Rules of the Game

Gregory L. Psaltis, DDS

Kathy, your loyal assistant of nine years approaches you one day with a “favor to ask” because of problems with her six year old daughter’s new day-care provider. She wants to know if  she can come to work 15 minutes later than usual each day, as long as she “promises” to “be really efficient” and “prepare all her morning duties the night before.” A part of you wants to say yes to this individual who has worked hard for you during her career in your office and a part of you sees the potential for problems with the other two assistants, both of whom also have children in day-care. This is one example of many requests that are put on the table for an employer to consider and it appears there is no decision that won’t in some way impact the office poorly. Losing Kathy would present a significant challenge, but alienating her co-workers could likewise create repercussions. What is a boss to do?

The greatest joys in my professional life are in the patient contact and the technical care I provide them. After years of practice, it is infrequent that my frustrations come from these two aspects of my work. More often I find that a variety of seemingly minor, yet relentless issues swirl around my head like mosquitoes. These are rarely, if ever, based on the actual performance of dentistry for me, but rather tend to fall into the broad category of “taking care of my Team.” While this generalization encompasses many different parameters, the focus for this article will be on the specifics of the conditions of my Team’s employment and the document that spares me untold grief when the inevitable questions arise. By having a document that spells out the “rules of the office,” it provides the answers “up front” for the vexing questions or favors that are asked and the resulting dilemma of choosing between being a “flexible boss” or being “hard.”

I was given excellent advice during a brief association with two experienced pediatric dentists in Sacramento, California. They had been in practice for 22 years and held the philosophy that they worked hard toward success, but planned carefully for failure. This is not a pessimistic viewpoint—it was one of the memorable pearls I learned from them that has served me in many areas of my life. I view the Conditions of Employment as a boundary-setting document that is primarily needed at times of confusion. My basic belief is that people can work together when everyone feels that he/she is being treated fairly. However, there will be times when questions arise. The goal of your Conditions should be to anticipate as many of these as possible so that everyone understands the rules. Let’s review some of the most critical components of Conditions of Employment. Yours need not be limited to these categories, nor must they include all of them. The more thorough you are, however, the fewer problems you will have in the future.

The Conditions of Employment in my partner’s and my office is 10 pages long and consists of twenty paragraphs. The sections that I feel are most vital to any office’s Conditions include the following:

1. Regular work schedule

This section will literally define the exact times that constitute your workday and workweek. It is the basis for pay and the basis for when employees are expected to be there. We also included a rejoinder about the nature of dentistry and the fact that we may run late on occasion. We specify that if a lunch hour is ever shortened by 30 minutes or more, the office will provide lunch to the Team. It is also important to address overtime and how it is handled. You should consult with an attorney to make sure your conditions meet state and federal standards.

2. Personal appearance

This is your place to define any requirements you have regarding the way your Team members dress, wear jewelry and perfume, keep their hair and what, if any, penalties occur because of infractions of these rules. In our office an Office Standards Committee deals with this, so that the Team is self-policing, thus taking the owner out of the enforcement role.

3. Probationary period

This section defines the period of time during which assessment toward regular employment will be conducted. For us, it also defines precisely how and by whom these assessments will be done.
Our “Success Committees,” which are comprised of three Team members and one doctor, regularly critique the new employee and provide specific areas in need of improvement. Improvement must be shown in order to continue working in the office.

4. Regular period of employment

Here we define exactly when the probationary period ends and which benefits begin. In our practice, some benefits, such as medical insurance, only apply to “regular employees.” During the first three months, some of the benefits are not available. By defining this specific point in time, new employees have a clear idea when to expect each part of the benefit package.

5. Wages

It is critical to spell out the terms of payment (whether hourly or by wage), the dates on which wages are to be paid and the basis for any bonuses, if applicable. We allow employees to become eligible for a bonus after a full year of employment. We also specify the requirement for employees to still be working up to the designated bonus payday to be eligible for it. In this way, we avoid questions about who “deserves it.” It is an objectively defined basis.

6. Holidays

Enumerate each holiday that the office observes and include a statement as to whether or not they are “made up” if falling on a weekend.

7. Vacation benefit

Many formulas exist for defining a vacation benefit. It is important to lay out the guidelines for when the benefit actually begins and how it accrues. In our case, we do not allow time to accrue from one year to the next, which we feel encourages the Team members to take time off. Our belief is that this is critical to their ability to perform at the level of competence we expect.

8. Medical insurance benefit (if applicable)

This benefit needs clear boundaries, including when it begins (at what point in time of employment), which plan is provided and who is included in the plan (whether or not family members can be added). We allow family members to be added, but at the expense of the employee. Team members may select a plan other than the one that we provide, but the practice only pays a dollar amount up to the equivalent of the premium for the designated plan.

9. Definitions of full-time, part-time and temporary employees

If your benefit package depends on the status of the employee, it is important to delineate between full-time, part-time and temporary. It is simple to cross-reference which benefits apply to each category once your Conditions of Employment are written in outline form.

10. Leaves of absence

It is wise to check with your attorney regarding your state’s laws about maternity leave. Local statutes may determine your policies. Beyond that, you can also establish guidelines here for extended illnesses or injury and how long benefits will continue under these circumstances. In our practice, we agree to a four-week period of time, for example, to continue medical insurance. We also specify that an employee on extended leave will have her/his job held open for six weeks from the time of absence.

11. Continuing education benefit

If your practice has either benefits or requirements around continuing education, this is where to clarify them. This may include a variety of possibilities. For example, you can define courses that are required by the employer and whether or not there is extra pay when they occur on defined “non-work days.” You should also address the courses that individual employees request to attend and whether or not the practice will pay tuition. Other issues may include whether transportation, room and/or food are included for courses that are not in your immediate geographic area. For our employees, we have defined a daily dollar amount for food per day for courses that require a single meal and an amount for courses that require an overnight. The more detail you can include, the less likely you are to have confusion.

12. Retirement plan (if applicable)

As with other benefits, it is appropriate to inform your employees about the practice’s plan and the basis for eligibility. We have a SARSEPP plan, which allows flexibility in participation. As a result, we have clearly stated that the level of the contribution each year is solely at the discretion of the employer.

13. Infection control training

Not only is it a good idea to have an infection control manual, but it is also wise to state in your conditions that it is required of the employee to study your manual. In this way, you have made clear that the requirement of OSHA training is being addressed in an active way in your practice so that no questions can later arise about its importance.

14. Termination of employment

This is one of the most important categories to address in advance—the specific reasons for dismissal from the business. We not only enumerate reasons (illegal activities, lack of aptitude, any reason detrimental to the practice, etc.) but we further include a “not all-inclusive” statement, so that we are not limited to our list. In this way you have established specific criteria that must be met as a minimum for continuing in the employment at your office.

One issue that we have included in our Conditions of Employment that we believe is important, but perhaps not vital to every office, is a Commitment to Positive Behavior. Because we spend so much time on the development of Team and communication, we feel it is important to not only address the issue of conflict, but also provide a framework for resolving it. In our Conditions, there is a four-step plan for conflict resolution that is taught and supported in our Team Meetings. When these are not followed, dismissal will result. This has been successful in minimizing infighting between Team members and has kept the doctors from being referees for disputes.

There are other points that offices may want to address.  One is a sickness (often called wellness) benefit. We combined wellness with vacation into a single category called “Days-off,” so that the less time the employee is sick, the more time she/he can take as vacation time. The total number of days that are paid, however, is clearly defined. We have also chosen to include a section about the Hepatitis vaccine and that the office will provide it for all interested. It is plainly stated that we recommend it. Administrative matters (such as employees receiving keys to the office) and general definitions complete our Conditions of Employment.

Conditions of Employment are works in progress. Each year it is good to review them thoroughly and to see what has been unclear, what has been omitted and what may simply no longer apply. Corrections are simple when the Conditions are on a word processor.  My partner and I have adopted the convention of opening the Conditions to discussion and/or suggestions by the Team in September or October, requiring that any ideas or questions be brought to us no later than November 1 for our consideration. In this way, changes can be made by December 1 so that the final document has a full month for Team members to read and ask questions. The document is then ready to sign on the first work day of the New Year without questions.

The services of an attorney are invaluable in the creation of your document. Clearly, you want to be in compliance with all federal and state regulations. By putting the time and effort into a well-crafted document, you can fend off numerous questions or problems that may crop up. Our Conditions have served us well even though it has been necessary to amend them on several occasions. It has enabled us to focus far more of our time and energy on providing the quality of care in which we believe rather than struggling to stomp out fires as they ignite.  Since providing care is the purpose and the greatest joy of our practice, the importance of our Conditions of Employment cannot be overstated in creating greater peace of mind for me as an employer.

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