We’ve all witnessed the extreme sides of management either first hand, through stories of others or even on TV. We’ve watched Donald Trump put eager contestants through grueling hell on The Apprentice for years. Even if you never watched the show, you’re likely aware of his scathing catch phrase, “You’re fired.” If you didn’t step up to the plate and knock one out of the park, you heard the catch phrase. If you didn’t work well with the rest of your group, you heard the catch phrase. Trump has a reputation for being a pretty brutal guy on TV and off. Another pretty brutal guy, who I was pretty fond of, was New York Yankees owner George Steinbrenner. After Steinbrenner passed away in 2010, I wrote a column about him and the way he managed his team. If his people weren’t the best, he shipped them off to the farm league and got the best. If you weren’t cutting the mustard, you were gone. You’re the big bat and you haven’t hit one into the stands in weeks? Adios. Can’t pitch? Sayonara, tiger.

The reason why I wrote a column about Steinbrenner and encouraged you to “win like George” is because I see the other management extreme in dental practices far too often. I’m talking about the soft-spoken, sweet doctor who keeps to himself, is afraid of confrontation and whose employees either rule the roost or are all looking to work at another practice. I’m talking about the doc who hears complaints about Amy from his entire staff all day. Amy never shows up to staff meetings, she’s rude to her co-workers in front of patients, she never sticks around for lunch-and-learns, she leaves early and she never helps prep for the next day’s patients… and the doc never does anything about her. Sure there’s probably a good reason why. Maybe she’s a really good assistant when she’s around the doc. Maybe she’s worked at the practice since before the drywall was put up. Maybe she’s the best friend of the doctor’s wife. The other employees absolutely love the practice, they dive for the ball every time and they’d love the place a thousand times more if the doctor would just get rid of Amy the bad apple. But the doctor can’t pull the trigger. What more damage does Amy have to do for the doctor to see she needs to go?

Being the owner and/or manager of a dental practice requires a skill set that you never learned in dental school. Dentistry is hard, but managing people can be much harder. People are infinitely more complex than a crown placement or even a trifurcated root canal. Nobody comes with a manual. Every person responds to positive and negative reinforcement differently and in different ways. You need to build up the courage to be a leader and make some tough decisions. You need to find ways to evaluate your teams properly. You need to find ways to reward your superstars and to weed out your non-performers.

When you employ a C, D or F player, they’re trading their time for money. They don’t care one iota about your business, your services or your customers. They’re working for you because it allows them to earn a living to do what they truly want to do, or perhaps, in many cases, in lieu of what they want to do. It’s likely they sit around all day just dreaming of what it is they’re going to do the second they get out of work. You need to fire these people, not just because they’re bringing your business and your team down(which they are), but because these people need to learn what their true calling is.

I once hired a dental assistant who was decent on paper, but she only lasted on my team for about three months. I was fresh out of dental school and she was about 10 years older than me and had been a dental assistant for about 15 years. She had all the credentials needed to do the job. She was fairly proficient, and I had very little concern with her ability to do the job. The main problem was she wasn’t a people person.

You’ve likely been in the presence of an assistant who pokes around in the patient’s mouth asking them questions to which they can’t possibly answer because their mouth is open and jammed with 80lbs of gauze, but she keeps talking, telling the patient what she sees in his mouth, what problem areas he needs to focus on, etc. That’s the kind of assistant you want. Someone who’s so concerned about the current state of your patients’ teeth she won’t shut up about it.

Well, this particular assistant of mine didn’t talk. She didn’t talk to the patient, or the rest of the staff. I’d watch her, puzzled. I couldn’t believe, when she actually did talk to people, how she talked to them. I couldn’t believe how she reacted to people. She had very little empathy for others. We got along pretty well and I genuinely liked her as a person, but I knew I had to let her go. When the big day came, I first said, “You’re being fired right now.” (And by the way, if you have to fire someone, “You’re being fired right now” really needs to be the first thing out of your mouth. No story. No hemming and hawing. None of this, “You’ve been a valued employee here for X amount of months and I’m really sorry to blah blah blah.”You need to lay it all out from the get-go, be like the Donald and say, “You’re fired.”). When she asked why, I told her I needed to give her some advice. I said, “You don’t like people. You don’t work well with people. In fact, I think you might actually hate working with people. You’ve been a dental assistant for 15 years and I bet you’re miserable doing it. You know what you need to do? You need to get out of dentistry! It’s not for you! I really think you need to find a job where you’re not working with people at all.”

(Yes, I was pretty blunt, and sure, this sounds cruel, but stay with me here.)

As I said this to her, I recalled the numerous conversations she and I had about her garden and her plants. She was really into it, man! She could list off what was in her garden and what it took to care for certain things and which plants needed more sunlight than others. Whenever she spoke to me about plants, it’s like the light turned on in her eyes.

I told her, point blank, “You seriously need to get a job at a plant nursery. It’s the only thing you ever talk about with any passion whatsoever, and I really think plants are the only thing on the planet that would actually get along with you!”

We settled everything pretty soon after that. She collected her belongings and I walked her to her car. Yes, she was shocked that she was getting fired, but I reinforced the plant thing.

Six months later, guess who shows up at my practice for her bi-annual cleaning? You got it. I was very surprised to see my old assistant. In fact she came in with her husband and her kids. She sought me out right away. I didn’t know if I was going to get punched or what. She shook my hand vigorously as she told me getting fired from my dental practice was the best thing that ever happened to her.

Seriously!

She told me she was completely trapped in thinking that she had to keep doing what she was doing because dental assistants made pretty decent money and that she had gone to school and spent all this time becoming a dental assistant that she never stopped to ask herself if she actually enjoyed it or not. She went to go work for a nursery and she loved it! She thanked me up and down for breaking her unfortunate momentum.

When staff in your office are not involved, when staff are detached, give them the freedom they need and fire them! Most people, when they’re being fired, think the person doing the firing is a total jerk. No! Not true! If this person loved their job, if this job gave them purpose, if it was the first thing they thought about when they woke up and the last thing they thought about when they went to bed, you wouldn’t have to fire them. They’d be doing a good job! Humans are too complex to offer up any blanket statement on anything, but from my experience, if you have to fire a C player, it’s because they really don’t like what they’re doing – which means they’re probably in the wrong career! It’s almost like a divorce. There can be fighting going on and total dysfunction, but it finally takes one person to take the high road and decide, “It can’t go on like this for 20 years. It’s time to end this for both our sakes.”

When you fire a C, D or F player, it’s not because you don’t like the person, it’s because they’re just not right for the job they’re currently doing. As crazy as it sounds, you might be doing many of these people a favor.

Employers too often settle for marginal employees. You have to aim high with your standards. You are allowed to be picky! The number-one mental error in practice management today is that managers think they are responsible for their team’s performance. This is completely backward. Management is responsible for finding teammates who perform exceptionally well. It’s not your job to motivate your team. They need to come to the office already motivated. I have never regretted letting someone go who wasn’t meeting expectations; and usually when we find a replacement, we find that the person works out so much better than the last person. The only regret I have is for not making the change sooner.

You don’t always have to fire someone, though. Sometimes there are other options. Let’s say your dental assistant is a really nice person. She’s great with people, she’s outgoing, she enjoys her interactions with you and your patients, but she just doesn’t like assisting. Then perhaps instead of keeping a miserable assistant around, and instead of letting her go, why don’t you move her up front where she can be around people and schedule appointments and thrive and not have to worry about prepping operatories or taking digital X-rays? I can’t tell you how many times I have been pleasantly surprised by how an employee who struggled in one position really excelled and thrived in a different position.

You constantly need to evaluate your team. Letting an employee know how he or she is performing in their job is still important to do on an annual basis, but if someone is really struggling and their performance is a major issue, you can’t wait until their annual review – that’s too damn long. If Amy is shirking her responsibilities or being a jerk, you need to nip that behavior in the bud and let her know what happens if she keeps it up right then and there. You can’t wait a year to tell someone they’re not doing what they’re supposed to be doing. Yes, letting someone go can be a traumatic experience for the person getting fired and the person doing the firing, but even more traumatic than not making this kind of tough decision is allowing someone with no passion for what he or she does to continue draining the life, spirit and (eventually) profits out of your practice.