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JCO Survey of Orthodontic Staff Job Satisfaction

Skilled and personable staff members are criticalto the success of any orthodontic practice.Once the best people are found and they areproperly trained, the orthodontist's next challengeis to retain them. The staff's job satisfactionmay ultimately determine how long they stayin the practice and, thus, have an impact on howwell the practice treats patients and performsfinancially.

To find out which job-related factors aremost important to orthodontic staff members, andto compare the staff's perceptions with those ofthe orthodontists who employ them, JCO surveyed1,025 randomly selected U.S. practices. Aquestionnaire for the orthodontist and a similarquestionnaire for the staff was mailed to eachpractice on Dec. 1, 2004. Respondents were instructedto make as many copies of the staff questionnaireas needed for every full-time employeein the practice, and to return the forms independentlyto JCO.


A total of 149 replies were received fromorthodontists, for a response rate of 14.5%. Staffmembers returned 567 questionnaires. Becausethe responses were anonymous, no attempt wasmade to relate individual orthodontists' answersto those of their own staff. The data were enteredon computer by an independent company andanalyzed using the Statistical Package for theSocial Sciences.

The orthodontists who answered the surveywere a mean 50.8 years old, with 20.7 years inpractice and 7.3 full-time employees (Table 1).The demographics were similar to those of the2003 JCO Orthodontic Practice Study, exceptthat more than 15% of the respondents to the presentsurvey were female. Staff members, whowere almost exclusively female, were a mean37.9 years old and had been employed in orthodonticsfor 10.2 years--7.7 of those in their currentoffices. The staff members representedslightly larger practices than the orthodontistsdid, with an average of 8.7 full-time employees.Roughly a third of the staff worked in the operatory,but so many indicated multiple responsibilitiesthat it was impossible to divide them by jobclassification for further analysis.

Job Satisfaction Factors

Both orthodontists and staff members wereasked to rate various factors as "very important","somewhat important", or "not important" interms of job satisfaction (Table 2). Each participantalso identified the one factor that he or shefelt was most important (Table 3). It should beemphasized that the orthodontists were asked torespond based on their perception of their staffmembers' opinions, rather than their own personalbeliefs.

Salary was rated the single most importantfactor by both groups and was the only item forwhich the difference in ratings was not statisticallysignificant. Although 39.3% of the orthodontistsbelieved salary was the most importantsingle consideration for their employees, only23.8% of the staff members thought it was themost important.

The next most important single factors forthe staff were job security and doctor compatibility.The orthodontists placed those items behindoffice environment and staff compatibility. Overall, a much higher percentage of staff membersrated each item as "very important" than theorthodontists did; the doctors were more likely toconsider the same factors "somewhat important".

Employee Benefits

The same pattern held true for employeebenefits, with staff members significantly morelikely to rate each benefit as "very important"(Table 4). Both groups saw paid vacation andholidays as more important than the other benefitslisted. Staff members placed retirement plansahead of medical insurance, however, whileorthodontists ranked those benefits in the oppositeorder. The greatest disparities in mean ratingsbetween the two groups were found for retirementplan, dental insurance, and continuing education.

A significantly higher percentage of staffmembers said they would like to choose benefitsfrom a cafeteria-style list than the orthodontistsbelieved would be the case (Table 5). Conversely,a significantly higher percentage of orthodontiststhought their staff members would accept benefitsin lieu of salary than the percentage of staffwho agreed.

Other Job-Related Issues

A relatively equal percentage of orthodontistsand staff--more than 70%--said that staffmembers could accept more responsibility (Table5). While the orthodontists were more likely tobelieve that bonuses should be awarded on specialoccasions only, the staff felt they should beoffered either annually or both annually and onspecial occasions. Staff members were also morelikely to think that bonuses should be based onpercentage of salary or length of service, whereasmore than 80% of the orthodontists maintainedthey should be based on merit. Eighteenorthodontists and 34 staff members indicated thatbonuses should be based on performance or production,and a number of respondents wrote inshorter intervals for paying bonuses, rangingfrom biannually to as often as weekly, withmonthly the most common interval.

Staff members rated their in-office trainingas significantly better than the orthodontists did,although few of either group thought their trainingwas inadequate.

More than three-fourths of each groupbelieved staff members sometimes felt stress onthe job, but the staff were slightly more likelythan the orthodontists to say they always or neverfelt stress. Both groups cited overbooking andstaff friction as the most important factors contributingto stress (Table 6). The staff members,however, rated doctor friction, inadequate training,home-office conflict, and emergencies assignificantly more important than the orthodontistsdid.

Other stress-causing factors listed by theorthodontists included non-compliant patients, alack of busyness, and staff absences, along withthe following:

  • "Occasional parents with selfish, hot-headedattitudes."
  • "Hygienists and general dentists can causeundue stress."
  • "[Staff] not paying attention to systems inplace; wasting time; not being organized."
  • "Lack of initiative; inconsistent staff performance."
  • "I think organizational development is the mostimportant issue facing our practice. The teammember developing trust in the organization andcongruence with the core values seems to me tobe dependent on the leader."
  • "There are two kinds of people in life: peoplewho like their job and people who don't workhere anymore."
  • Stress factors listed by staff membersincluded:

  • "Unscheduled procedures; frequent repositioning,sometimes on same teeth after final wires areplaced. Makes office look incompetent."
  • "The doctor doesn't back us up on his officepolicy we enforce with patients."
  • "Phone too busy--no voice mail!"
  • "Division of work is a problem. Some have alot more than others for similar pay."
  • "Office troublemakers."
  • "Racial comments."
  • "Conflict with staff in adjoining office."
  • "Favoritism is very bad here."
  • "Doctor's respect level for assistants."
  • "[Annual staff] reviews are not being done. Iwould like the doctor to take more responsibilityin that area."
  • "Communication!!"
  • "We belong to too many discounted insuranceplans. I think we would benefit by deleting thereally low-fee plans. In the long run things wouldrun smoother, and it would not make a differencefinancially."
  • "I should not be discriminated against due toage concerning my health coverage. I haveinvested 22 years in a very successful practice,and my medical reimbursement doesn't evencover hospitalization."
  • Several staff members also listed lack ofadvancement opportunity as a stress-related consideration,and there were two lengthy commentsabout the problems of staff working alongside theorthodontist's spouse--one from a staff memberand one from a spouse.

    Factors Related to Number of Years in Orthodontics

    The importance ratings of the factors listedin Tables 2, 4, and 6 were broken down by theorthodontists' number of years in practice and bythe staff members' number of years employed inorthodontics. No significant differences werefound among the orthodontist groups, whichcould be partly due to the smaller sample size.

    Among the staff, those who had beenemployed for 10 years or fewer were significantlymore likely than those with longer tenures toconsider advancement opportunities important totheir job satisfaction (Table 7). The younger employeesalso placed significantly more importanceon child-care benefits (Table 8).

    On the other hand, staff members who hadbeen employed longer were significantly morelikely to consider paid vacation to be an importantbenefit (Table 9). This pattern was even morepronounced for retirement plans (Table 10).


    Orthodontists may have the best interests oftheir employees at heart, but may not alwaysknow what their staff members think about therelative importance of job-satisfaction factorsand benefits. This survey shows that orthodontiststend to focus on strictly work-related issuessuch as salary, job performance, the office environment,and staff relationships, while their staffmembers may be more concerned about long-term,outside-life-related issues such as job security,insurance, and retirement planning--as wellas their relationships with their employers, whichhave a substantial impact on their security.

    Orthodontists may want to consider conductingsimilar surveys within their own offices,guaranteeing anonymity in some way to ensurecandid responses. The results would allow themto tailor their employment policies and benefitsto suit their present employees. In many cases,there would be little or no economic impact, butstaff members would almost certainly be happierand, therefore, more likely to remain with theirpractices.


    Dr. Keim is Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.


    Dr. Gottlieb is Senior Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.


    Dr. Nelson is Director and Research Consultant, Nelson Associates, Nederland, CO.


    Mr. Vogels is Managing Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.

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