When Your Team Stops Showing Up

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When Your Team Stops Showing Up

How orthodontists are rethinking attendance policies in an era of chronic call-outs

Orthodontic practices run on predictable schedules, reliable staffing, and the assumption that team members will show up when patients are on the books. But what happens when that assumption breaks down? When one or two staff members are out almost daily, when migraines become a standing excuse, and when babysitter issues mysteriously arise only on clinical days despite ample non-patient workdays available?

It’s a frustration that’s reached a tipping point for many practices. One orthodontist recently shared on the Orthotown message board that their office was experiencing near-daily absences, primarily among clinical staff. A long-term assistant was missing patient days at an alarming rate, often citing migraines. Other staff routinely called out for child care issues or family appointments, claiming they couldn’t secure alternative times despite having multiple non-patient workdays available each month.

The orthodontist and office manager had reached their limit. They were considering implementing a strict new policy with an annual cap on unexcused absences and a requirement for doctor’s notes for extended illness. The sentiment was blunt. Show up, or make room for someone who needs the job.

This sparked immediate recognition from other practice owners who had faced similar struggles. What emerged was not just frustration, but a broader conversation about how to address chronic absenteeism without becoming punitive, how to protect the morale of reliable employees, and whether the employment landscape has fundamentally shifted in ways that require new thinking.

Accountability before goodwill runs out
Many orthodontists responding to the discussion emphasized that a policy only works if it’s monitored and enforced. Without consequences, attendance expectations become suggestions, and the message sent to the rest of the team is that showing up doesn’t matter.

Several practice owners shared that they had already terminated employees over attendance issues and felt it was long overdue. The reasoning was straightforward. When absenteeism affects the rest of the team, forcing reliable employees to cover constantly or work twice as hard, resentment builds. Good employees start questioning why they should make the effort, or worse, they leave.

One contributor noted that accommodation without limits eventually leads to confrontation. The longer an attendance issue is tolerated, the harder it becomes to address, and the more entitled the offending employee may feel. Firm, fair, and direct communication from the doctor was seen as essential, particularly when a long-term employee has begun taking advantage of goodwill.

Others pointed out that in many states, only a certain amount of sick time is legally protected. Beyond that threshold, even absences with a doctor’s note may not shield an employee from disciplinary action. Some orthodontists expressed skepticism about doctor’s notes altogether, noting that they are easy to obtain through telemedicine and may only add to administrative burdens if the practice is required to cover the visit fee. The standard some applied was simple: you’re either here or you’re not.

There was also acknowledgment that enforcing attendance policies might require letting one or two people go before the rest of the team takes the expectation seriously. Several practice owners recommended starting the interview process early, anticipating that turnover might be necessary to reset the culture.

Rewarding presence instead of punishing absence
While enforcement had its advocates, a competing philosophy centered on positive reinforcement. Rather than punishing absences, several practices implemented attendance bonuses as a way to reward employees who consistently show up.

One common structure involved a monthly bonus tied directly to attendance. Employees who didn’t miss any patient days received a set amount. Some practices randomly doubled the bonus in months with low overall attendance to make the reward more visible.

Others described tiered penalties for missed days, with bonuses reduced by 25%–50% per absence and forfeited entirely after multiple call-outs. The structures varied, but the principle remained consistent: miss work, sacrifice income.

The reported results were striking. Practices that implemented these bonus structures saw near-immediate improvements. Call-outs became rare, and the culture shifted. Employees understood the expectation and knew there was grace for legitimate emergencies, but they also recognized that chronic absence had financial consequences.

Some orthodontists described the change as life-altering. Where absenteeism had once been an almost daily crisis requiring constant rescheduling and stress, it became the exception rather than the rule. The bonus structure seemed to work not because it was punitive, but because it made the value of attendance explicit and measurable.

The nuances
As appealing as bonus-based systems sounded, they came with complications. In some states, employers may not reduce bonuses when employees use accrued sick time. Practices in those regions had to carefully structure policies, docking bonuses only when sick time was exhausted or absences were unexcused.

There was also concern about unintended consequences. If bonuses are tied too aggressively to attendance, do employees start coming to work sick? One commenter raised this question directly, asking whether practices were inadvertently incentivizing contagious staff to report to work and risk spreading illness to patients and coworkers.

Others noted that not all absences are created equal. An employee caring for a dying parent, managing a serious medical condition, or dealing with a legitimate family crisis deserves support, not a docked bonus. The challenge is distinguishing between genuine hardship and convenient excuses, especially when some employees seem to save their absences exclusively for clinical days.

Several orthodontists emphasized the importance of consulting HR professionals or dental practice specialists before implementing new policies. Employment law varies significantly by state, and missteps can expose the practice to legal risk, particularly when medical reasons are cited for absences.

A shifting workforce
Beneath the practical discussion about bonuses and write-ups was a quieter acknowledgment that something has shifted. Multiple contributors referenced changes in how employees approach work and commitment, particularly since the pandemic. Remote work and flexible scheduling have changed expectations in ways that orthodontic practices, which require in-person presence, cannot easily accommodate.

Some practice owners admitted to overstaffing slightly as a hedge against call-outs. Others described feeling stretched thin constantly. There was also frustration that attendance, once considered a baseline expectation for any job, now requires bonuses and formal policies to enforce it. Yet many acknowledged it as a necessary adaptation to current realities.

The fork in the road
Orthodontists managing chronic absenteeism face a choice. They can enforce strict policies and accept the turnover that may follow, or they can invest in bonus structures that reward reliability while accepting that the cost of doing business has increased. Some will do both.

What’s clear is that the old approach of hoping employees will simply do the right thing no longer works in many markets. Whether through carrots, sticks, or some combination of both, practices are having to codify expectations that once went without saying.

Is chronic staff absenteeism a failure of accountability that requires firm consequences, or a symptom of broader workforce changes that practices must adapt to with updated incentives and flexibility? 
What’s your take?

Share your thoughts in the comments below.

Hot Topic articles draw inspiration from active online discussions among orthodontists. Written by the editorial team with the assistance of AI, each piece is thoughtfully developed and refined under full editorial oversight.
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