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Howard Speaks: The Four Horsemen of Turnover by Dr. Howard Farran, DDS, MBA

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Categories: Practice Management, HR and Accounting;
Howard Speaks: The Four Horsemen of Turnover 

by Howard Farran, DDS, MBA, publisher, Dentaltown magazine

If you’re losing good people, it’s almost guaranteed that one (or more) of these Four Horsemen of Turnover is at play in your practice. In a 2023 Gallup survey, 97% of employees who quit a job did so due to one of these issues. This isn’t theory. It’s a fact. If your team is a revolving door, it’s time to face these issues head-on.


Horseman #1: engagement and culture (41%)
Nearly half of all employees leave because they don’t find purpose or connection in their workplace. Your team doesn’t just want a job—they want a place they’re actually excited to show up to every day.

Now, ask yourself: Is your practice that place? Or is your culture non-existent, with low morale and people simply going through the motions? Without a positive culture, people will check out. They may still clock in, but you’re not getting their best, and eventually, they’ll clock out for good.

Patients see this instability, too. Imagine a patient walking in and seeing new faces every few months, assistants and hygienists they don’t recognize, or a front desk team that’s constantly rotating. It doesn’t exactly inspire trust or confidence, does it?


Horseman #2: well-being and work-life balance (28%)
People simply won’t stay where their health and happiness suffer. Dentistry is demanding—there’s no doubt about that. But if you’re running your team into the ground, don’t be surprised when they find somewhere else to work that respects their boundaries and well-being. When was the last time you talked to your staff about their workloads, about what would make their day-to-day experience better? If you can’t remember, it’s time to start. The reality is that burnout isn’t just bad for them—it’s bad for business.


Horseman #3: pay and benefits (16%)
You can’t pay peanuts and expect loyalty. It’s not enough to say you’re offering “competitive wages.” Competitive in today’s market means up-to-date, not five-year-old pay scales that worked before inflation shot up.

Good people know their value, and if you’re not paying them what they’re worth, someone else will. Yes, inflation has made costs go up. But if you think scrimping on pay is saving you money, think again—it’s costing you more to constantly hire, train, and lose people. You’re better off paying reliable team members a little more to keep them satisfied and committed. It’s a smart investment, not a burden.


Horseman #4: managers and leaders (12%)
The final horseman may be the hardest to face. A poor manager or unskilled leader is a surefire way to lose good people. Some turnover stems directly from employees who leave because they don’t feel respected or supported by those at the top.

If you’re running things the same way you did a decade ago, or if your management style is “my way or the highway,” then take a good look in the mirror. Stubborn, outdated management styles are pushing people away. Today’s workforce values leaders who listen, who adapt, who build up their team. If you can’t or won’t change your leadership approach, be prepared for the fallout.

Micromanagement, rigidity, lack of support—these aren’t just minor flaws. They’re reasons people walk out the door. Being a leader means more than giving orders. It means creating an environment where people feel empowered and respected.


Defeating the Horsemen
The bottom line is that if you’re seeing high turnover, these four horsemen are your most likely culprits. Stop pointing fingers and start taking control. Build a culture people want to be part of. Respect work-life balance. Pay your people what they’re worth. Lead with purpose and respect. Because if you’re not addressing these four horsemen, you’re just waiting for the next good employee to ride off into the sunset.
See Howard Live!

Dentaltown founder Dr. Howard Farran, known for engaging dentists worldwide through his columns and podcasts, is now taking his presentations on the road. He will speak live on Jan. 25, 2025, at the Waukesha County Dental Society in Wisconsin.

To book Howard for your event, contact Rebecca Wheeler at 480-341-9777 or rebecca@farranmedia.com.

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