are you looking for a podcast where you can hear from real people regarding their real dental drama If so then
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you've come to the right place Join hosts Bethany Penny and Dr Reena Kuba as
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we dive into the solutions we've created and the mistakes we've made while
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managing dental drama Let's get started Lady it is
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almost time for summer I know I'm ready I am so ready even though it like gets to be a billion degrees in Texas with
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the humidity Um but I'm ready I'm ready too Let's do it Um so I have a yay and a
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yuck So you want to do the yay real quick Let's do the yay first Let's start positive Okay I'm super excited You told
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me that we've been talking about this resource hub that we've been working on creating and spending hours upon hours
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of making resources available to um colleagues and practice owners And I
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think um you know the challenge with that is for example I think you had somebody reach out to you and say can I
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you know I'm about to onboard an associate like can you get me a a contract Mhm Now you can find free
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contracts online a bunch of them But I'm pretty sure most of us don't want that
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and we kind of want to know how do or or it's a you know 60page document and we're like for real like I got to read
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this then make sure the associate reads this and then like this sucks Um so can
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you just customize one for me and what about the legalities of the state I'm in and the maybe I don't want to do an
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associate contract Right So your goal in creating this resource hub is what our
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goal has been for the podcast and for the subscription is the how How how am I
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doing this Um one so that I don't uh have a mental meltdown over this Two so
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that I don't bury my head in the sand and get somebody to sign something that's going to be actually a detriment to me Um and three without breaking the
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bank because I know if I took this to a lawyer God only knows what I'm getting Am I going to get the 60-page document
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the 30-page document if I want it more customized am I getting charged by the hour So now I end up spending two grand
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on a contract And so anyway the resource hub is there to have these practical
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how-to documents Yes And there's a ton of them from associate contract to
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morning huddle samples to what's a written warning how do I put that together Like so many practice owners or
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managers just get stomped at that point of like okay I need I know I need to do a write up but what does that look like
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and what's a good write up And so anyway this hub is chocked full of documents
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that are helpful the documents that are available for purchase and it's a resource that we're going to continue to
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add And and if I may give myself or us a plug in there for this I think again
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because y'all who've been listening you know like for me I don't like the vague I want to know what do you mean Like
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what does that mean when you say you know these three steps get your associate to sign a contract In the
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contract you need to make sure you put blah blah blah What does that mean What is the verbiage What is the order Like
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how am I actually executing this So everything in the hub is something that I have
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laid my eyes on to go would that be useful to me Yeah because Bethany you created this and that makes sense to you
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but I'm still telling you you're assuming that I know these three steps and I'm telling you I'm not that bright
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Like that is your world That's your everyday but as the actual person who has to execute this I I have too many
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questions on those nitty-gritty details And so everything on the resource hub should be as usable and user friendly as
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possible to where you may just need to tweak it to meet your needs Yeah Um so I'm super excited about that So that was
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my yay That's a huge yay And that's launching at the end of this week So it's not live yet but stay tuned for
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those of you listening It will launch at the end of this week And we are pumped We are pumped I'm pumped to have these
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resources available for people Um do you want me to get to my yuck now Let's do
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it We got to talk yuck at some point I mean okay I And I really think this is a big yuck and I think I'm about to
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be I'm trying to prepare myself because I'm about to be in this boat and it's been a little while since I've been
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there and just the thought of it is making my stomach turn when you are onboarding an associate because we've
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had a couple of episodes recently here about associate ships and one of the big
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questions that I think all of us would prefer to dodge and would wish we had a wand to just make it happen um is the
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clinical proficiency So if you were to read any article about onboarding an
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associate well you need to make sure your clinical philosophies align Okay that we can all talk about from here to
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there But when it comes to actually doing how am I making
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sure We could all say and I'm sure we're all going to hear these iterations of
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I'm looking for a practice that you know patient care comes first and quality of care comes first right Like that's what
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every associate's going to say or flip side the doctor is going to say I need somebody who really puts the patient's
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needs ahead that is still so stinking vague Who's going to walk in and say um
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yeah my my goal isn't to provide good patient care I want to see as many
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patients as I can So I'm going to do some crappy fillings shove some stuff in there I don't care what materials I use Like who's going to say that Nobody
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We're all going to talk about like this is our goal you know in the practice to
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whatever But how do you really decide Do we align on this I just heard it um just
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yesterday I was talking with a practice manager who they're having a transition the uh owner doc just sold and so now
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new doc wants to put some stainless steel crowns on things and uh the rest
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of the team is like oh well we would have put a filling on that put a filling there like all it needs is an mo
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composite and I'm like well does it because I think for knowing that
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practice it is a very uh preventive focused practice there's
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not a lot of treatment needs that go into that practice just cuz the clientele that they see it's a very
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educated and they are doing a lot of the right things So I don't think they get a lot of decay in that practice And when
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they do yeah go the conservative route But this new owner that's stepping in I
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know the the pool of patients she is used to seeing is a very high risk right
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patient So she's used So there's no right or wrong but from the I can only imagine if I were to talk to this new
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owner going "The hell are they putting all these composits in there that are going to fail?" like are they just
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trying to get more of this patient's money Like they're going to put a restoration they know is going to fail
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and then a year later they're going to charge the patient again and at that point insurance isn't going to cover it And at that point we may lose the
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opportunity to like I can see high carries risk doc coming in with one
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mindset and of course the office that as it's been is going look at this aggressive doctor just wanting to put
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these ugly crowns all over the place So digging deeper there I'm sure when they spoke to each other I'm sure the
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dialogue was "Oh nobody wants to overt treat nobody wants to undertreat We you know want to take care of our patients
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and do the right thing that but there's different ways to do the right thing."
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And so depending on which perspective you're coming from you know I've I've heard the whole gamut of oh yeah you
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know you do oral conscious sedation that must mean that you don't have any chairside manner You want to make this
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easy for you And then there's a flip side going why am I torturing this patient when there are resources to help
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this kid and this parent would rather their kid not be tortured So to you know
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to how do you have those conversations I'll give another example I had a really sweet doc coming and helping me for a
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little while and um he was treatment planning mods on primary teeth And to me
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that is a big no no And I know I'm probably ticking off half your audience now going "What do you mean that's a no
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no?" Well I'm not going to get into the nitty-gritty of that but to me that is a no No Um and that's that And so that's
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more of a okay yes you barbarian you just want to do your crowns and make it easy on you or what are you talking
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about An mod on tooth number A That is not standard of care You know we we both
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are right and we both are wrong But that's one that I was like if this dog had stayed in my practice longer that's
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going to be tricky for me because it's not a new doc It's not a new graduate right It's somebody that's been practicing for you know not as long as I
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have but not far from that Now how am I supposed to say "Sir you are wrong in your treatment planning." Like that's
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just an awkward conversation that I don't really want to have Yeah Um so I
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guess that's where I'm going with this is how do we I think we could talk all day but
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when when it comes down to like actual doing how are we looking at this new
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associate whether they're a new do new dad or not how are we going I'm going to be looking at your treatment plans And
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then how am I telling you if you're right or wrong And if you as associate are going yeah please tell me guide me
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on what's norm in your practice but at what point are you going to go you know what you are really overdiagnosing or
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you're really underdiagnosing and I don't feel comfortable in this practice I can't practice the way I want to So my
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question to you for this uber yuck you gave me an example Um and I'm sitting
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here going you know I how my current associate I think we
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did have some initially um awkward moments me going uh what are
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you doing man And I knew it was just the youth like you were just starting to practice and you were going to come and
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see why that's not going to work for you But he was so open to being a sponge to
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that and being open to me mentoring and guiding him And it did mean he had to trust me right You know he did have to
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see the why behind what I was saying And he did have to experience some of the
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okay that's why she said what she did I get it now And so I had to give him room
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to do that He had to give me grace to go okay she does know what she's talking about And we had to kind of trust each
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other Um and so I think it worked really well But now fast forward four years
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later I'm back in that boat again going "Okay I'm really scared of finding another provider that and then you add
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on okay what if we are alike in our philosophies Like we've got to make sure we're on par there but what about the
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actual execution Okay yeah we did decide we're going to do a crown on this and I think your crown is yucky." Yeah and my
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assistant told me "Your filling was gross and it took you 45 minutes to do that when it should have." Right Like I
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I don't have those issues with my current associate We we sorted that out pretty quick early on and now we're
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completely in sync and to have to start over with that I'm now going "Okay
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whoever comes in am I just at the beginning saying I'm going to be following your treatment planning and
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this is what I'm going to be okay with and this is what I'm not." Yeah
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And am I going to turn off an associate And then they go "You're bad crazy lady You have control issues." Um I
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don't know I'm at a loss So I'm putting this to you Uh I'm What What are some of
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your thoughts And then also what you just shared with me about an associate that left a practice I'm going to quit
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talking here and let you kind of share that But again this goes back to what I said a few weeks ago like this is where
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we are um not excited about onboarding an associate and it is so much easier to go
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never mind I'm not doing this But that's not practical either I don't suggest doing that There are a lot of good
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things that an associate can bring But how can we be prepared for for this
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Do you have any nuggets of um any I don't know any heads up any
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advice thoughts Man you weren't joking when you said yuck No I wasn't I mean
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like you went into the deep dark end of Well I gave us a great yay I went on the
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edge of that going man we've got some resources Like here we go We are about to make people's lives a lot easier And
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so it's only fair that I go completely to the other end That's true That's Yeah you've you've done a both at 100% So
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well and I I guess I've kind of knocked you down cuz I gave you a high and a yay Bethany You got your portal going and
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now I'm like "All right Missy what you got Here's some yes topics Go ahead
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expert." Oh so you you said something that I like stood out to me when you
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said um this can come across as very disrespectful when you're asking an
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associate like "Hey by the way I'm going to be watching your treatment plans." That can be super disrespectful And I
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would say absolutely there can be like a yuck factor to that But I see it from
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the flip side and I go "This practice owner is putting their reputation
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their liability their um patient retention
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they're putting their implicit faith in an associate to handle all of those
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things well." And I think that's a very risky decision Um so yes there's going
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to be some some awkwardness that uh in the things that I suggest but I think that awkwardness is absolutely worth it
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to protect your practice and to protect your patient base And at the end of the day these are your patients Every
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associate contract that you look at says that these practice these patients belong to the practice owner So these
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are your patients and you have to do what's right by your patients and ultimately managing or overseeing or
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having open dialogue with your associates is a part of that So I think there's some things that a practice
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owner can do from the get-go We need to set the norms from the
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get-go And the norms are we're going to talk through treatment plans together
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We're going to look at pre-op x-rays and photos We're going to look at posttop x-rays and photos you know for the first
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6 months We're going to do a do a lot more intraoral photos after the completion of treatment so that we can
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look at those things together and dialogue about what could have gone better with this particular procedure So
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you set this tone from the beginning It's not hey I'm going to be watching you and I'm going to be looking for
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mistakes We are going to collaborate a lot together I'm going to show you some of
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my cases I'm going to show you some of my treatment plans I'm going to show you some of my pre and post X-rays and
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intraoral photos We're going to dialogue together about my cases Even chart notes
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Yes that's another big one I'm like this is my expectation of your chart note You put this down but for me that's not
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enough And if I had to come in and I had to deal with this parent and this I happen to be here and I saw or heard
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certain things but you've left me no breadcrumbs in this clinical note or I see that you're used to doing it that
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way over there but we follow like to me the you know we these documents are important I need you to make sure we've
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got this this this um so e even down to including that part of it
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Absolutely Yeah all the nitty-gritty details And when you are looking at the full case together you're going to be
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looking at documentation You're going to say "Let's go look at that chart Now what did it say Why did we do this What was mom's rebuttal this particular
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treatment plan?" Ah see ah here we go This is why we did the alternative
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treatment on this tooth rather than this cuz mom blah blah blah blah blah So it's
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a very comprehensive look at everything Uh heck I would say venture into looking
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at the financial documents that were put in for this particular patient Make it
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comprehensive I even go down to down to the nitty-gritty of the appointment note
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Yeah So did you look at that and how did you incorporate that Like did you address the chief concern Did the front
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schedule it the way it needed to be Did you proactively approach the front Like
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if you saw that the front planned this for an SSC and nitrous and you knew you
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were going to need to take an X-ray but you didn't bother to correct that ahead of time and now you finished what you
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needed to do but they didn't collect but now mom is upset because like even down to those little details making sure that
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they're connecting the dots from a whole flow perspective Absolutely Absolutely
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So if you set that stage from the get-go with your associates and you make it
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dialogue it's not hey I'm going to call you into my office twice a month and I'm going to shame your treatment planning
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or I'm going to be asking what in the heck were you thinking on this I'm not going and looking for your mistakes
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We're just having a clinical collaboration a meeting of the minds where we get together and we dialogue
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through a couple cases Now it's easy to do that if you set the stage from the get-go Now as you're
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interviewing associates that can sometimes kind of be like "What You're going to be looking at my cases?" No
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we're going to be looking at our cases together and dialoguing because we want to make sure that clinically we're on
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the same pathway for our patients That doesn't mean that the treatment plan that owner doc puts together has to be
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exactly followed by the associate It just means that that associate is going
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to be getting insight into why the practice owner treatment plan's this way or that way and that should influence
18:47
the associate So we still want clinical autonomy We want that doctor to be able to make his or her own decisions because
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that's important There's there's some um some ownership that that practice
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associate needs to take with each treatment plan But the more that the doctor the owner doc and the associate
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doc are collaborating the more that associate doc is going to then become likeminded with the owner doc um or not
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And then you're going to quickly realize this is not working This is not okay Yeah Yeah Now if you're already in an
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associate situation this becomes hard to then all of a sudden insert this
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But I will say I have found very few times where I don't think I've ever found a
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time I'll be honest that I didn't think it was appropriate for the owner dog and associate doc to collaborate some on
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clinical conversations When that doesn't happen here's the what what's the why behind
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all of this At the end of the day the care that patients are given falls to
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the responsibility of the owner doctor So I can't tell you how many times I've s sat with a practice owner that had an
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associate that unbeknownst to them were
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overdiagnosing underdiagnosing completely missing things pissing patients off and they had
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no clue because the owner dog's like "Oh you know here we go Great Got a wonderful doc on the team Yes let's go."
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And then it's like they're in their own world Owner doc is in her own world and
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our worlds are never colliding And then that associate doc moves on and owner doc absorbs those patients or passes
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those patients on to a new associate and they're like "Oh my gosh this was a mess
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of so what but how do you think that happens Do you think it's because of one
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the assumption that this is another doc and they they know what to do so there's lack of communication and calibration?"
20:54
I would imagine that's a lot of it And the other part is the ickiness of it Like do I really have to babysit and
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handhold and be the bad guy totally dentists you know four out of five
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dentists all do different things And so you know what They went to dental school They they probably know what they're
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doing Yep It is absolutely both of them It's awkward all the way around For whatever reason it's awkward to have to
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have these kind of calibration type conversations What about if it's the opposite way What if it's the associate that's like "Okay I sat in on this doc's
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work and the owner doc left an open margin Owner doc missed that." Like do
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you ever see it that way Very seldom but when I do I've got one associate in mind
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that this was happening where she was like "What in the heck's going on?" And
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so my challenge to her was "Ask for these meetings ask to see if you get get
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together once a month with the owner dog and she brings a case and you bring a
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case and y'all dialogue about it together So associates have the power to ask for that And again the owner may say
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"Nah I don't have time for that Don't really want to do it." And if that's the case that may be
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the writing on the wall where you're like "Okay I probably need to move on because first of all I don't agree with
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some of the clinical output here and owner doc's not willing to talk about
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it." Um so all that to say an associate can certainly vouch or push for one of
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these uh monthly type meetings I think the other thing that is super helpful um
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that I that is easy and I I uh I think that can get missed and it goes back to
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communication but as owner doc checking in with your team Yeah And so for me
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especially the first couple of months if I remember correctly I would say okay how did that day go Yeah What went right
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What went wrong Did anything stick out to you as being weird And what we don't want is the is the assistant or the
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hygienist or the front person saying "Well that's not how Dr Kuba would do it." Like if I was an associate I would
23:03
be like "Well I'm not Dr Kuba." So um so it's got to be very respectful But so
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for us for example I think the MOD example you know I think my uh as the
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front was putting that treatment plan together and then the treatment coordinator was about to go over it they
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already were like "The hell is this?" Like they had never seen an MOD treatment plan on a primary tooth in our
23:27
office And so they were like "The hell is this Was this a mistake?" And then you know the rumblings of "No it's a new
23:33
dog over there like saying to do this." then that treatment coordinator going and saying "Can can I just make sure
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this is what you want to treatment plan?" Um and and I I know you're a doc but uh I just know we typically a lot of
23:47
times even just the person saying that the doc is like "What Why Why are you asking this?" Well I've just never seen
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Dr Kuba treatment plan a mod composite on tooth number A Like I just have never
24:00
seen that Um and none of the other associates that have been here have ever done that So I just wanted to make sure that this wasn't a mistake Right Right
24:07
So that that may be the the nicer way of doing that And and I think that's what happened where that doc then the next
24:13
time I was there with him he was like okay clearly I missed the mark on here and I want to make sure I'm doing things
24:18
the way you do them So he was very gracious about it Um but what you know I
24:24
think that leaning on your team to make sure they do it in a respectful way but
24:29
they're your spies basically You know like tell me what you know or my current associate doesn't say much He's not
24:36
phased by much which is so great in so many ways But then I'm like were there
24:41
things that either a he missed and is unaware of and this is about to like I'm
24:46
about to come back and have to deal with this pile of you know what and he's clueless about it or did he just think
24:53
it wasn't a big deal or whatever right And so I'll ask my team hey how did Ivy
24:58
day go Any hiccups any issues any parent issues any concerns anything we need to improve upon upon next time So not even
25:05
for a picking on the dock but as far as the flow went or we have a new assistant
25:11
you know how did how did she do on IV day How did she do on her first day Like making sure you take the time to check
25:17
in with your people to see because sometimes they'll bring it to you but a lot of times they're just like "Oh well
25:24
this is how it is." and um you know you you want to make sure
25:29
that or vice versa that that the associate doc is not going to you know
25:34
harbor something going okay these assistants are driving me crazy with the well Dr Kuba wouldn't do that
25:39
well Dr Kuma does it this way well Dr do it that way So luckily I' my assistants rock They're not going to ever do that
25:46
but that happens frequently in other offices And you don't want to where you've done all this work to onboard
25:51
this associate and then the team is the one who chases associate off right And you were none the wiser Yeah Um
25:59
so that's a lot of treatment planning and blah blah blah What do you do in the case of if you see crappy dentistry Yeah
26:06
Yeah cuz that's the other one where I'm like "How do I tell you your SSC is yucky?" So I actually had a practice
26:14
owner that he was concerned about the quality of work that was being put out Now
26:21
his expectations were very high on himself and on others in incredibly uh
26:29
detail oriented Every line of that composite needed to be
26:35
perfection Um but he so he we started
26:41
doing these clinical collaboration meetings and because he was seeing things that he didn't like he was able
26:48
to bring those up and so they would talk clinically like "Hey this is how a treatment plan
26:53
blah blah." so they have a good clinical collaboration And then he would bring up hey by the way as I was auditing because
27:00
again from the get-go he makes it clear like hey I do audit not every case but just kind of pick a few you know
27:07
throughout the month and I'm auditing those cases If I see any concerns I'm going to bring those to you So he had
27:12
set the stage with this associate And so in the clinical collaboration he's like "Hey by the way I had a concern that I
27:19
wanted to bring to your attention Hey look at this filling You see this I feel like this could have been cut better
27:24
here This blah blah blah And so he talked through it and then from that was
27:30
like I want you to take pre and post uh
27:36
x-rays on your fillings and I want you to take pre and post IOPS on any filling that you do for this next week IOPS
27:42
intraoral photos sorry intraoral photos Yes Um so I want you to take those Let's revisit this next week So
27:50
let's not wait for our monthly clinical calibration but just for this next week can you have a real extreme So what do
27:57
you what do you tell the patient I'm going to take an X-ray now after I'm going to take a photo after Like what do
28:02
you not even address it with the patient You don't even address it You just do it You know hey our doctor really wants to
28:07
check with a X-ray to make sure that everything looks perfect We want a perfect filling for your tooth So we're
28:13
going to do an X-ray afterwards and I'm going to take a couple pictures But even if you didn't even say anything they may not even notice that you're doing that
28:19
they wouldn't even notice I mean I guess an X-ray they would but an IO they may not even notice Yeah Very very little
28:24
will push back against that Um but what I like about this strategy is that for
28:31
that next week cuz it's just like a hey let's focus on this thing and then let's revisit it next week So it's a short
28:36
timeline because you don't want a bunch of crappy dentistry going out for a month You want to be able to address it quickly But what's great about it is
28:44
there's a tangible next step Take pre and post on your fillings x-rays take pre and post IOPS Heck take photos
28:52
during the prep if need be so that you can see how does that prep look Do that for this next week and then we'll get
28:58
together and meet about it the actual process of daily as that doc does a
29:04
filling he or she is taking a pre and post she's taking IOPS or her assistant
29:09
is but she's becoming aware throughout that week of either inconsistencies or
29:15
things that she doesn't like but then you've got this end meeting where it's like oh at the end of next week let's go
29:21
back and look at some of your photos the doctor the owner dog can see was there improvement do we have the capacity to
29:28
improve proof Can he or she actually see the errors that are occurring Or is she
29:33
like "Yeah look at that pre and post X-ray Look at the photos That's a beautiful feeling." And the dog's like
29:40
"Oh gosh that is so what do you do in that case?" Then to me it's like "Okay we're we're going to have to part ways."
29:46
Because if there's if that uh associate doc is looking at it as perfection and that owner doc is looking at it like I
29:54
would not put that in anybody's mouth there is to me too much of a clinical gap that we would not be able to close
30:00
So do you write that into the contract like the first three months are where we're going to be checking your work and if clinical proficiency or are you stuck
30:07
with this person contract or what So any clin any contract should have an out
30:12
should have an out clause Usually that's a 30-day notice that either party is able to give the other Sometimes it's
30:19
longer but I like I prefer the 30-day notice because as an I see it from an
30:25
owner doc standpoint I want that owner to be able to go "Hey by the way I'm in I'm giving you your 30-day notice This
30:32
is the stated reason why." And that contract should be able to say that you can give that But how do you say that
30:38
We're just clinically not on the same page Yeah Like how do I say I think your dentistry is crap Well to me if you've
30:45
had a a couple of these like corrective type hey this filling was off Let's do
30:50
this He or she's going to know it's coming Okay So it kind of gets some of the awkwardness out of the way And then
30:56
you're just like hey I've done a lot of thinking on this I don't think this is a gap that we can actually close You look
31:02
at a filling and you call it good I look at a filling and I say that's an F feel filling And again that's just us not
31:09
being able to see things from the same direction But if a couple of these conversations have already happened he
31:15
or she knows that that's okay that's coming So I think I like this because now as I'm looking to narrow down you
31:23
know whoever I'm bringing on I think that's what I'm going to do is say and I think I'm sure you say it too There's a
31:28
lot of collaboration We want to make sure we're on the same page as far as treatment planning verbiage for parents
31:34
Um and then uh asking for you know giving them the heads up hey I'm going
31:39
to be taking uh intraor orals before and after and x-rays so that we can just
31:44
make sure you know it's our quality control Certainly if you see something of mine you know you're welcome to bring
31:49
it up to me Um and I I want you to be able to ask questions but you know doing our due diligence to make sure you're
31:55
successful in our practice Um you know there's a certain amount of autonomy I want you to have but there's also a
32:01
certain amount of you got to do it our way And um so we're just going to be making sure So certainly the team is a
32:07
valuable resource They're more than happy to answer for you the what and why Like if you were going to go in and you
32:13
were going to go you know extract preolars and just offer nitrous that's
32:19
appropriate sometimes but you know use the staff lean on them to say what what
32:25
has typically been done here and why uh will this be a successful treatment plan
32:31
or not I mean it may be what we want but no parent is going to agree to it you know So we've got to like make sure
32:36
we're all working in the same boundaries of things for us to reach our common goal of getting the kid the care they
32:43
need Exactly Um and so my staff is a resource for you Please use them Um
32:48
they'll be giving you feedback I'll be giving you feedback and I'm sure you'll be giving us feedback too on things Yeah But just be very clear with that cuz
32:54
that's the one thing where I'm just like you know the treatment planning part of it and then the actual dentistry part of it
33:02
Yeah That I'm just like how would I tell a colleague I think your work is garbage Like I don't know that I could actually
33:07
say that But now you've given me tools that I don't have to say that but we can allude to it that we're just not on the
33:14
same page Yep Exactly And to me again this is the practice owner's
33:19
responsibility to do this This to me is not elective or optional things You are
33:25
responsible for those patients and the care that they're receiving And if you're having a separate set of hands
33:31
carry out the work that's necessary on those patients then it's your job to
33:36
oversee and to ensure that it's quality work that's happening Thanks for joining the
33:43
conversation today We hope that you are comforted in knowing that you are not alone but we also hope that you're
33:50
walking away with some really great tips and tricks to try in your practice We value your feedback so
33:57
please take a few moments to rate and review the podcast Finally we want to
34:03
make sure that we're covering the topics that matter to you So track us down on Facebook Instagram and Twitter and let
34:11
us know what topics you want us to cover As always please know that we are
34:16
rooting for you today as you manage your dental drama