My office had advertised for a sterilization assistant and I was pleased and excited that Tricia, a former patient, had applied for the job. Tricia and her brother had been long-standing patients in my pediatric practice until they had reached the point that they “didn’t feel right coming to a children’s dentist anymore.” I had known their father outside of the practice and gotten to know their mother through my care for the children. I felt Tricia would be an excellent fit for our Team concept. She had married and was working at a local grocery store as a checker on the night shift. She didn’t like the hours and wanted to make a career change and she indicated that dentistry had been an idea she’d had for quite a while. After her interview and our explanation of the job, everyone was in agreement that she was the best candidate. It seemed we had the ideal situation—a qualified, enthusiastic new employee. She was thrilled that she got the job and came in for the final details. Unfortunately, our offer was clearly far below what she thought she would be earning and she told us she’d have to “think about it a little.” The next day she called to say that accepting the job would represent a significant pay cut for her and she and her husband just didn’t think they could afford it. She turned the job down.

Today’s job marker has become increasingly competitive in terms of offering attractive benefit packages for workers. When I learned what Tricia was earning as a checker in a grocery store, I was quite amazed to realize that from a salary standpoint, there was almost no way we could provide a competitive offer to her in dollars and cents. As a result, she is still working nights away from her husband and family. Dentistry has much it can offer in terms of offering a workplace that is in a professional setting, has regular, predictable hours that rarely, if ever, involve shift work and gives employees the opportunity to have actual hands-on ways of helping people. In short, there are many benefits that don’t show up on the paycheck. However, to attract skilled people to come onto your dental team, you will still need to have a benefit package that elevates the worth of the job for the applicant.

Some employees may view their paychecks as the alpha and omega of their benefits. By providing a detailed explanation of the total benefit package this misconception can be alleviated. Not only can this serve as a source of information, much like the Conditions of Employment (see “The Rules of the Game,” Dental Economics, August, 2000), it can also serve as a reminder of which benefits are available, so that the employees can more actively benefit from them. For example, if the practice participates in a retirement plan and the employees aren’t even aware of it, then the concept of the retirement plan being a “benefit” to the employees is actually moot. It has become more common for employees to expect certain benefits and by not establishing an attractive package, it may eliminate some talented candidates for positions in your practice. In addition to the concept of attracting qualified people, I view the benefit package as a reflection of my own values and my desire to share those values with the people who work with me. That is, while the standard of living a dental assistant can expect cannot approach that of a dentist, I feel there are essential elements of their lives that can be favorably impacted by the benefits you offer. It is in this caring for them that they will see some of the value beyond the actual dollars and cents. The benefit plan we offer our employees is reflective of benefits that we, as employers, would want for ourselves and for our families. Let’s look at some specifics of a benefit package.

Medical Insurance

This has practically become a necessity for employers to offer to employees. It is important to set the guidelines for the plan, such as the timing for when the employee becomes eligible, the plan itself, and what happens if an individual wants to use a different plan of her choice. In our practice, we have the same plan for all employees, including the doctors. This is, I feel, important for the employees to know that they are being offered the identical plan that the doctors have chosen for themselves. As an employer, it is a wise plan to consider the actual needs of your employees in the same manner you would view your own. Any time that there is a suggestion of a “cheap” alternative, it will be discussed and it will not be in a favorable way. We offer the option for employees to select their own health plans, but we specify the actual dollar amount we are willing to pay. If the plan they choose exceeds the monthly premiums we pay, it is the responsibility of the employee to cover the difference. We also specify that health insurance only begins once the employee has passed their probationary period, so that there is no confusion about the benefit beginning immediately upon hiring.

Retirement Plan

After medical insurance, I would put a retirement plan as the next most important. My thinking on this is that most dental employees will be young and may not have even begun to consider putting money aside for retirement. Given the fragile state of Social Security, I have worked toward establishing my own future security on the assumption that I will ultimately receive no dollars from Social Security. These are thoughts that never entered my mind when I was in my 20’s, but are extremely important to me now. I also have a much greater grasp of how time and compounding interest can change one’s future with some careful forethought. I have discussed these issues on many occasions with my employees and encouraged them to set dollars aside now, so that 40 years from now, when they are at retirement age, their “small monthly contributions” will expand into significant nest eggs.

Regarding the type of retirement plan that is best for your practice, you should consult with an accountant. There are many options, including 401K, profit sharing, SARSEPP and others. Some require significant management fees and others are quite simple. I would suggest you have your CPA review the various plans with you to help you see the advantages and disadvantages of each. In our practice, we started a SARSEPP (Salary Reduction Simplified Employee Pension Plan) years ago. It enables each employee to withhold an amount (up to a legal limit) from each paycheck (this is the salary reduction part) and then the business adds a contribution at the owner’s discretion at the end of the year. Other plans require a vesting period that enables the owner to front-end load many dollars before contributing to the employees’ funds upon qualifying. This is a policy decision that the dentist must make.

Vacation or “Days Off”

This is a benefit that may take many forms and provides the dentist the opportunity to make it more attractive without spending any money! In particular, to increase the “value” of this benefit, each employee can be allowed to take the vacation time whenever she wants. The feasibility of this plan may depend on the size of each office’s dental team and the ability to adjust with people missing. In our practice, we have 14 employees, so that we are fairly flexible in being able to have employees gone. When the practice designates the time that employees take for vacation, it may appear to be less of a benefit unless there has been a group process around the selection of the time. It is hard to fathom, though, that a given week (if specified by the practice) would somehow miraculously encompass family weddings, graduations, time-share weeks, etc. If I were an employee again, I don’t think I would want my employer dictating my vacation times.

My partner and I offer one week of vacation after one complete year of employment and two weeks after two complete years of employment. Recently we adapted our Conditions of Employment (see “The Rules of The Game,” Dental Economics, August, 2000, pages 110-117) to incorporate our vacation time with our “sick days.” That is, until a couple of years ago we had two separate categories, independent of each other. My perception of the “sick days,” or “well days” as we began calling them, was that when employees hadn’t used them, they felt they had “lost” something. Our first strategy was to pay them for unused sick days at the end of the year. However, it dawned on us that it could become yet another benefit if we simply combined the two categories under the heading of  “Days Off.” The incentive became that the fewer days taken for sickness, the more days would be available for vacation time. It has worked well and is perceived as an added benefit. It has also reduced the number of days missed due to marginal sickness.

Continuing Education

Continuing education is another way to provide a significant benefit to your employees if you can see it as a way to increase the skills of your employees and to increase morale. For example, taking your entire group to an out-of-town meeting may be expensive, but in terms of the good will and cohesiveness it generates, it may be priceless. In our practice, we specify dollar amounts we will pay for food and lodging at out-of-town meetings so that there is no confusion about those issues. We usually have a group conversation regarding the possible meetings we can attend and make the decision together as to which one to attend. This has been effective, in that we can spend time together outside of the office space and outside of the confines of our tight daily schedule. In many cases, our employees have indicated that these trips would have been impossible for them to afford on their own and they are grateful. Once, when we went to a meeting in New Orleans, more than one of our employees told us it was the first time in their lives they had been East of the Mississippi River.

The other aspect of Continuing Education is that depending on which advisors you work with, the skills being learned may be applicable well beyond the workplace. We routinely work with a consultant who comes into our practice three or four times a year and during those sessions we learn about issues such as communication skills, conflict resolution, future planning and other issues that arise both in our professional and our personal lives. This is a unique benefit, in that the emphasis of the learning is on the practice setting, but the usefulness of it extends well beyond the workplace.

There are many other benefits that are possible for any dental practice. Among them are uniforms, dental insurance (although you may also simply offer to provide the care yourself), profit sharing, bonuses and more. It is my belief that the more your benefits reflect both the literal value as well as your degree of caring and commitment for your personnel, the more likely you will be able to retain your existing employees and attract new ones. Given the reality of today’s economy where (for example) Starbucks makes each employee a shareholder, you will run into the situations like Tricia’s, where you cannot match the offer. Furthermore, there will be people who will only view the dollar figure on their paycheck as the “total package” no matter how attractive your benefits are. The best strategy you can take is make certain that your benefit package is genuine and reflects your own values so that it doesn’t appear cheap. If it does appear minimal, you will attract the people whose performance may reflect that notion. Make your benefit package reflect the type of employee you trying to attract. It’s not a coincidence that it will accomplish exactly that.