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10 Things Every Orthodontist Needs to Know About HR Management by Ann Marie Gorczyca, DMD, MPH, MS

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When I ask a fellow orthodontist how things are at his or her office, we frequently end up discussing a personnel situation. The orthodontist may be distraught. Often, he or she is burdened by a problem with an employee and wondering how to find a peaceful solution.

No aspect of dental practice management is more difficult or daunting than human resource management (HRM). Doing HRM right will help you conquer your challenges and create the orthodontic practice of your dreams. Here are 10 things you need to know to make your HR management easier.

1. Working without a team handbook is like living in a lawless land
Countries have laws. Orthodontic offices have rules. Having a team handbook is critical to your success. No office is safe without this written procedures-and-policies manual. It is a behavior guide that makes it easier for team members to understand the standards, the mission, the core values, and the rules of their office. Staff must accept and abide by these office rules of conduct. Office culture is not optional. This is not a contract, but a standard that you set for those who work in your office.

Insist upon a signed statement that each employee has read the team handbook and is aware of all that is contained therein. Have your team members read the handbook on the clock, and note that in their personnel records. Store these affirmations in each personnel file. This practice could prove useful in the future.

Attorneys often state that it is difficult to defend clients on employment issues when there is no documentation of having a team handbook that is legal and up-to-date. When opening a new office, put creation and enforcement of a team handbook at the top of your list of office-management necessities.

2. Thirty-one percent of new hires in the U.S. quit their jobs within the first six months
Despite everything you may do to hire a dedicated, engaged and capable new team member, statistics show that 31 percent of the U.S. workforce quits their jobs by voluntary leave within the first six months. The reasons for this are:
  • Changed their mind (career path)
  • Work is different than expected
  • Boss was a "jerk" (tyrant)
  • Didn't receive training
  • Job wasn't fun
We can't do much about the first two reasons, but we have the ability to be a great boss, to train and coach our new hires, and to keep the office fun. These actions will maintain turnover at an ideal rate. Note that the average employee in the U.S. stays at a job for only three years.

Voluntary resignations need to be done in writing, including name, date, time, and signature. The doctor and a witness should also sign the document. This statement will be useful in the preparation of the final paychecks. Remember to issue separate checks for regular hours worked and accrued vacation time. It may also be used as documentation in the denial of state unemployment benefits in the future, as unemployment insurance cannot be collected if the employee quits voluntarily.

3. Paying overtime is the law
No one is above the law. Paying overtime is the law. Employees cannot volunteer away their rights. Any activity that has to do with patient care will not be viewed in the eyes of the court as "voluntary." There is no such thing as "voluntary" when it comes to employment law. When an employee's presence is specifically required by the doctor, the time spent at this activity must always be paid.

While there are not federal laws that require lunch breaks, a few states such as California require a half-hour meal-period break after five hours of work. This is true even if there is a "lunch and learn"—even if food is being served, employees must clock out and take a half-hour break after five hours of work. If a team member is not offered this opportunity and work continues on, then the half-hour meal period plus one hour of additional premium pay accrues, in addition to any time paid beyond eight hours, at the overtime rate of "time and one-half" in the state of California.

Always pay overtime when it is due. Employment rules vary by state. For more information about your state's overtime laws, you can contact an HR adviser in your area.

4. Background checks may surprise you
Always check references for a new hire. Optimally, you hope to encounter a statement that the former employer would rehire this candidate if they had the chance. Confirm that prior employment dates are the exact dates given on the résumé. Fudging employment records to make unfavorable work history disappear should be treated as an immediate red flag. Until the applicant passes a background check, it is best to not have him or her working, seeing patients, or having access to any private health information or credit card data. To find out more about federal laws relating to background reports in your state, visit Business.ftc.gov.

5. Keep your eye on performance during the 90-day introductory period
Determine if a new hire is workable and someone you desire as a permanent member of your team during the introductory 90-day period. The answer needs to be a certain and confident "yes." If not, move on. State the expected performance standard and clearly state and document when there needs to be expected improvement. This is especially important when it comes to attendance. When the expected performance level is not reached, always have the employee acknowledge receipt of performance review in writing, with the date and employee's signature. Hold this conversation prior to dismissal. Everyone deserves an opportunity to improve, but when the performance standard cannot be reached, have the courage to change course.

6. Dealing with undesirable work behaviors is perhaps the most difficult task of HR management
Although uncomfortable, dealing with unwanted behaviors is exactly what needs to be done for the best team performance possible. The first step in eliminating unwanted actions is to clearly identify that they exist and to understand them. Such happenings might include:
  • Taking company belongings
  • Exaggerating work hours
  • Working slowly or not at all
  • Gossiping and starting rumors
  • Covering up mistakes
  • Competing with coworkers
  • Blaming others or circumstances for personal problems or mistakes.
Orthodontists who are too nice to address these issues suffer at their own peril. What great HR managers know is that not everyone has unlimited potential. When someone has undesirable work behaviors, it can be a welcome holiday when that team member is away. Consider this an important sign that there is a need for a permanent HR change.

7. Embezzlement is prevalent in dentistry
Published statistics, including some from the American Dental Association and from Dumoulin and Associates, suggest that 50 percent to 60 percent of dentists will be embezzled. David Harris of Prosperident, a dental fraud investigation firm, reports that the average dental embezzlement he sees is more than $100,000, with some cases well over $1 million. Embezzlement is a large-scale problem in dentistry.

A doctor can take many actions to increase the probability of detection and minimize damage from embezzlement. These include:
  • Behave ethically
  • Use security features in practice software with user ID and password
  • Have an alarm system for the office and monitor office access after hours
  • Do not allow staff remote access to practice management software
  • Make it a policy that every staff member takes a vacation when the office is open.
Embezzlement is most often detected by the presence of annoyance and agitation to reasonable questions regarding collections. David Harris reports that embezzlement may occur by a long-term trusted team member, with five or more years of tenure, who may have had a personal setback or psychological change of mind.

8. The employment-at-will doctrine is an important statement of present-day team handbooks
Employement-at-will states that there may be termination of the employment agreement by either the employee or employer for any reason whatsoever. Even so, federal and state employment laws have been evolving for many years, creating more rights for employees. Public policy prohibits all termination for what is considered a "bad reason." There may not be termination for:
  • Discrimination
  • Retaliation
  • Refusal to do an illegal act
  • Engaging in a protected activity
  • Demanding back pay or payment due
HR employment law is a composite of federal, state, county, and municipal statutes and ordinances. Your local attorney or HR firm will know these laws best.

9. Have an office policy not to give written references
Good or bad, giving a written reference can cause future liability. It is recommended by attorneys that the following information be given:
  • Date of hire
  • Position held
  • Duties performed
  • Response to a document asking to verify a specific rate of pay to confirm or deny
  • Date of separation
If you gave a good reference for an employee who proved to be unsatisfactory at his or her next job, there is potential liability with respect to a false reference. If you gave a bad reference to an employee who has become capable or motivated, you may be subject to retaliation. The last thing you want to be involved with is a libel (written) or defamation (verbal) lawsuit.

10. There is work-life balance in dentistry
Dentistry is still voted the No. 1 best job in the U.S.! Dentistry offers great pay with the possibility of growth. Dentists work reasonable hours.

The work provides an inherent sense of fulfillment by providing patient care, doing good, producing something of value, and making the world a better place.

With a comfortable mean salary of $146,340 for all dentists, the Bureau of Labor Services (BLS) predicts that dentistry will continue to grow, with an additional 23,300 new dentist jobs through the year 2022. The future continues to look bright for dentists and dentistry.

Dentistry also has the highest suicide rate of any profession. The Business Insider reports that of all careers studied, dentistry was No. 1 in suicide, with a rate 5.45 times the national average. Patterns contributing to this statistic are frustration with manual labor, Caucasian male demographic, financial burden, isolation, rejection, competition, and lack of sleep.

The good news is, no dentist is alone. We're all in it together. This is why I love the message of Howard Farran and Orthotown Magazine: "The purpose of Orthotown is so that no orthodontist will feel alone or practice alone again."

The last thing I would like orthodontists to know is that the size of your practice does not determine your overall financial success or your ultimate state of happiness. We have the power to choose how we run our careers, our practices and our lives.

When you have total confidence and satisfaction in the decisions that you make, how you spend your time, and what you do with your family, you will be happy. Life will be good. You will be the most fullfilled orthodontist in the world!

Dr. Ann Marie Gorczyca is author of the book, Beyond the Morning Huddle—HR Management for a Successful Dental Practice. She graduated from the Harvard School of Dental Medicine, the Harvard School of Public Health, and Northwestern University.
She is a diplomate of the American Board of Orthodontics and a member of the Angle Society. Her private practice, Gorczyca Orthodontics, is in Antioch, California.


Orthotown Magazine
September 2025
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