” to minimize the chance of inadvertent disclosure of a patients’ personal health information via oral communication to others who may be near
• Establish “Business Associate” contracts with labs, consulting firms, e-claims clearinghouses, collection agencies, and computer software/hardware vendors to protect private health information
• Provide information to patients about the privacy rights and how their personal health information can be used.

What will HIPAA privacy regulations not allow me to do?

• Prohibit dentists from talking to each other and to their patients (Health and Human Services guidance recognizes that providers understand the sensitivity of oral information, and acknowledge the importance of oral communications occurring freely and quickly in treatment settings)
• Prevent an insurance carrier from verifying patient eligibility when contacted by a dental office
• Prevent an insurance carrier from reporting the status of a pending claim to a dental office when contacted by the office
• Prevent a dentist from sending appointment reminder cards to patients
• Prevent dentists from having a sign-in sheet at the front desk, however the reason for the appointment should not be listed on the sign in sheet
• Prevent dentists from engaging in billing and collections activities, including the use of collection agencies
• Require dentists to obtain written consent from patients for disclosure of health information. Dentists and other providers will be required only to make a good-faith effort to give patients written notice of privacy practices and patients’ privacy rights.

Where am I now?

1. Make sure all existing consent and authorization forms are up to date and continue to comply with the regulation. Continue to have patients read and sign visually separate consents for assignment of benefits and use of healthcare information.
2. If you’re using protected health information for any purpose other than treatment, payment, or operations, make sure you have a special authorization form that conforms to the requirements of the privacy regulation.
3. Draw a diagram of your facility and plot each point where consent for information use might be obtained in your organization. Make certain that you provide an environment where patients can privately review and ask questions about the consent and how you will use their personal health information.
4. Draw another diagram of your facility and plot the locations where protected information could be inadvertently released by paper, phone, fax, and computer. Implement strict policies and processes for employees who work in these locations. Besides mail, fax, and electronic communications, don’t forget about wired and wireless phones as a high-risk medium. Make sure that your staff protects phone conversations from being overheard by patients and visitors in reception areas and corridors.
5. Inventory all of your business associates whom you disclose protected health information to, describe the information you disclose, and explain the business purpose for which disclosures are made. Execute business associate agreements with those business associates.
6. Determine that your policy and process for documenting and tracking any disclosures of health information for reasons other than payment, treatment, and healthcare operation is being followed and secure.

After doing a thorough check that your policies and procedures are intact, it would be wise to have an office meeting to revisit HIPAA regulations, discuss the following insert as well as have each employee sign and keep this form in the permanent employee record:

Patient & Records Confidentiality

We make available to each employee certain information, including patients’ names, dental history and addresses, communications, files, bills and payment records, office forms or manuals, etc. These items are of substantial value, highly confidential, constitute the professional and trade secrets of the doctor and are provided and disclosed to the employee solely for use in connection with your employment. We ask our employees to:

• regard and preserve practice information as highly confidential and the trade secrets of the employer. Such information must not be discussed away from the premises or within hearing distance of any patient or unauthorized person.
• not disclose, or permit to be disclosed, any of this information to any person or entity
• not photocopy or duplicate, and not permit any person to photocopy or duplicate, any of the information without the employer’s consent and approval.
• not make use of the information for your own benefit or the benefit of any person or entity other than the employer.
• continue to keep any information confidential even after termination of employment with the office.
• release personal information about other team members-phone num­ber, address etc.- only with the team member’s specific and prior approval in writing.

Employees who handle confidential information are responsible for its security. Extreme care should be exercised to ensure it is safeguarded to protect the practice, each team member, the suppliers, the patients, and the employer. Any employee who violates this confidentiality and disclosure policy is subject to disciplinary action up to and including discharge and in extreme cases, legal action.

It is very easy to become complacent in the day-to-day operation of any workplace. But it is wise to be on the look out for possible gaps in a seemingly well run practice and safeguard against unfortunate events that could arise.

Should I compensate my employees for continuing education courses away from our hometown? How about courses in town? What if they choose not to attend CE courses that I subsidize and ask for them to attend?

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. Once a policy is initiated and the protocol set, commit it to a formal written document, and have each member of the staff acknowledge and sign off agreement with the policy. Finally, include this document as part of the office’s personnel policy manual.

A general “rule of thumb” to follow is if an employee is required to attend a lecture, meeting or training seminar, the employee should be reimbursed for his/her time.

Situations in which paying for the employee’s time would be an option are:

• The employee chooses to attend a CE event, which is not required, 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.

How much should I compensate my employees for Continuing Education?

When the team is required to participate in continuing education either during regular working hours or outside the normal schedule and they are not creating revenue, compensate employees at a Continuing Education, or CE, rate of 50% of their regular pay. Each employee will be responsible to note on his/her time log the hours that are accumulated for CE, and travel time if away from the office. If an employee is salaried, their compensation remains the same, regardless of when the continuing education course is in session.

For hygienists and employee dentists, I suggest offering to help pay for courses they need to complete their requirements, but not compensate them for time spent while at the course. Require pre-approval of the course, and offer full tuition reimbursement of up to $200 annually for hygienists, and use your own discretion as to how much reimbursement you wish to make available for employee dentists. This is optional, and is dependent upon the employer and budget. In reality, the employer is assisting in keeping employee dentists and hygienists up to date with CE and licensure compliance, which is ultimately the responsibility of these professionals, 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 supplementary expenses to each employee, including hygienists. The per day allowance will also help cover gas to and from the airport. 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 so that the business will grow and develop along with the entire team’s performance.

What if an employee chooses not to participate in a continuing education “trip” away from home?

It may occur that an employee chooses not to participate in a continuing education trip away from home. Certainly, family issues, health issues, or personal reasons may result in the employee choosing not to attend. In this case, the employee must take time off from work if the course is during normal working hours. They may choose to use their accrued and unused paid time off to receive pay, or not work and not be paid. An alternative is to allow the employee to work in the office, if the course takes place during the normal work schedule and receive their normal rate of pay. However, be precise as to what is required of the employee, make a list of tasks that must be completed, and require the employee to be accountable for completing the tasks. A good idea is to have a briefing of what was accomplished on the first day returning from the course. If the tasks were not completed, this privilege to work unsupervised may not be offered to this individual in the future.

What if I don’t want to pay my employees for continuing education?

This is an option for an employer. In that case, I suggest creating a policy within the practice that requires employee acknowledgement. Use a form with the following verbiage.

Voluntary Participation For Continuing Education

Training sessions are attended on a voluntary basis and employees are not paid for their time. Please sign this statement of voluntary participation to avoid misunderstandings.

I am voluntarily attending: ____________________

Scheduled for (date and time): __________________

I understand I will not receive wages for the hours attending.

Employee signature _____________

Date _________

Summary

In conclusion, 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 business plan to support an educated and organized team.
• A significant investment has been made on their behalf to advance their knowledge and skills.
• The skills learned and camaraderie created amongst the team will benefit the patients of the practice well into the future.

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 put forth improved expertise.