Locum dentists: the balancing act

Simon Palmer, June 2008 - Whether it is for a holiday, a personal injury or sickness, an emergency of another kind, or for continuing education, every dentist will occasionally need to take time off from their practice. When this happens, the vast majority of private practitioners will prefer to shut their practice rather than to take on a temporary replacement (in the form of a locum or dentist friend) to cover for them. This is understandable. The last thing any dentist wants when they have to take leave is stress over whether their temporary replacement is a benefit or a liability to their practice. However, what if the risks could be managed and minimised so that your mind is at ease while you are away? Before any dentist decides to close their doors, it is important to consider their options. Weigh up the costs involved against the potential risks and see if these risks can be managed or minimised.

What are the costs of shutting your practice?

A. Fixed costs
All practice expenses can be broken into variable expenses and fixed expenses. Variable expenses are expenses like supplies and lab that vary from month to month depending upon how much work we do. Fixed costs are expenses of the practice that are incurred regardless of how much you work. Examples of a practice’s fixed costs include the rent of the facility, equipment lease instalments and wages of your permanent support staff (dental assistant/s, front office person/s, practice manager, etc). It is important to remember that when you temporarily shut the doors of your practice for any reason other than retirement, your fixed costs continue unabated.

B. Opportunity cost
It is not enough to work out the cost of shutting your practice purely in terms of how much money will be spent doing so. A dentist also needs to work out what business he has missed out on by not being there. This is called the opportunity cost and it will have several components in a dental practice:

• The cost of potential income loss is easy to calculate. If your normal average take home is $X per week then the cost of potential income loss is $X per week.
• Existing patient loss. Your existing patients may need your services while you are closed and choose to visit another dentist in your absence. Some of these patients will choose not to return. It is difficult to put an exact figure on the rate of existing patient loss or the cost.
• New patient loss. New patients may need your services while you are unavailable. A percentage of these will choose to see another dentist and join their practice instead of yours. Again, it will be difficult to put an exact figure on the rate of new patient loss or the cost.

What are the risks involved in taking on a locum/temporary replacement?

There are definitely risks involved with engaging a locum or dentist friend to cover for you while you are away. However, it is important to realise that some of these risks can be managed.

Risk 1: If the replacement is poor clinically and/ or interpersonally, they may compromise the practice’s reputation and your relationship with patients. This in turn will reduce patient loyalty to the practice and increase the risk of the patients going elsewhere.

Risk Management:

1. Only hire an experienced dentist
2. Check references thoroughly. As with all employee dentists, you should ask for and check all references thoroughly.
3. Trial run. If you have a long lead time to when you need the locum (like if you have a planned vacation) it may be possible to get the candidate to come to the practice for a trial for a day or so to make sure that they are the right person for the job. Get feedback from the DA working with the candidate about their interpersonal and clinical skills or oversee their work yourself.
4. Check in yourself. If your locum is to replace an employee dentist or to replace yourself when you are in town but unable to practice for some reason, there is the option of checking in on the dentist yourself.
5. Check in by others. If the locum will be temporarily replacing one of many dentists within a practice, you may be able to set the expectation up front that the locum position will be one that is supervised.

Risk 2: If the replacement tries to maximise their income by doing as much comprehensive work on your patients as possible, they may ruin the relationship the practice has with the patient and reduce your remuneration.

Risk Management:

1. Have a legal written agreement in place restricting their work to only maintenance and procedures that cannot wait until your return to practice. If in doubt as to their abilities or diagnostic criteria, you can restrict their crown and bridge or indirect restorative work.
2. Set up the replacement’s remuneration so that there is no incentive for this to happen. If you had them working on an hourly rate for example there would be no reason for them to want to do comprehensive work.

Risk 3: If your locum is a dentist who works in the area, the patients may decide to leave your practice for theirs.

Risk Management:

1. If the dentist works in the area, chances are they need someone to cover for them sometimes as well. Set up a reciprocal agreement whereby you cover for each other but cannot otherwise treat each others patients.
2. Put in a non solicitation clause in a written agreement for the locum.
3. Restrict their work to only maintenance and necessary procedures that cannot wait until your return to practice. If in doubt as to their abilities or diagnostic criteria, you can restrict their crown and bridge or indirect restorative work.

Conclusion
There is no doubt that having a locum dentist in your practice is a balancing act. Are there risks involved? Sure there are, but there are also costs and risks involved with not getting one. It seems that in many situations, the risks associated with locum dentists can be quite easily managed and negated and if this is the case, the potential benefits to a practice can be substantial.

{Published in Australasian Dental Practice 2008}