Never Try to Teach a Pig to Sing
One of the most significant and consistent findings of the JCO Orthodontic Practice Studies has been that practices with high net incomes have twice as many employees as practices with low net incomes. They delegate more tasks to their employees, pay them more, and yet have a lower overhead rate. Not surprisingly, high-net practices also have lower employee turnover--an important factor these days, when competition for an able staff is becoming more intense than ever.
Traditionally, orthodontists have not paid high enough entry-level salaries to appeal to many people, and that reluctance to pay will probably work against us even more as we try to replace departing staff during the next decade. A review of starting salaries would be in order for many of us.
The article by Dr. Mel Mayerson in this issue directs our attention to the many nuances of staff selection, training, and retention. Mel is one of the few people I know who has systematically studied this subject, so when he tells us it costs $11,000-12,000 to hire and train a new employee, we ought to take notice.
Hiring a new person is a major investment not only in money, but also in time and emotion. Nothing is quite so disappointing as the discovery that a new hire isn' t working out. Several years ago, a series of such disappointments inspired me to attempt to discover a successful orthodontic assistant personality profile. A psychologist and I spent several months and several thousands of dollars in the quest (see Search for an orthodontic assistant personality profile, Am. J. Orthod. 94:350-353, 1988). The bad news, I discovered, was that there was no consistent profile among the more than 400 assistants we interviewed. The good news was that most of the competent assistants came from that undifferentiated, middle-of-the-road, and thankfully, plentiful average population.
This is the group that is most likely to present for employment in our offices, and also the most likely to succeed. We don't have to mount a search with highly sophisticated tests for people with rare talents; rather, we can use simple selection procedures and expect to find people who can learn the tasks we are trying to teach.
But even if we don't need a hiring process as involved as what IBM or duPont might use, we still need to get an idea of our applicants' abilities. Nothing frustrates current staff as much as trying to train someone who simply can't learn the job. It reminds me of some advice I once read: " Never try to teach a pig to sing. It wastes your time and annoys the pig." If there isn't at least a fair chance that our efforts will bear fruit, then we probably ought not start.
Mayerson offers some simple but effective ways of choosing only people with the potential to learn the job. His dexterity tests have particular appeal because quite often, in my office, highly intelligent employees have proven utterly incapable of mastering chairside tasks. For much too long a time, I erroneously believed that high intelligence was the attribute for learning orthodontic assisting. I wish I had used Mel's dexterity tests, because I could have saved myself and many aspiring assistants a lot of agony by encouraging them to enter another line of work. Clearly, a certain level of intelligence is necessary, because even the gods fight in vain against stupidity. But after 30 years in this business, I'm convinced that dexterity is as important for orthodontic assistants as the ability to think abstractly.
The 1989 JCO Orthodontic Practice Study showed that only 22 percent of orthodontic offices have a written training program. Mel's office is one of the few that offer new employees a special curriculum, and I completely agree with him about poor staff training being one of the major shortcomings in most practices. My own study of 124 orthodontic offices found that employees who had a special training program received higher performance ratings and stayed on their jobs longer.
Mel's formal approach obviates the pressure to move the new employee from typodont to patient before the person has the required skills and confidence. This means there is much less likelihood of violating "shaping principles"-- getting people to progress toward a goal by taking small, successful steps. Educators tell us that failing to observe shaping principles is the most common reason for learning failures. We expect too much too soon and don't provide lessons in manageable bites.
Most orthodontists I know tend to be impatient; they want new employees up and running before they are able to crawl. When new staff members come to drink from our fountain of knowledge, we shouldn't turn on a fire hose, or we're likely to blow them right out the door. With the cost of training at $12,000 per person and rising, it only makes sense to try to keep the good employees that we find.
There will be many orthodontists who yearn for the good old days when you could make a reasonable living by working alone, with maybe one assistant. When I started my orthodontic training, prominent clinicians were advising 65 patient starts per year as a maximum figure. Well, that piece of advice has become as anachronistic as the 100-acre farm. At one time small practices could be run profitably, but modern economic realities make it all but impossible today.
Certainly, high-quality treatment is still our most important professional duty. But to deliver such care we need-- now more than ever-- competent, caring assistants who can magnify and extend our own special knowledge and efforts, as well as make such care economically feasible. Since we can expect it to become more and more difficult to attract these people, Mel Mayerson's message has a special relevance for every orthodontist.