For most of my 29 years as a practicing dentist, I suffered periodic bouts of lower back pain. No question in my mind that this was in large measure an occupational hazard. Treatment consisted of mega-doses of ibuprofen, strapping myself up with a corset, lying flat on the floor during lunch break, and somehow getting through the day. Symptoms would disappear in a week or two, but for those of you who’ve had your back go into spasm, you know how weak and uncomfortable you feel. Since my problem was muscular in nature, I found that a strict regime of back and abdominal exercises helped enormously to lessen the frequency of lower back discomfort. But in spite of everything I did, back spasms would still occur, often for no apparent reason, and always at the worst possible time-like before a golf tournament or in the middle of a vacation.

In the last few months, I have listened to and commiserated with many of you about your own back problems. I have heard about your chiropractors, your massage therapists, and your regime of back exercises. I used to think that I was the only one with this problem-evidently it is a common curse for dentists. So I would like to recommend a wonderful product that works for me.

The product is called S’Port All. It is an adjustable back support attached to an athletic short so it won’t ride up even with vigorous movement. Two velcro straps provide unbelievable support at the base of the spine. After having the experience of wearing cumbersome, bulky, and uncomfortable orthopedic corsets, I can only tell you the S’Port All is like a gift from heaven. You might want to check this out.

When was the last time, Doctor, that you entered your office reception area through the front door just the way your patients do? Many of you enter the office by a rear or private entrance to avoid walking through a reception area filled with patients. I would like to suggest a reality check. Imagine yourself as a new patient entering your office for the first time.

Is everything immaculately clean? Look closely at the woodwork-is it chipped or damaged? Is any of the wall paper stained or peeling? Sit down in a chair and slowly look around. Any cobwebs in the corners? Are the windows clean? When was the last time the outside of the windows was professionally cleaned? What is your honest impression of the artwork on the wall? What about the ceiling tiles-any stains? Is the carpet worn? Do the plants look thirsty? How current are the magazines? Are they interesting-perhaps what you would choose if you had a choice? How does it smell in your reception area? Are there any odors of dental materials? Any odors from a nearby kitchen area?

Not get up and go into to the patient restroom. Is it pristinely clean? Well lit? Is it well stocked with toilet paper and toweling? Is the soap dispenser full-how about bathroom spray? One of my pet peeves is that there probably is not a hook in the bathroom, either on a wall or on the back of the door, to hang a jacket.

Studies show that new patients begin to form an impression of you as a doctor within 30 seconds of entering the reception area. And within five minutes, they are already thinking about whether they will stay in the practice. If they are not warmly and enthusiastically greeted by a staff member, they may imagine you as cold, aloof and uncaring. If the reception area is messy or dirty or cluttered, wouldn’t it be reasonable to assume that the clinical area is just the same?

Let’s make the correct initial impression by making the reception area a conversation piece-from the decor down to the smallest detail. My feeling is that if it has been five years or more since the reception area was decorated, you are overdue for an upgrade.

I have always looked to dentistry as a means to an end. It is an incredibly wonderful privilege to be a dentist-to be able to help people by relieving pain and suffering or to create beautiful smiles. And you can make a terrific living. But we can’t let the profession consume us. I read something recently that said to try to imagine life as a game in which you are juggling five balls. The balls are work, family, health, friends, and integrity. And you are keeping all of them in the air at the same time. One day you come to understand that work is a rubber ball-and if you drop it, it will bounce back. But the other four balls are made of glass, and if you drop any one of these, it will be irrevocably scuffed or even shattered.

Once you understand the lesson of the five balls, you will have the beginning of balance in your life. Remember the best way to measure your life is the time you spend living it. Today is a gift-that is why it is called the present. So my message again is to work hard but please remember to play hard – and don’t forget to take the time to smell those roses.

When one year ends and another begins, I always become introspective. I look back at what I’ve tried to accomplish over the past year both personally and professionally. But most importantly, I reflect on what I am thankful for. And at the top of the list is the fact that I am in good health. Because without good health, nothing else really matters.

I think that in these days of total connectivity with smart phones and computers and 24/7 news and information, our lives have become so extraordinarily busy, that we tend to forget the basics. I’d like to offer some suggestions.

1. Have an annual physical. I always schedule mine around my birthday. The association is an easy one for me to remember.

2. Make time for cardiovascular activity. Even walking half an hour every day leads to a more healthy existence. We all say, “But I can’t find the time!” If all of a sudden you were told you only had six months to live if you didn’t start exercising, you’d find the time!!

3. If you smoke–stop. Immediately. There are many options now available to help you.

4. You can’t control your sex, age, or genetic makeup. But you should be able to control your weight with a healthy diet.

5. Review your will every two to three years with a qualified estate tax planning attorney. The rules are changing constantly. Of course, I am presuming that everybody has a will!

6. Execute a durable power of attorney and a living will. This is simple and inexpensive and absolutely necessary for the peace of mind of your family.

7. It is never too early to plan for retirement.  You are missing the boat if you don’t have a well thought out plan in place that estimates how much money you will have accumulated at present levels of contribution that will satisfy retirement requirements. Your accountant should be able to recommend a qualified financial planner to assist you. Don’t be one of the 90% of dentists nationwide who can never afford to retire and maintain their current life style.

8. And most of all, don’t forget to take the time to “smell the roses.” Enjoy your family. Enjoy your friends. Life passes us by much too quickly. This is not a dress rehearsal. We all want to live long, healthy and productive lives. Let’s be in charge of our future–be proactive about your health. My best wishes for a healthy 2011.

In the current environment of rising health care costs-with no end in sight-the staff benefit most treasured and most desired is a contribution by the practice to pay for health care. I would also offer an opinion that failure to offer healthcare as a benefit will limit your choices of attracting quality staff. Here are my thoughts and recommendations.

The days of you paying 100% for single person health coverage are gone. The costs are just too prohibitive and it is impossible to anticipate or budget for the inevitable annual increases. And we all know that it is very difficult to take away a benefit that staff are accustomed to. But all employees-whether in big companies or small companies-are rapidly understanding that going forward, they are going to be required to share part of these increased costs of health insurance.

As a matter of courtesy, any change that you intend to make as an owner regarding what you will contribute towards healthcare should be made known almost a year in advance to allow employees time to adjust their own personal budgets.

My recommendation is to offer staff one of the following choices that you decide on. One option is to take what ever dollar cost you currently pay monthly, and announce that as of the beginning of the next calendar year, that dollar amount will represent your total contribution no matter what the actual premium is. A second option that is a bit more generous would be for you to take the dollar cost you currently pay-calculate what percentage that is of the total cost-and announce that going forward you will continue to pay that same percentage.

The point is that you have to take control of these spiraling costs and put some kind of cap on what you are willing to contribute. A new year is about to begin, so this is the perfect time to let your staff know of your intentions. You want to continue to be fair-but it is also time to stop the bleeding!

This is my last post in this current series on the topic of office policy manuals and staff benefits. It has been wonderful to hear from so many of you, and I hope you will feel free to continue to contact me with any questions or comments.

There usually is no confusion regarding paid holidays for full time employees when properly listed in the office policy manual. But you can run into problems if you give a pro-rated number of paid holidays for part time employees. What do you do for example when you have a part-time hygienist who normally works two days/week on Monday and Thursday. As a part timer she perhaps is entitled to two paid holidays a year – but the office might be closed for six Mondays, a day she normally works. Here is the proper language to use.

The following holidays are observed by our Practice: New Year’s Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day, and Christmas Day. Full time employees are eligible for six paid holidays from their first day of employment and are compensated based on an eight hour day. Part time employees will be paid for a maximum of two holidays, only when the holiday is observed on the day they would normally work. If a part time employee requests, the Practice will make every effort to schedule that employee additional days to compensate them for any days missed due to holidays not eligible to be paid.

In addition to holiday pay, I suggest that your practice can offer four paid personal days/year as a very nice benefit to full time employees. These days can be used for sickness, bereavement, or personal problems with no rollover into the next calendar year. In an effort to prevent staff from abusing this privilege, I strongly suggest you pay a $100/day bonus for any unused personal days. It’s just human nature to take full advantage of a personal day benefit. “Why shouldn’t I take the day – I’m entitled – and I do have a headache!” But someone might think differently when they are going to get paid double. And that dental assistant or hygienist is going to cost you a lot more than $100 in lost production if they call in “sick”. Here is the proper language to use.

Paid personal/sick time applies to full time employees only. Half a personal day is accrued for every month of employment completed with a maximum of four personal days given a year based on an eight hour day. Unused personal/sick time cannot be rolled over to the next calendar year. The practice will reward a $100/day bonus for any days not used payable in the first payroll payment of the following year. Employees will not be paid for unused personal/sick days upon termination.

Avoid problems before they happen. Check your manual and protect yourself with the proper language.

The concept of “at will employment” is probably the most important feature – the seminal arrow in the quiver – of employer/employee relationships. Simply stated, it means that an employee works for the dental practice at the will or discretion of the dentist – and that employee can be terminated at any time provided the dentist does not discriminate. As long as this concept is clearly and explicitly stated in the office policy manual in the proper “legaleze,” the dentist should be protected from an unlawful termination lawsuit.

I commonly see two flagrant “no-no’s” showing up in office policy manuals which unwittingly contradict the at will employment concept. The first is a description of a ninety day trial period of employment. This infers that if a new employee gets by the probationary  period of time and is still working at the practice, that future employment is somehow guaranteed. You passed the test, and you now are a real employee.

The second example is when the manual states that if an employee decides to leave the practice, it is expected that he or she give two weeks notice. If the employee must give two weeks notice, wouldn’t the employer then be expected to do the same? This clearly would contradict at will employment.

A poorly written office policy manual can sometimes do more damage than no office policy manual. Review your manual – and if you have anything resembling the above mentioned inconsistencies – remove them immediately.

My last few blog posts have been on the topic of office policy manuals. I would like to continue that discussion with some thoughts regarding employee benefits and the necessity for including them in your manual. Staff benefits usually involve some combination of vacation days, personal days, paid holidays, dental benefits, continuing education, retirement plans, and health care.

I feel that the cost of staff benefits should be thought of as part of your overall marketing budget. Marketing most often is a combination of strategies to attract more new patients – obviously very important. But if assembling and keeping a talented, loyal, hard working staff is a major component of the success of your dental practice, why not market your benefit package as a way to find and retain these valuable employees?

These benefits are usually offered to full-time employees, so it is essential to clearly define the hourly requirements to qualify. And if you intend to offer a scaled-down package of benefits to part-time employees, be very clear on the distinctions. It has been my experience that in many practices, the manual has been inconsistent thereby creating confusion and dissension. How ironic-the dentist in trying to be generous ends up being the bad guy or gal.

Over the next three to four weeks, I will examine these benefits in detail, and share my thoughts of what works- what doesn’t work- and why. Make no doubt about it-even though the recession and the weak economy have created a deeper labor pool of talented people seeking jobs, an attractive well managed package of benefits may often be the key to finding your next superstar.

Welcome to America where anyone can sue anyone for anything. And why not? We are the only country in the world  where lawyers are allowed to take cases on a contingency basis (the attorney only gets paid if the lawsuit is successful). We are also the only country where if you lose your lawsuit, the loser most of the time does not have to pay the legal costs that you incurred to successfully defend yourself.

There is an excellent product that I recommend for all of my clients called EPLI – the acronym for  employment practices liability insurance. The annual premium cost for a policy with protection of $250,000 is usually under $1000. This policy covers the cost of a legal defense and a judgment against. Remember-if you get sued by an employee for something like harassment, discrimination, or unlawful firing-and if you lose-the judgment you will have to pay is NOT  covered by your malpractice insurance. And even if there is absolutely no validity to the claim against you, you have to take the necessary steps to defend yourself-and the costs of litigation are very significant. It would not be unusual to have to fork over 20 to 25 K as a retainer for a defense attorney.

With EPLI  at least you don’t have that worry. As I mentioned in my most recent blog post a well written office policy manual will serve as a deterrent for a large majority of potential lawsuits.  But EPLI provides that extra level of security and comfort. Please check with your insurance agent, and be sure to get coverage immediately.