We asked Dr. Mike Smith, an administrator and one of the most-followed Townies on Dentaltown’s message boards, to track the thoughts, experiences and decisions he had to make during the first weeks of coronavirus-related closure. How close does his story mirror yours?
On March 16, the Illinois State Dental Society released a position statement that recommended all Illinois dentists discontinue in-person treatments except emergency care, through at least the end of the month. My first emotion upon getting the news is, honestly, relief.
After much personal deliberation and discussion with colleagues on Dentaltown’s message boards, I’d already decided to limit my practice to emergency treatment only. The reason for my relief lies mostly in the nature of my practice, which has a large and loyal patient population—but the downside is a resulting long wait time for an appointment. When I decided to limit practice to emergencies only, I was concerned about how patients who’d already had to wait three months to see me were going to react when I asked them to reschedule two or three months later.
Now, though, I have reinforcements! With the state dental society’s official recommendation, I can point patients to their guidance to help redirect their distress over delayed appointments. I informed my staff about my decision and the ISDS recommendation, then sent an email blast to our patient base informing them of the news.
On to the next consideration: What to do with my staff?
At first, the decision was easy: Give them work to do. We had many side projects in the office I could rely on my staff to address. While my front desk staff called to reschedule affected patients, clinical staff rolled up their sleeves and got to business. We emptied all the drawers, cabinets, bins, tubs—everything. We scrubbed shelves and drawer bottoms. We found lost instruments and obsolete supplies. We purged old chart records. We resorted and redistributed all our instruments.
One week into the shutdown, the governor announced an official “stay-at-home order” encouraging all residents to practice social distancing. With that order in place, I didn’t feel right requiring my staff to continue coming in for their paycheck, so I had the office manager distribute a message I’d drafted to all 17 employees. I guaranteed everyone their average weekly wage but wouldn’t require anyone to come in to work.
Some days I was alone in the office; others, a handful of employees came in and continued some previously initiated projects. I started on a mountain of personal side projects—replacing worn-out outlets, fixing dripping faucets and shutoffs, installing battery backups for all the computers and rerouting cords and cables to clean up everything’s appearance. I finally got around to some phone calls I needed to make, including one to a locksmith to rekey the office locks because many of my staff’s keys didn’t work perfectly in all of the locks.
Coming off the phone call with the locksmith, I had a new project: Replace the door hardware myself! For half the price I was quoted, I could replace all the handles and knobs with new ones sporting that fancy Microban coating. I got to work. You know what else might be nice? One of those electric door release buttons for the waiting room door! Added to the list and checked it off.
I got a lot of projects done without all that “pesky dentistry” getting in the way. Plus, I got to head home earlier and spend more time with my kids during the week!
During all these projects, I was getting updates on trends and policies through colleagues on Dentaltown and trying to make sense of everything I was seeing.
As we approached the end of Week 2, the shutdown got extended.
I wasn’t too concerned about money at that point—I had cash in the office account that could cover payroll and loan payments for some time—but I was thinking that this situation could go on for a long time. What was my plan? How low could my account get before I really started to lose my mind? How long could I realistically continue to guarantee my staff their typical wage? I said to myself at the start of everything that I wanted to take care of my employees—I wanted to provide for them as long as I was able to. Like many other Americans, some of my employees live paycheck to paycheck, and missing one or going on unemployment would be devastating to their household.
My accounting firm had a web meeting scheduled that weekend to talk about the CARES Act and how it may affect small businesses financially. It also talked about SBA loans, emergency grants and the Paycheck Protection Program.
I have new things to consider. What’s going to be best for me, my staff and the office account? There’s too much up in the air on exactly what way I should move forward. Is the bump in unemployment going to be prorated? Are my employees going to end up better off on unemployment? Should I apply for the PPP right away to limit my financial losses during the shutdown? I didn’t have enough information to make a decision then. Fortunately, I was home, it was the weekend, and my kids and chores do a darn good job of distracting me from office woes.
I approached the beginning of this week the same as the one before: Tackle some projects I’d had on my back burner, reassure the staff that their jobs are safe, try to figure out what the hell I’m going to do long term. I didn’t have to wait too long, though, because my accounting firm came back with an update regarding the CARES Act. Unemployment bump went through as proposed. Time to do some math!
Some of my friends know I’m a dork for spreadsheets. I made one to figure out what worked out best for my employees—to stay on payroll or go on unemployment. It took a little bit, but I got an answer that allayed some of my stresses: All but one employee would get more on unemployment than if I simply maintained their weekly base pay. I spent an afternoon making calls and explaining things directly to each employee. I had an idea how much they’re getting, so the conversations went smooth and easy.
I didn’t lay everyone off, however: I’ve kept my office manager, two assistants and one hygienist on payroll to help handle emergencies, continue calling patients to reschedule and help with some more projects around the office. The hygienist is the one employee who would have lost money on unemployment; the others would get a temporary bump in their pay to exceed what unemployment benefits would be. My overall monthly cost just dramatically plummeted by laying off 12 people, and I don’t have to worry about their financial health.
The woods aren’t clearing
Of course, that wasn’t the end to all of my worries. How long will this go on? When should I apply for the PPP loan? If I put it off too long, would I miss the boat? What am I going to do when we can resume normal operations? I already had a three-month wait list for treatment, and every week we aren’t performing routine dentistry is another week added to my wait time for appointments.
On top of that, I have one assistant leaving in June to start dental school, and another going on maternity leave in August. I need to find and train a replacement assistant and be able to throw him or her into the proverbial deep water of a fast-paced dental practice. Two months ago the plan had been to hire with enough overlap to train and ease someone into the job, but without routine treatment going on, how could I acclimate someone to my style? When could I start a new employee?
So much is still up in the air right now. At the start of this year I’d decided to hire an associate, but with the upcoming staff replacement and maternity leave, I decided to push it off because I thought I’d have too much on my plate at once. Now I’m beginning to think the best choice for my practice would be to find an associate to start when we resume normal practice, or soon after, to help with the long backlog of patient appointments. What do I do about hygiene? I’ll have a lot more choices to make in the coming weeks, but given the official extension of the state stay-at-home order, I’ll have a lot of time to think about them.
Well, it seems like the PPP loan is off the table, at least for now. I didn’t apply right away, because I’d just laid off nearly all of my staff and bringing them back right away didn’t seem like a great plan, especially since I’d just had conversations with them about the extra money they’d be getting on unemployment. Of course, when I went to investigate the application process, my bank had closed the application portal “temporarily” but with no concrete plans to reopen it. I’m sure I could’ve tried to apply through other means, but it turns out the program is already out of funding.
Some of my friends are convinced that the program is simply over, but considering the general discontent with the program results, I’m in the camp that the PPP loans will get additional funding. Considering I still have no idea when I can actually get back to work, I have no problem with the ambiguity there. A friend of mine was really counting on that program, though—he does not have a large staff and was much earlier in his practice ownership than I. He doesn’t have the luxury of office cash reserves to help him get through.
I’ve made slight progress on my hunt for an assistant. I did manage one virtual interview using a Zoom meeting and I had a second set up, but the applicant had some technical difficulties and decided to ghost us afterward. While that was frustrating at the time, it was a relief to not have had some similar event happen after hiring.
My office manager tried to set up some other interviews, but the applicant pool we had seems to have all decided to stop responding. I suspect the current pandemic has something to do with that; some may be happily enjoying the additional unemployment without looking forward to when those benefits run out, and some may simply be turned off by working in a dental office. I have no idea. I do have one strong candidate, though, which is good. We were fairly honest with each other during the interview about timing and unemployment benefits, etc. My office manager is nervous about her because she expressed concerns about PPE when coming back to work, but I have similar concerns.
Taking a “break”
I did take “a week off,” which is funny to say considering the circumstances. I had originally had the week of my kids’ spring break scheduled off from the office. Because my kids didn’t have any distance-learning obligations and I was originally planning to be out of the office, I stayed at home during that week. My time during the day was nice. We didn’t start any of the home projects we were originally planning to undertake during the break, and we didn’t do our weekend trip to visit friends in Ohio, but taking a break from going in to the office and thinking about everything was nice.
During normal times, though, it always seemed like taking any time off from the office resulted in an exponential increase in dramatic emergencies—and this time was no different. I seem to be getting even more calls every day, and a higher percentage can’t be handled over the phone.
Speaking of handling things over the phone: Good lord, those phone calls take forever! I much prefer delegating those calls to my staff. It seems like I can never get anything done when I’m alone in the office because I spend so much time on the phone!
I’ve been keeping up with little projects around the office. Everything does take longer when I don’t have people following me around cleaning up after me. My staff all know I have a habit of leaving messes everywhere I go, and they have been fantastic cleaning up my slack. I’ve finished up with most of the little side projects and am starting to get into more of the “big” stuff. I tore out a cabinet and mounted sliding shelves for all the autoclaves. I’m rearranging the sterilization area for a better flow. I’m also planning out a centralized instrument storage center, instead of having various packs tucked away in all the individual rooms. It’s more of an undertaking than I anticipated: I first need to inventory everything I use for procedures, then figure out an efficient distribution of those items to try to minimize “waste.” I almost feel like I’m not going to have enough time to finish before the shutdowns end!
On the subject of shutdowns ending: There has been a lot of talk recently in the media and on Dentaltown about things needing to open back up. In Illinois, things are still ambiguous. The official stay-at-home order is in place until the end of the month, but there have been no assurances and only vague responses from the governor about extending that time period. Schools have been closed officially for the rest of the school year, so to me, the chances of the orders not being extended into May are unlikely.
I did decide to pull the trigger on officially hunting for an associate. I put up my first listing and decided to give the “active recruiting” service offered a try. In the ideal situation, I’d find someone while everything is still shut down. I have the time available to conduct interviews and such, but I don’t want to settle for the wrong associate simply because I’m in a hurry. It is another thing I’ll have to balance when things pick back up again, but I think in the long term, the juice will be worth the squeeze.
That does bring my thoughts back to the hunt for an assistant. I still have concerns about timing. Even if I decide to hire the one strong candidate I interviewed, how much time do I need to get her trained in our systems and my practice style? I also have the fast-approaching deadlines of my current assistant leaving for dental school and another going on maternity leave shortly after.