DSOPro: Can you give us an update or overview on what’s happening in terms of recruitment and talent retention? Are you seeing any shifts or improvements so far in 2024?

This continues to be a struggle for the DSO space, because as emerging groups are getting more robust and plentiful, everyone is recruiting from the same limited pool of available dentists, hygienists, and dental assistants (DAs). It’s highly competitive, and the organizations who are winning are those who have a great culture and better opportunities to offer candidates. Higher comp, upward mobility, training and development, great benefits, and flexible schedules are what candidates look for initially.

Many hygienists have retired, and others have not returned to the workforce since Covid or have found non-clinical opportunities. That’s a real concern for DSOs that are trying to attain clinical staff. I don’t see anything changing in the next 5 years.

I believe organizations should focus on retaining their current teams and what that looks like in terms of compensation, benefits, development, and company culture. It’s much more expensive and unproductive to chase new candidates than to ensure the people you have are happy and thriving. Retention is more important than ever before.

Let’s say you’re a dental hygienist, and you’re somewhat happy and not really looking for an opportunity, but four or five recruiters call you and start throwing higher hourly rates and better benefits at you. You want to validate your employees are content, so that when recruiters come calling—and they will—they’re not easily swayed. However, if their hourly rate is far behind the current average and they haven’t complained or asked for more money and are offered $5 more an hour, they will probably take a look at it.

Also, if your employees see you hire someone making more than they are, what does that tell them? They won’t feel valued and may start looking elsewhere. When I was training recruiters, I advised them to consult with their hiring managers and ask, “What are we doing for the people who are still with us, and are we calibrating their pay? Are we doing a climate check to see how they’re feeling about their role and their development, and those types of things? When I open this requisition for you to add the additional team member, the pay range is posted, and could cause significant morale and productivity problems and resignations.”

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DSOPro: They don’t really have a choice because people looking for jobs now do expect to be paid more, right?

Absolutely and they have multiple offers. They can say, “I like your office and location; however, I have a sign-on bonus with another opportunity and another offer with a location that has a better compensation and benefits package.” Or if they’re looking for flexibility in hours, it may come down to that. It depends on the situation, but the practices or the organizations that are super rigid with comp and flexibility will lose the candidate to someone else. If you won’t work with them on office hours, or whatever they are looking for, they’ll just take the opportunity that is more appealing for their situation.

DSOPro: Are enrollments currently down or steady in the various dental professional schools?

It’s steady, but enrollment is still limited, they haven’t increased the number of students they accept. It is still highly competitive to get into both hygiene and dental schools. It used to be easy to hire entry-level DAs right out of school for $16 or $17 an hour. But that is not the case anymore, especially when In-N-Out Burger and other fast-food restaurants are paying $22 an hour, not to mention the amount of online remote work that is available now.

So, DAs are thinking, “Yeah, I went to school for this, but I can’t make any money.” They leave and go into food service or other fields. This has hurt the DA pool immensely because organizations haven’t calibrated their compensation to $25 to $30+ an hour to attract experienced and productive DAs.

It’s simple math: if you pay more, you will attract a higher caliber candidate, which in turn would increase your office efficiency and case acceptance. When the doctor leaves the room, patients consistently look to the DA for further clarification on treatment. If you have a professional assistant who communicates well, the patient will most likely say yes and start treatment. You’re paying more for the DA, but you will really increase your case acceptance and revenue potential.

DSOPro: How much are candidates attracted by the equipment and technologies they will be using? Should practices be marketing themselves as technology forward?

Absolutely. Especially to new dentists and hygienists. They’re very tech savvy. They want to work with the latest and greatest so they can do their best dentistry. If you’re looking at a dentist who sold a private practice but decided to keep a hand in dentistry for a couple more years, it may not matter as much to them. But when I was recruiting, new dentists would ask me right up front, “What technology do you have? CBCT scanners? CEREC?” This is especially important to new grads because it’s what they are learning or want to learn.

Another challenge I see that negatively impacts retention is that candidates who don’t initially ask about supplies and equipment may get into the practice and realize there are supply shortages, there are not enough instruments or maybe they have old, poorly working equipment.

While supplies and equipment are crucial, most don’t mind being on a budget, or ordering different brands. But when they consistently don’t have what they need to do same-day dentistry, they won’t stay. If a recruiter catches them at the right time, they will begin interviewing and planning their exit, just because of that day-to-day frustration.

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DSOPro: Has Walmart closing their health centers provided an unexpected opportunity to find talent?

They had 51 clinics. I talked to a couple of recruiters and sent them information about where the layoffs were so they could reach out. I know the Chief Dental Officer, Dr. Victoria Yu, and I saw her LinkedIn post about the closures. I guarantee that every recruiter in those states has already reached out with their current opportunities. Clinicians and auxiliary candidates will not be out of work for long.

DSOPro: What are some tips for identifying good candidates?

In this competitive market, what I learned organically and coached my recruiters and hiring managers about was to stop profiling or trying to figure out a person by their resume or CV. Don’t try to predict their success from that. I learned to talk to everyone. You look at their name, role, find their email and phone number, and that’s all. Then you call them. If you try to figure out if they will be successful by what they wrote on a CV or resume, you will miss out on some really viable candidates because people move around DSOs all the time for one reason or another, and you shouldn’t reject them for that reason. I’ve heard recruiters say, “Oh, this person hops around too much” and I think, “Do you know why they moved around?” If you don’t, you’re judging them without even giving them a chance to clarify.

Maybe a family member was ill, or they were laid off because the organization was failing. That doesn’t mean they’re not good dentists or employees. When I started teaching people this, I saw our offer acceptance rate and the number of clinical and non-clinical hires really increase. Those recruiters or hiring managers came back and said, “You’re right. I had all these preconceived notions going by their CV, and when I talked with them, they were perfect for the role and are now thriving in our organization.”

A better mindset to have is that regardless of what is indicated on a resume, think “How can our team help this person be successful?” Instead of interrogating them on what they’re going to do for us, let’s flip it and see how we can help them be successful with us. When I started doing this, recruiting life became so much easier. I’ve seen CVs and resumes that look pristine, and then I talk to the candidate and discover the person will need a little more development. Their resume looks good, but they need help working on case acceptance. Training and development are key. You can’t always judge success by experience, and hiring managers need to know they shouldn’t be declining or not calling people because of something on their resume they don’t like.

Maybe they joined a DSO right out of school and decided it wasn’t what they were looking for. Maybe the DSO didn’t have a mentorship program to help that dentist be successful. Maybe they can’t figure out how they’re getting paid. You see a lot of moving around in DSOs for those reasons. Most likely, it’s a simple fix—check in often to avoid a resignation.  

Often, people have a very rigid way of interviewing, and asking candidates non-value-add questions, which makes the entire process super stressful. I can get all the information I need in a 30-minute conversation without asking one stock question. They usually tell you everything you need to know, without you going down a list. I think that’s very impersonal. Some of those dated interviewing techniques are ineffective.

Spending or wasting time interrogating a candidate will not indicate if that person will be successful in your environment. You can talk to them multiple times and make them take assessments and still not predict if they’re the best hire. It is really going to be what they experience in the office and with the organization that will determine longevity.

I always advised the DSOs I worked with they need to be “EASY to do business with.” The more complicated they make things, whether it’s the pay structure or schedules, you will not be able to retain people. Figure out how to make the schedules work, change the hours, or have two shifts. If people are happy with their schedule, they will stay. If it works in their life so they can get the kids off to school or attend their sporting events, they’ll work hard for you when they’re there. And that goes for all team members, not just the dentists.

The people-centric organizations that pay people well for their contributions and ensure team members feel valued and help them develop in their career will have the most success with retention and fewer shortages, so they can provide better access to care to patients.

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DSOPro: What other trends are you seeing?

Dental and hygiene schools are cautioning their graduates to really evaluate what they’re getting into. They’re saying, “Don’t just take the first offer you get. Visit multiple practices and ask pertinent questions.” We used to start getting signed contracts around December or January for students graduating in May. Now they’re not committing until closer to graduation and until they have done their due diligence. I think that’s smart, and it may squash some of the moving from DSO to DSO. They’re not as frantic to jump in just to get any job because they are nervous about paying their student loans. Candidates are being more cautious now. DSOs need to give students a good representation of their organization and an exceptional experience when they visit the office because they have so many choices now. Review your interview process and candidate experience to validate it is optimal.

DSOPro: How can they best showcase or allow someone to test the DSO environment?

For clinicians, having a quick conversation with a recruiter, or whoever is the gatekeeper. Get them excited about the opportunity by relaying what they can expect and what type of support will be available. Invite them to the office to meet in person and meet with any decision makers and the team. Encourage them to stay as long as they like. Keep it super informal and not stressful. And then quickly come to a decision. Tell them you really enjoyed your time together and make them a verbal offer. Get the process going. Send them a contract so you can work through any revisions. Be flexible. Remove barriers from the contract such as non-compete clauses and long contract terms. Ideally, no more than 12 months with a 30- to 60-day notice period. Utilize a retention bonus vs a sign-on bonus. Simplify dentist contracts with easy-to-understand legal language. The more lengthy and harder the contract is to understand, the more likely they will choose a different opportunity. Move quickly because most dentists already have two to three contracts they are reviewing before they even come to your office for an interview.

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