Dental Practice Heroes

The Turnover Tax: 3 Simple Moves That Keep Your Best People (and Profit)

• Episode 607

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Imagine losing a team member who's been with you for years. Beyond the obvious recruiting costs, you're facing a cascade of hidden consequences: the training burden on your remaining team, eroding morale as staff wonder if they should be looking elsewhere, and patients noticing unfamiliar faces at every visit. That's the reality of turnover, and it's far more costly than most dentists realize.

Drawing from my own practice experience—nine years of remarkable stability followed by a challenging period of departures after COVID—I've discovered that reducing turnover doesn't require complex systems or extravagant perks. It comes down to three fundamental principles that are surprisingly easy to implement but transformative in their impact.

Recognition sits at the heart of retention. When I committed to giving each team member two specific compliments weekly (what I call "filling buckets"), I was shocked to discover how many quiet contributors I'd been overlooking. Creating systematic appreciation—sharing patient reviews, implementing token recognition programs, celebrating achievements—transforms recognition from an occasional afterthought to a cultural cornerstone.

Regular one-on-ones provide the psychological safety team members need to express concerns before they become resignation letters. These structured conversations aren't just problem-solving sessions; they're relationship-building opportunities that demonstrate you value each person's perspective. I've consistently found that periods of team unrest coincided with lapses in these critical meetings.

Finally, investing in your team's growth and creating a workplace where people genuinely enjoy their colleagues builds remarkable loyalty. People will tolerate significant workplace challenges when they love the people they work with and feel they're continuously developing professionally.

Ready to transform your practice into one where people want to stay? Visit dentalpracticeheroes.com to schedule a strategy call. We'll discuss your specific challenges and explore how our coaching program can help you build the team-driven practice that gives you more freedom, profitability, and peace of mind.

GRAB THE FREE PLAYBOOK HERE - Discover 30 proven strategies top-performing dentists use to increase profits, cut clinical days, and finally enjoy the freedom they originally built their practices for.

https://www.dentalpracticeheroes.com/playbook

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Paul Etchison:

Now I want to share a story with you guys. If you've been listening to this podcast since it started in 2017, you know that I used to go speak and I used to talk a lot about low turnover. I mean, I was like the low turnover guy that's how I was like branding myself. I had a practice that was like five years old at the time and I hadn't had a single person leave and we went almost like nine years without having anybody. I mean, we had, like some people that might have moved away and we had one girl that went to nursing school but nobody left. Like we had such a good culture that nobody wanted to leave the team. We had such a good team and we had a team of man I mean we were probably 20 plus people. But I remember speaking at Voices of Dentistry and this was my first speaking engagement and I talked about the idea of psychological safety and the evidence I was giving that this works was showing that I had a huge team and I didn't have a lot of turnover. And then somebody came after me and spoke and they made like a jab at me. They said, hey, if you haven't had any turnover at your practice, that's not something to brag about. That's bad leadership, and I still disagree. I don't think that's true. I think that was great leadership on my part. I think I was doing great.

Paul Etchison:

But, truth be told, after COVID happened, well, I got my ass handed to me with turnover. So maybe I was just due, maybe it was karma, I don't know. But what I want to share with you is that I did things that kept my turnover really low, and turnover was not something that I was experiencing in my practice for the first like nine years practically. So it was really easy for me not to understand what a problem it is and how harmful it is. So for me, early in my career, we had very low turnover and then, after COVID, I got to see a period of really high turnover, which a lot was pandemic, a lot was the labor market, but a lot of it was honestly the way we were running the business. It was my leadership, to be honest. So that's what we're going to be talking about today how can you drastically reduce your turnover at your practice and not in the sense of all that fluffy stuff I'm talking about how can you make sure that your team stays? And I think it's a lot easier than you think and I think a lot of the consultants and speakers on the circuit. They really overcomplicate this and I think it comes down to three basic things. I'm gonna share with you today what those are.

Paul Etchison:

Now you are listening to the Dental Practice Heroes podcast, where we teach dentists like you how to run a team-driven practice so that you can make more money, take more time off and spend more time with your family or just doing whatever it is that you love doing. I'm your host, dr Paul Etchison. I'm the author of two books on dental practice management, a dental coach and the owner of a large group practice in the south suburbs of Chicago, and if you are looking to practice less days and have more peace in your life because of the way your dental practice runs, you've come to the right place. All right, let's do it.

Paul Etchison:

So why does turnover hurt so bad? And I see this attitude on the Facebook forums. A lot People are like just hire somebody else, everybody is replaceable, nobody cares, don't tolerate that stuff. You get what you tolerate and I get it. I do agree with that. You do get what you tolerate, but I don't think the solution is often letting people go Like that whole like being slow to hire and quick to fire.

Paul Etchison:

But it does hurt. The turnover kills us. I mean the costs are huge. We have to recruit in dentistry. I mean now more than ever Back in the day. I mean now more than ever Back in the day. I mean like 10 years ago we used to line people up and like we were the badasses. We were like we've got the stuff that you want. We would interview people one after another and it would be like tell me why you think you deserve this job, and like we had that good stuff that everybody needed. And now we're like okay, do you have a heartbeat? Do you think you could actually show up for an interview? And if you came to the interview and we gave you a job, could you actually show up to it? Get your ass in here. You got a job, you can start tomorrow.

Paul Etchison:

So the turnover costs are the big recruiting. A lot of it's that, but a lot of it is also in the training. It's in that slow drag that it creates on your team when they have to train others. And there's a ton of morale loss when people start to see their friends and their peers at work. They're leaving and they're looking at that like where are they going? You know, they still keep in touch. They're like texting each other like, hey, where are you working now, how is it over there? So you got these people that are like, oh yeah, it's great over here, so much better than over there with Etch, etch sucks, and that can turn into like a poach fest.

Paul Etchison:

But I guess I didn't do this to somebody, but I had like three people come from another office at one point because I hired somebody and then they brought their friends. I didn't reach out to solicit them, I didn't encourage it, but I didn't necessarily discourage it either, because I really needed the people. So now in retrospect, karma came back. That happened to me once before, but I would never reach out to people to try to poach them. But if they weren't happy there, they're not staying where they're working. So if they're going to go anywhere, I'd rather they go with me. I mean, I could use some good employees. I think we all could.

Paul Etchison:

But losing people on your team, it can really create this ripple effect and just drag your team down and it just doesn't look good. It doesn't look good from a patient perspective. I remember so many times that I've had a patient look up to me and they say, you know what's weird? I don't recognize anyone in this practice anymore. What happened to everybody? And I would be like, hey, like everybody's still here. We just grew our team. We're just growing really fast and, dude, like we still got, like we opened in 2012. We've still got so many of the people that have been there since the beginning. I mean, I've got so many people that are passing their 10 years coming up. So we've got good culture in our practice and I think that's a testament to what I'm going to share with you today.

Paul Etchison:

So, main point is there's a lot of hidden costs that come from starting over with a new hire, because they take a long time to train, even like the most simple things. I mean just to learn your systems and to learn like your culture. I mean those are things that you can't train on. You can't train on culture. I mean you can say what you want, but they have to experience it to see, like, what do you do when this happens? What do you do when the patient's upset about this? How do you take care of people? You just can't train for those things because they're just random. The new team members got to experience them. They just have to be part of the team when those things happen. So it takes a lot of time to get people developed to that level and get people trained up. So when we do, we want to keep them.

Paul Etchison:

So I hope at this point in the podcast you're starting to think and starting to feel that turnover is a little bit more detrimental to your practice than maybe you thought before. So let's talk about why people really leave. I mean, a lot of people will leave because they just don't get any recognition for what they do. Now, on the flip side, it is so easy to not notice and not acknowledge them. I remember one time when my team was smaller maybe they were like 15 or something like that I made a commitment to give each person two compliments each week.

Paul Etchison:

It was this thing that I called filling buckets and it comes from this book that my daughter had. It was called something about filling buckets, but it's this idea that everybody has an invisible bucket above their head and that's how they're feeling. If they're feeling good, their bucket is full. If they're not feeling good, their bucket is empty. Now, when you give somebody a compliment, you recognize something about them, you show them gratitude, you fill their bucket a little bit, but when you fill somebody else's bucket, that also fills your bucket, and the idea being well, if all of our employees' buckets are full, they can fill the buckets of our patients. So I just said I am going to fill the buckets of my team at least twice a week for every single team member, and I made a chart to keep in my doctor's office and wouldn't you know, I thought I gave a lot of compliments to my team.

Paul Etchison:

When you start tracking it, it's a lot less than you think and I guarantee you, if you do this, you're going to have the same experience. You're going to find out that there's some people on your team that you don't even notice because they're so quiet and they're just sitting there and they're flying under the radar. But then we have these some employees that every time they do something good, they're going to tell you about it. Hey, dad, guess what I did? Hey, high fives, like they're very vocal about it. So it's really easy to recognize those people, but it's easy to overlook the more quiet people. So when you keep track of this, you'll see that and you can give more effort to give recognition to the quiet people.

Paul Etchison:

Now, why else do people leave? They leave because of a toxic culture. And where does a toxic culture come from? It comes from lack of communication. It and where does a toxic culture come from? It comes from lack of communication. It comes from all of those conversations that we can never pull out into the open. So when we don't have the conversations with our team about the things that are upsetting them, that's when they start to have resentment for each other, and resentment builds and builds.

Paul Etchison:

And then the gossip shows up. And I'll tell you, this is what I always see in offices with gossip. I think gossip is a symptom of a lack of autonomy. When somebody feels like they have no autonomy, they don't have any control over what's going on in their workplace. This is the psychological way that people react. To get some control back, they start saying bad things about people, start saying bad things about the office, and the reason they don't have any autonomy or power is because no one's really asking what their opinion is on things. Nobody's asking them what's going on, nobody's asking them for suggestions and the issues just keep getting brushed under the rug, and that's what leads to resentment and eventually gossip.

Paul Etchison:

So you need to give your team autonomy and this is why you need to talk to your team. You need to solicit those conversations, you've got to take the time to ask for feedback, you've got to ask them how are things going. And this loops back into that psychological safety thing. That's what I was talking about at the Voices of Dentistry conference when I was talking about the low turnover. It was psychological safety the idea that your team feels safe to bring things up, that they feel safe to say they need more training, they feel safe to tell you about things that went wrong because you're not going to make them feel bad or guilty about it, which this is one of my leadership principles. That's part of the first phase of the OmniPractice program that we go through with all of our clients. We teach you how to do a one-on-one, how to properly do them, what kind of questions you should ask, what kind of attitude do you need to bring into these short meetings so that you can have these conversations with your team and give them the autonomy and show them the gratitude that they deserve and I can't tell you how many times I have shown the power of one-on-ones to a client, so they're so powerful.

Paul Etchison:

If you want one single thing that you could take from Dental Practice Heroes and never, ever forget it, it is that one-on-ones are the most powerful thing that you can do in your practice if you do the principles correctly. And the principles I'm talking about is things like psychological safety. There's a few other ones, too as well, but you just got to do these things and don't overthink it. Just do it, because I remember in my practice, like every time we went through these phases where there was just this feeling of discontent, there was like tension. We could feel it. You feel in the room like you're in a meeting and you know something's going on in your practice. I mean don't act stupid. You could feel these things A lot of times. We want to act like we don't know because we don't want to address it, but you know what I'm talking about, you can feel it. So all those times that I felt like that, I could look back and say you know what?

Paul Etchison:

I don't think we've done one-on-ones in a really long time. Have I been communicating with my team? Have I been talking to my team and asking them? Have I been building the relationships with my team and just seeing how things are going going and nine times out of 10, I was really busy and I just hadn't done it. Lately I've been locked in my office and I'm not spending the time managing my practice, doing these very basic things that you have to be doing. So this is why, as your practice grows, you start to build a leadership team so you don't have to be the one worrying about doing this and you make sure that they do this one-on-ones with their departments on a regular cadence. That's how we do it now at the practice. My leads do this. I don't do this anymore. I do one-on-ones with my leads because I can't do one-on-ones with 35 plus people. But, like I'm saying, there's a lot of times in my practice career it got bad and showed up in the culture and the way people were feeling Okay, other than gratitude and communicating with your team via the one-on-ones.

Paul Etchison:

What else can we do to retain and protect our team and keep them together? You've got to invest in them. You've got to invest in the culture, in the leadership of your practice. You've got to train your leaders. If you have a leadership team, I can tell you we just did this the other day with our leadership team. We all took a conflict management training and we went through. We had a facilitator, we role-played some situations that are going on in the practice and I know this is gonna make a big difference in our practice. So even taking your team like full team to CE events, that's another way you can invest in your team.

Paul Etchison:

You train them in your team. They wanna do a good job, they want to learn things. They wanna say how do you play this game that is dental practice management? How do you play this game that is dental practice management? How do you win the game of answering the phone the best way? How do you win the game of presenting treatments so patients get healthy? Your team wants to be good at these things. So you got to provide this training and they're going to appreciate you for that and they're going to be so much more engaged in your practice.

Paul Etchison:

So you got to make sure that you're doing all these things, because when you get a team member, that's upset. They don't feel valued, they don't feel like they're growing, they don't feel like they have autonomy in your practice. They start looking for another job and when they are at that point where they're looking for another job, they might as well be gone because they are no longer contributing positively to the culture. At that point they might be just doing the bare minimum, but they are not doing good things for your practice. You want that person out of there or you want them to value the job that they have. So if you're on my team and you're listening to this and you're like, well, I've been looking for a job for six months, would you do me a favor and just please leave? We don't want you. We want people that are there and want to be there and we want people that contribute positively to our culture. All right, anyway, I know I'm all over the place today, all right.

Paul Etchison:

Next, we've got to create systems for recognition. Now I gave you the filling buckets example. Here's a few other examples. We have a Slack channel with our team and one of them is for posting all the five-star reviews. Now, I don't post every five-star review. I just know that, as a practice owner, I get an email when we get a five-star review. My team does not get an email. They don't get to see it unless they actually go look for it. So I want to post these five-star reviews. I post all the ones where people write nice things and it makes them feel good. They see that we're affecting people, that people are happy with what we're providing, and I love it when the patient uses someone's name or gets really specific about what they loved.

Paul Etchison:

Now, another thing we do for appreciation is we do these appreciation tokens. So every month, every team member gets three tokens and they are to give that to somebody else. When somebody does something nice or does something to help them, they want to explicitly recognize. They appreciated that. So they hand them this token and they say thank you. Now, at our team meeting each month, everybody turns in their tokens. So and they get some tickets for it, they get raffle tickets. So whoever has the most tokens will get the most raffle tickets and is more likely to win a prize, because we do a raffle and we give away prizes like Amazon gift cards, starbucks gift cards, things like that, and then everybody gets their three tokens back and we do it again the following month. And then I mentioned the one-on-ones. That's another opportunity for you to show some recognition, some appreciation for your team. That's part of what we teach in our program. That's one of the parts of doing the proper one-on-one.

Paul Etchison:

So, lastly, we want to make our practice a place that people want to stay at. Make it fun. Make it fun to do things together. Set up social functions so that you can learn how to play together. One of the things I remember in this book that I read I don't remember where it was, but it was that people will stay at a job that they just freaking hate way too long, like way longer than they should, because they just freaking hate way too long, like way longer than they should, because they just love the people that they work with. So if you can give your team an opportunity to get to know each other outside of work and hang out, that's awesome for your culture. I mean, my team hangs out with each other all the time. They're all friends and I love that they all get along. It makes me feel like I've got the right people on the right team. I love it. And learn how to inspire your team. Learn how to train yourself as a leader. There's so much leadership training that I put on Dental Practice Heroes and all the programs that we do. We've got tons of videos for all of our coaching clients that are created by me and I think they're very to the point. You can get through all of the leadership ones and the culture ones in probably two to three hours. So learn how to inspire your team.

Paul Etchison:

And this episode was really not about this, but it's on my mind right now is another thing about turnover is you've got to make sure you build your onboarding systems and your training systems in your practice so that when you do experience turnover because you're going to, it doesn't hurt you so bad. You don't want to have that one employee that knows how to do everything and nobody else knows how to do it, because if you lose that employee you're screwed, and I've seen this happen to dentists. They lose that really well-trained office manager person and there's nobody to fill the shoes. So this episode is really just about retention. We want to retain our team and we're not just talking about culture and it's not only about culture, I mean, we're talking about the profitability of your practice.

Paul Etchison:

So I want you to think about what is one thing that you could do this week to make your team feel more valued and supported.

Paul Etchison:

Maybe you'd try that filling buckets exercise, maybe you do some one-on-ones, maybe you learn how to be a leader and you put the systems into your practice so that you can finally have a team-driven practice and your team can take more autonomy and more responsibility and feel good about that. And if you want help on how to do this and how to create this type of practice so that you can have a ton of time off and a lot of freedom in your life, I want to talk to you on the phone. Can we do a strategy call? Would you go to dentalpracticeheroescom and get on my calendar? It is a very low pressure thing. I will let you know about our coaching options and I will hear what's going on in your practice and I will give you my best advice at that point. So, at bare minimum, you're going to learn a lot from me just by having a conversation. So reach out to me there, dentalpracticeheroescom. Thank you so much for listening. Have a great week, everybody. We

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Dr. Paul Etchison

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