THINKING BUSINESS
a blog by Chris Barrow
  • Chris Barrow

A question of balance



My apologies for "going on" about remuneration for self-employed hygienists, therapists and associates again.


Sometimes this blog is my way of responding to the same question arriving from multiple sources.


In this case, my Daily Briefings on Facebook Live, the Business Confidence Forum on Thursday evenings, messages via social media and conversations with clients.


This has been the week in which pay for clinicians came to the top of the list and, as the week has unfolded, the mounting pressure for "the answer" has been noticeable.


What was the question?


As I mentioned in yesterday's "Storm Warning", "how do I make this pay and who do I pay?"


I've seen a few spreadsheets knocking around (including my own) and heard a few online debates.


I've realised the problem - that owners want a quick fix so that they can get this issue off their desks and focus on the practicalities of "return to work" (RTW).


There is a resounding chorus of "CAN'T YOU JUST TELL US THE PERCENTAGE?"


Therein lies the problem - in this phase of RTW there isn't a one size fits all solution.


Clients have been asking me:

  1. If I bring back my self-employed hygienists/therapists, what percentage or hourly rate?

  2. Should I bring in a sliding scale for my associates and, if so, what are the bands and rates?

  3. If not a sliding scale, what percentage?

A coupe of weeks ago, like many other advisors, I began a search for the answers - wouldn't it be great to say "yes", "no" or "x%" and then be able to move on?


No such luck.


Trust me - I've tied myself and some of my clients in knots with this.


Two conversations yesterday (after I wrote the "Storm Warning") helped me to take a different view.


During the morning I took an emergency call from a client facing an impending meeting with a small team of associates and stressed by the lack of answers. I was presented with an elaborate and very clever sliding scale spreadsheet created by the finance manager of the business.


The sliding scale was unfair to the associates.


The whole objective of the sliding scale concept (recommended by me over the years) has been to protect the owner during periods of low activity (holidays, courses, etc) and to reward the associate when productivity increased (longer hours, better communication skills, higher conversion, post-graduate skills).


However, the RTW cycle takes the control of productivity away from the associate as hours worked, patient flow, diagnostic options and, ultimately, productivity are dictated at the moment by SOPs.


Not fair.


My second epiphany of the day came courtesy of Kevin Rose who, whilst guesting on the Daily Briefing, suggested that we need to drop the whole idea of "the percentage" and start to "reverse engineer" with self-employed clinicians in individual face to face conversations:


  1. What do you need to live on?

  2. How much of that can come from NHS payments?

  3. How much of that can come from plan payments?

  4. How much of that will have to come from Fee Per Item payments?

  5. Given the requirements of our SOPs and our pricing strategy, how many hours will you have to work per week in order to hit your income target given your current percentage?

At this point a stark reality.


If the above sequence of questions and answers produces an unworkable solution, then we may have to ask the clinician to accept that their take-home pay might be lower than that required FOR A SHORT PERIOD OF TIME until normal services can be resumed.


This, though, subject to a monthly review during the RTW.


"Let's sit down every month as we learn the dance steps of Dentistry 2.0 and as lockdown is released. Let's review the 5 questions every month and get you back to normal as quickly as possible."


Thank you Kevin for lifting the lid on my thinking.


Arguing about percentages is a battle of egos - never pretty.


Collaborating on the solution to an income requirement - that speaks to me of leadership.


I'm thinking that we need to start from the bottom up in this whole debate and stop thinking top down.

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