HR Quandaries in the Post-COVID Age

  • by Carrie Pallardy
  • Sep 13, 2021
The COVID-19 pandemic forced the closures of dental offices for months, some completely while others were only open for emergency procedures. Employees were thrust into job uncertainty, and practice owners had to contend with keeping businesses afloat with diminished or nonexistent revenue. While reopening meant a return to work and revenue generation, the process came with a tricky set of questions. How can dental offices keep patients and staff safe? What if employees didn’t feel comfortable returning to work? How can practices keep up with changing federal, state and local guidelines? 

Human resources (HR) leaders in the dental industry, whether represented by a single office manager at a private practice or an entire HR department at a dental service organization (DSO), have been inundated with questions. What role is HR playing in handling the pandemic and guiding the industry forward? 

Understanding HR in the Dental Field 

HR is an important business function that touches nearly every nonclinical aspect of a dental practice, including hiring, onboarding, benefits, payroll, employee relations and termination. In large businesses, HR typically operates as a well-oiled machine with an entire department’s worth of resources. But, in an industry with so many small businesses (76.1% of dentists were private practice owners in 20191), the approach to HR isn’t always so uniform. 

“Dentists went to school to learn how to be great dentists and great clinicians. Oftentimes, they aren’t taught anything about HR or people management,” said Samantha Leonard, co-founder and CEO of Stream Dental HR. “A lot of practices don’t have the luxury of having a dedicated HR manager, which typically costs around $75,000 a year on a salary. Most of the time, the practice owners become the unofficial HR managers.” 

In private practices, HR may be written on one of the many hats that practice managers wear, but the scope of HR is often beyond what they can handle with their other responsibilities. As a result, HR is often overlooked as an unnecessary expense. Even getting an employee handbook in place can be a challenge. An HR manual from an outside company might cost $4,000 to $5,000 plus a yearly fee, according to Teresa Duncan, MS, founder and president of dental practice consulting firm Odyssey Management. An HR manual can encompass elements like a time clock, software and HIPAA training. 

In lieu of paying for a handbook, private practices may opt to find a free version online or put one together themselves. But an HR manual is not a static document. “Practices will download one and think they have a complete manual and never update it. State laws change all the time, and those changes must be incorporated into the manual,” said Duncan. 

HR is meant to help keep dental practices compliant and running smoothly. With the onset of the pandemic, this mandate became even more difficult. “I think what this pandemic did was really put a spotlight on HR as more than just a handbook. HR is the human part of your business,” said Leonard. 

While some dental practices can retain in-house HR talent — a given if the practice is a part of a larger DSO — others cannot. Rather than leaving HR partially addressed or absent entirely, dental practices have the option of outsourcing the entire process. “These companies are expensive but cheaper than an in-house HR department. Uptake is slow but may increase with more government regulations post-COVID,” said Neil J. Gajjar, DDS, MAGD, AGD past president.

Navigating the Pandemic From an HR Perspective 

Whether dental practices had a formal HR team in place or not, they were all faced with the same challenges presented by the pandemic. While many industries outside of the healthcare sector had the flexibility to transition to remote work, the dental industry was in no such position. “You can’t fix teeth from home,” said Cindy Roark, DMD, MS, senior vice president and chief clinical officer of DSO Sage Dental. 

Some practices didn’t survive the pandemic. “We know practices that went bankrupt and never came back to the office,” said Justin Jory, founder and CEO of management services company Light Wave Dental. Those that did survive needed to figure out how to reopen in what felt like a completely different and uncertain world. 

Even with guidance from government bodies and industry organizations, practices still had difficult decisions to make about how and when to reopen. “What’s right for one practice may not be right for another, so what’s most important is that everyone is informed and feels respected because their concerns are not ignored,” said Denise Baker, vice president of People Services at Hero Practice Services, a practice management organization. 

Some of the most common HR issues to arise in the early days of the pandemic, which continue to be of concern today, include the following. 

Health and Safety 

Naturally, some of the most common HR questions employees have been asking of dental practices revolve around health and safety. Employees want to know what the practice is going to be doing to ensure they do not get sick and, in turn, infect their families. 

Dental practices do have outside guidance to rely on to limit the spread of aerosols, provide proper personal protective equipment (PPE) in a healthcare setting and ensure social distancing.2 This led practices to invest in technologies like HEPA (high-efficiency particulate air) filters and implement protocols like patient screening questionnaires, temperature checks and virtual check-ins. 

Employees also want to know what happens if they contract COVID-19. How long will they be out of work? The Centers for Disease Control and Prevention (CDC) has guidance specifically for how to manage the return of healthcare employees after infection with the virus.

While many dental practices may feel confident in the protocols put in place to protect patients and employees, a relatively new issue looms large in the minds of HR departments in every industry. “The most common question I get today: Can employers require employees to become vaccinated?” said Roark. 

The American Dental Association and the U.S. Equal Employment Opportunity Commission (EEOC) have both released guidance indicating that employers can likely require vaccination, with some caveats.4,5 Employers must provide accommodations for employees who do not want to be vaccinated due to disability or religious reasons. Employers are also able to request vaccination status, but they cannot ask for any medical information beyond that without violating federal and state laws.4 

If an employee does not want to be vaccinated, dental practices can be placed in a difficult position. “It’s important to support employees’ rights to make this choice themselves and give them all the information you have about the implications of being unvaccinated,” said Baker. 

The practice may also consider ways to provide accommodations to that employee. Do they have access to the proper PPE? If they are an administrative employee, can they work remotely? “You want to make sure that you consult with an employment lawyer and your dental association to make sure you have the proper guidelines in place to mitigate your risk,” said Leonard. 

Benefits and Unemployment 

The pandemic was a major financial disruptor for practice owners and employees. “During the initial lockdown when practices were closed, many questions centered on continuation of benefits and how to navigate the unemployment procedures,” said Baker. Does a dental practice have a paid time off package to cover employees if they do contract COVID-19? What happens if the employee in question does not have access to paid time off? The answers to these questions will vary from practice to practice. 

Employee Accommodations 

Dental practices and employers in general have had to learn the value of flexibility throughout the pandemic. Practices need employees to keep the doors open, and employees are juggling the demands of not only their jobs, but also remote school, sick family members and their own mental health. “We in healthcare have to open up to the fact that employees who work for us are human. They are not machines,” said Roark. 

Dental practices may need to take a second look at strict HR policies in order to accommodate employee needs. “Post-COVID, we have to be more flexible employers. For example, remote work policies, dress code and schedules need to be more considerate of employees’ needs. That’s something we are working on now — finding the balance between old policies and new,” said Baker. 

Tackling Tricky HR Issues 

While so much focus has been necessarily on the pandemic, HR departments regularly face plenty of non-COVID-related challenges as well. 

Hiring and Employee Retention 

While HR is more than just “hiring and firing,” finding the right people to fill positions and keeping them there is a core function. Staffing in the dental industry was a challenge before COVID-19 and has only been exacerbated by the pandemic. “We are definitely at a crisis point with staffing in dentistry. We are not bringing in new people. We don’t typically offer many benefits. We don’t pay the highest wages. We can’t compete with unemployment in some markets,” said Duncan.

This challenge is forcing dental practices to take a fresh look at recruiting and retention practices. “If we aren’t retaining our team members by supporting them and giving them a reason to stay, they are going to apply to the hundreds of other job openings and opportunities that are available to them,” said Leonard. “We need to approach recruiting differently now. I can’t just put up a two-sentence job ad and hope a great resume is going to land in my inbox.” 

Issues like pay and benefits are, of course, salient for prospective employees, but not all dental practices can afford to offer significant pay and benefits package increases. Practices can take a look at how they are presenting themselves to potential employees and how they are treating people once they are hired. 

Does the practice have a website? When it comes to millennials, a generation that constitutes a large part of the workforce, 81% will look at the websites of potential employers.6 What kind of impression does the website make? Does the practice have social media and online reviews? Jobseekers are probably looking at those as well. 

Filling positions is only part of the battle. How can dental practices keep their good employees? The culture of a business can play a significant role in answering that question. “Does your office do daily huddles? Does it do weekly or monthly staff meetings? How does the team communicate? Do you do performance reviews? Do you survey to get feedback from the team?” said Jory. “Those cultural and communication values for a dental team can be the difference between staying in a job long term or not.” 

HR can have an active hand in shaping that culture. At the most basic level, the employee handbook outlines how a practice’s team operates. Digging deeper, HR can be responsible for onboarding new people. “I think one of the biggest holes in the dental industry is employee onboarding. The dental industry is one that really has no training foundation in it, top to bottom,” said Jory. If new employees are not given adequate training, they are likely to feel overwhelmed and disconnected from the job, leaving them open to the idea of finding a position elsewhere. 

HR can also head up employee engagement initiatives, from team lunches and group outings to continuing education events. “I think some doctors have woken up to say, ‘These are great employees, and I need to keep them.’ Team building is a good way of doing it,” said Duncan. 

Employee Conflicts and Bullying 

Regardless of the business size or industry, employee conflicts are inevitable. Personalities will clash between team members. “Employee conflicts often don’t get reported to and managed by HR,” said Jory. “That can create liability for the doctor and the owner. It can really destroy your culture.” 

Just because a practice owner doesn’t know of any employee conflicts — either limited in scope or extensive like a culture of bullying — that does not mean the problem doesn’t exist. “We need to teach people to address problems quickly and openly without fear of repercussions,” said Baker. “Giving your employees different channels to do that, such as town halls and anonymous platforms, is important. The last thing you want is for the channel they choose to be the legal one due to ineffective communication or, worse yet, spreading rumors to others and poisoning your employee base.” 

HR can mediate conflicts in accordance with federal and state laws. Documentation is another vital function of human resources. “If it was never documented, it didn’t happen. It is important to have the policies, the job descriptions, the write-ups — make sure you have the proper documentation for each of those incidences to really protect your business,” said Leonard. Anytime there is any kind of employee incident, whether related to conflict with a team member or to job performance, there should be documentation. If a practice needs to terminate an employee, that documentation is essential to protecting the business from potential liability. 

Social Media  

Social media can be a valuable tool for dental practices in terms of marketing and connecting with patients, but it can also be a minefield in people’s personal and professional lives. “I can’t tell you the number of times I see people make mistakes on social media that are really going to cost practices a lot of money,” said Roark.

Dental practices are responsible for protecting patients’ private health information. Taking a picture at work and posting it to social media may seem innocuous, but it is potentially a major liability issue. “Everyone lives by their phones, and it is a constant battle to keep that out of treatment areas,” said Roark. Gajjar recommends having a formal social media policy in place. “Patient privacy is important, and employees should be accountable for protecting this privacy,” he said.

Diversity, Equity and Inclusion

Diversity, equity and inclusion (DEI) are significant considerations for businesses small and large. “That has not been on the radar of most individual dental practices. If you don’t think this is an issue in your office, it is probably because you don’t know, or people aren’t speaking up,” said Jory. “Staying silent on this issue and doing nothing is a losing formula in today’s landscape.” 

Addressing DEI as a small business can be a challenge. “You don’t want to venture into these conversations without training or help,” said Jory. The cost for launching a DEI program as a small practice can be prohibitive, according to Jory. State and national dental associations may offer some resources to start the conversation. 

“It is important for practice leaders to make sure unconscious racial bias is not creeping into the hiring habits, compensation rates and disciplinary actions for employees,” said Jory. Dental practices can examine issues like hiring and compensation. Is the practice interviewing a diverse pool of candidates? Is there any pay disparity related to gender, race or sexual orientation? Does the practice offer employees a way to provide feedback on inclusivity? 

HR and the Future of Dentistry 

“I think if HR is used properly, it can solve a lot of problems before they even happen,” said Leonard. “HR gets a bad rap. A lot of people think it is all about firing, but it is really about making sure you have the structure to set up your business and team for success.” In many ways, the pandemic has demonstrated how important it is to have comprehensive HR resources. For private dental practices, this could mean taking a closer look at how to formalize human resources, either in-house or through outsourcing. 

HR could be one of a number of factors driving a trend of consolidation in the dental industry. “If you compare dentistry to medicine, no one comes out of medical school and says, ‘I am going to hang out a shingle’ anymore. Dentistry is 15 to 20 years behind that,” said Roark. Some practice owners, as well as dentists entering the field, may decide to opt for the resources and liability protection offered by a larger group. Regardless of the shifts in the dental practice landscape, human resources will remain an essential business function for compliance and shaping business culture. 

Carrie Pallardy is a freelance writer and editor based in Chicago. To comment on this article, email

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