Who’s the Boss?

Unhappy staff. Too much stress. To change this, dentists are learning to be better leaders and transforming their practices 

By Diane Peters 

About five years ago, Shawn Monga 0T4 bought a second dental practice. In the following months, he watched while one of his locations flourished with positive team chemistry. The other, meanwhile, had a negative atmosphere with employees micromanaging each other and a lot of staff turnover. It made little sense: the offices were a mere 10 minutes apart, both in the Greater Toronto Area, and some staff members worked at both places. 

Monga wanted to fix things. He’d learned business basics in dental school such as how to read appraisals and secure a bank loan, but little around leadership. “The real challenge is how do you go from dental school to learning how to manage a team?” he says. 

With the guidance of a business coach and by observing his employees, Monga developed a philosophy that has helped his practices — he now has four — run as congenially and efficiently as possible. “As the dentist and the owner, I put myself at the bottom of the hierarchy,” he says. “My job got easier when I empowered everyone else to do their job well and I valued the work they did.” He avoids micromanaging. With lots of positive encouragement and an openness to hearing his staff’s ideas, he humbly does his job and lets others do theirs. 

This approach, plus frequent in-office and after-work celebrations (when safely possible) to make his team feel appreciated, has made running a private practice a lot more joyful for Monga, and helped him retain staff in an increasingly competitive labour market. 

Dental practice owners have often struggled with this dichotomy: being a great dentist has little to do with being a successful business owner and manager. Now, expectations in the workplace have changed. In many regions, staff can easily find work in another dental practice. 

Even the most junior of employees know that they don’t need to deal with autocratic leadership styles, or subtle — much less overt — sexism, racism or any other kind of prejudice from their bosses, colleagues or even patients. Today’s workplace leaders increasingly must be seen as a positive force in their employees’ lives. “When you lead a team, you’re responsible for their well-being in the workplace,” says Shervin Rowshani 1T0, who owns dental practices in the Muskoka region in central Ontario. 

Today’s dentists are under pressure to become skilled leaders, not just great clinicians. “There’s a greater recognition that being a dentist and being an oral healthcare professional requires a much larger skillset beyond the clinical piece,” says Laura Dempster 7T7 Dip DH, 8T1 BSc D, associate professor at the Faculty of Dentistry.

TOXIC WORK 

Dentistry-related workplaces can be toxic. A 2009 survey of dentists doing postgraduate hospital training in the U.K. revealed that one quarter had been victims of bullying while nearly half had witnessed colleagues being bullied. But 60 per cent of those surveyed, even those who didn’t consider themselves bullied, had experienced one or more bullying behaviours on a checklist. This happens in Canada too: a 2018 Statistics Canada report found workplace harassment happens more often in health-related jobs. 

A 2018 Statistics Canada report found workplace harassment happens more often in health-related jobs. 

Some of these issues stem from how medical professionals are trained. Dental education, for instance, has traditionally focused on teaching precise technical skills. Dentists have also been schooled in the social determinants of health and are encouraged to treat their patients with compassion and understanding. However, less time has been devoted to honing interpersonal skills more broadly, including skills around managing a team. “Leadership training is virtually non-existent for dental students, and practising dentists rarely engage in any form of leadership development, relying primarily on mentoring by senior colleagues and on-the-job experiences,” trumpets the first line of a 2017 doctoral thesis out of Walden University on dentists’ role as clinic managers. 

Dempster says the fact that the DDS is comprised of older students has further kept this kind of training out of the four busy years of the program. “Huge assumptions have been made that because we deal with adults here, and they’re older, that they’re going to be able to do things like communicate.” During the program, students deal with patients face-to-face, so they often learn to navigate those relationships. “Many instructors are teaching this, but it can be ad hoc,” says Dempster. Dental students get few opportunities to practise communicating with hygienists and assistants, plus they receive minimal training around leadership best practices. 

TRANSITIONING TO PRACTICE 

Sally Safa 0T2, 0T7 MSc Perio says the precise, technical and perfection-focused nature of dental training and dentistry itself can translate into a stressful practice management experience. “We’re lone wolves. When we go through our training, there’s not a lot of collaboration. We are very detail-oriented, our jobs demand it. So our leadership style tends to be very authoritative. That’s not what you need to be a good leader,” says Safa, who is an associate at a periodontal practice in Toronto and has served as a clinical instructor at the Faculty. 

A 2016 article published in the British Dental Journal also argues this point, showing that characteristics such as autonomy, being detail-oriented and having excellence in technical ability make for being a good dentist, but can be a barrier to being an effective leader, especially of larger practices. “The American Dental Association and various other dental organisations have formal leadership training programmes and dentists must consider these as critical learning opportunities rather than optional extras,” the paper concludes. 

Safa is convinced this mismatch directly leads to problematic management habits for dentists and contributes to the stress many professionals feel. “We think that work is a pyramid and we’re at the top. So, it’s all on me. I have to look after everyone and everything. So we become overwhelmed,” she says. 

Many professionals have the same problem. “What I’ve seen in dental practices isn’t different from other professional practices,” says Sandra Bekhor, practice development consultant with Bekhor Management, a consulting firm based in Toronto. She sees engineers, lawyers and accountants avoid conflict with their teams — but if they keep skirting difficult issues and conversations, they never discover what’s going wrong and find ways to fix things. She says workplaces can quickly become toxic if no one listens to each other; problems never get solved and roles and responsibilities don’t get sorted out. Staff leave and a practice’s reputation “is going to spread like wildfire,” she says. 

TRANSFORMING LEADERSHIP 

Increasingly, people in dentistry have become aware of the profession’s challenges around dentists acquiring the well-rounded skills they need for their careers. 

"The cultural shift of understanding stress and seeing how our emotions influence those around us helps build better teams"

Dempster has been teaching communication and has plans to research the characteristics that contribute to someone becoming a successful dental professional. In 2016, the Association of Canadian Faculties of Dentistry identified five competencies that dental school graduates need to enter general dental practice. While Dempster notes that these competencies — patient-centred care, professionalism, communication and collaboration, practice and information management and health promotion — are represented equally in the association’s infographic portrayal of the competencies, “That’s not necessarily reflected in the time spent on these skills in the curriculum.” 

While dental schools have been working to carve out space for teaching these kinds of skills, the likes of U of T’s Continuing Dental Education (CDE) department sees huge uptake for its communications and leadership offerings — CDE’s Dental Practice Management course is currently running for the 18th consecutive year. Rowshani personally wanted to learn more to help him be an effective leader, so he completed an MBA three years ago. He chose the Rotman School of Management at U of T because it went beyond the numbers side of business. “It focused on developing the kind of leader you will be versus just your business skills,” he says. 

Others have found their own approaches to making the interpersonal side of dentistry a priority. For Safa, that has come through a mindfulness practice. “Mindfulness is awareness. It doesn’t mean you have to be happy all the time.” She says it’s about slowing down and having self-awareness, perhaps identifying just how stressed you are and trying to understand why. Then, it’s having compassion for yourself and others regarding the challenges and stressors of life and work. “I think the cultural shift of understanding stress and seeing how our emotions influence those around us helps build better teams,” says Safa, who has run mindfulness seminars on behalf of the Faculty. 

Like Monga, Rowshani realized that upending the traditional workplace hierarchy made for a better leadership experience. “I set the tone that everyone is at the same level. Everyone calls me by my first name. Even my hygienist who graduated two years ago, when she was hired out of school,” he says, noting that he runs his office with a high respect for the other trained professionals he works with, trusting that they know their jobs. 

Bekhor, who has consulted a number of professionals in different settings, says many business owners think it’s just about being nice and not bossing people around that leads to better management. “You could be the nicest person and still not have a good culture. It’s not about being nice. If you’re a really nice person and you’re afraid to deal with the issues in your office, you’re enabling a toxic culture.” 

Doing the hard work of facing conflict, listening to team members openly, stopping yourself from micromanaging and making gradual change takes hard work over time. “You don’t fix the whole practice at once. You fix one little thing at a time,” she says.

CHANGES IN PROGRESS 

The dental education community increasingly appreciates the value of communication and leadership skills, but there are barriers to adding these elements to the curriculum. Along with challenges around finding the time, Dempster says dental educators grapple with both how to teach some of these competencies and, even more complexly, assess them. “How do you know if someone is doing a good job in health promotion?” she asks rhetorically. While other university departments, such as those in the humanities, have a higher comfort level with such types of assessment, dentistry and other science-focused faculties sometimes dismiss subjective forms of grading, even those created with rigour and following rubrics. 

Once dentists are running a practice, the leadership challenges keep on coming — they’re not easy to fix with one great initiative. Bekhor says leaders that try something just once risk undermining trust from their employees. “You have to follow through. Otherwise your team won’t be interested in your efforts anymore.” She admits that early initiatives might work, but the next challenge is often not far behind. Solutions related to leadership and running teams are never simple, one-shot fixes. 

For Monga, meanwhile, even practice locations with the most positive workplace culture will shift and change over time. “If you take a snapshot of my staff in January, April and October, every team is going to be different.” Being an effective, sympathetic and aware leader is a moving target. There’s no set path to acquiring these skills, no guarantee that being a better leader will always result in a well-functioning workplace. And yet, the future of dentistry as a happier and healthier profession hinges on this emerging change. 

NAVIGATING HOSPITAL CULTURE 

Think private practice requires stellar management skills? Try running a dentistry department in a hospital. “The actual dental units are great, but the problem is where they fit into the organization and where they are valued,” says Bob Wood 8T2, 8T6 MSc, 8T6 Dip OR, the emeritus head of the dental department at Princess Margaret Hospital. “In hospitals, 50 per cent are trying to move things forward, and 50 per cent devote their lives to make it very difficult to get anything done.” 

Wood found the bureaucracy would get in the way regarding replacing a piece of equipment or dealing with a staff conflict. He put up with time-consuming meetings — which often led to little concrete action — and focused on building trust within his team and forging good relationships with other departments. “We were valued because we made sure that we provided a great service.” 

LEADING AROUND INCLUSION 

Shervin Rowshani recalls a not-so-recent time when society stayed silent around discrimination or prejudice related to race, gender or other factors — at work and beyond. “This used to be the polite way to deal with it,” says Rowshani, who owns practices in a part of central Ontario where he used to be the only dentist of colour in the region. 

Now, he feels more comfortable saying something. “If you see it, you have to address it,” he says. “You have to ask why. You have to poke.” These have resulted in some tough conversations at work, mainly with patients. “I’ve had patients say they don’t think a female dentist is skilled enough. I’ve had them say they don’t want this hygienist because they have a thick accent. They don’t think they’re skilled enough because of their accent.” 

Sandra Bekhor agrees that addressing discrimination and micro-aggressions alike is now a must-do for leaders. “There’s definitely been a shift in our culture in North America,” she says. “People aren’t going to take things anymore; they’re done. If you want your practice to thrive, you have to embrace these ideas or your reputation will spread.”

Illustration by Hanna Barczyk

Interested in more stories? Read the PDF edition of the U of T Dentistry Magazine Summer/Fall 2021 Issue