And the winner is...

TGIF.

I'm about 7 hours from "Miller time." (The AGD doesn't condone drinking to make your problems go away; that's my idea, not their's.)

You know I like to tell you about the funny things that happen at home. David, my 13month old, is officially walking. Really, it's more like wobbling... it is so cute. But my wife was looking at David walking and asked if I thought one of his legs was longer than the other. I about died laughing. I am laughing while I am writing this because I am thinking about the way he walks and thinking about how crazy parents can get.

If you are not a parent yet you don't know this, but parents worry. They worry about everything from the first day the kid is born to when they have children and then they worry about the grandkid. They worry if they are blind, or deaf or have a learning disability. Parents know it isn't healthy but they do it all the time anyway.

"Honey, we have been to the pediatrician 15 times this year. You don't think 'one leg is longer than the other' might be something she would let us know about?"

I started watching Modern Family this week. I have heard so many things about this show that I DVR'd it. Well, I loved it. I laughed at one thing so hard the milk I was drinking came out of my nose. My wife, who was hell-bent against not watching it, loved it as well. I recommend it.

Topic de jour...

The Chamber of Commerce did this "The Best of Apopka" thing. (Apopka is the nice little town I work in.) It was announced that every category of service was up for the Best of:
best mechanic, best restaurant, best hair salon, etc. Of course, dentist was a category.

So I wanted to win. I have a few reasons for wanting to one. Partially because I want people to like me and to validate all my efforts. But also, I didn't want any other dentist to get more recognition (it is all about marketing and PR). I think there are about 11 or 12 dentists in Apopka.

The voting went on for a couple of months. I did some things to help myself out. I had my whole staff vote (10 votes!) and I put a flyer at my front desk letting people know that they still had time to vote. I didn't tell them who to vote for; I encouraged them to vote for their favorite dentist.

The voting ended two weeks ago, and we got a call from the local paper saying that we were in the top three. They were not allowed to tell us if we won or not, but they wanted to know if we would like to put an ad in a special section of all the top three winners. In all, I received three calls from the paper and 3 faxes wanting me to put an ad in the special section.

I took one of the calls. I asked if I was going know if I won before the paper came out. They said I would not, and I told them that I didn't want to run an ad if I didn't win 1st place. I can see it now: "Thank you for voting me third best dentist in Apopka.

So how do you find out if you won? Well, funny you should ask. They are having an awards dinner at the local town hall. For $20 a head, you come and have a spaghetti buffet and find out what place you came in.

There were about 40 categories, and three people from each category were invited, but there were only 200 spots. I know that may seem like a lot, but let's say "Best Bank" is a category. Each bank might bring 5 people.

I wondered if I should go to this dinner. My thought was that if I win and don't show for the dinner, I look like an unappreciative ____. But if I go and don't win, I look like all the other second and third place people.

I was confident and decided to go. On the day of the dinner I called the Chamber to ask for the dress code and they told me that I haven't RSVPed. Here is the thing: I usually tell my people, "I want to go to this dinner, can you take care of it for me?" And it happens.

Now my wife wanted to go with me, so she asked the person in charge to email her the information. This must have short-circuited our finely-tuned machine here, because it became a lot of, "I thought she was going to RSVP," and "Why would I RSVP? I just asked for the information?" (I'm not blaming anyone.)

I asked the woman at the chamber what we could do. She said that there are always available seats so just come a little late and we will find you two seats. I thought this was kind of a weird way of doing it, but I was game. We would get all dressed up and if we couldn't find a seat, my wife and I would go out for a nice dinner.

We showed up at the local VFW and it was a madhouse. We couldn't find a seat; half of the people weren't seated because they were in line for food. We told them we would wait. So she said that would be $40, cash or check. Hmm, now we have a problem. Between the two of us, we only had $6 on us and no check book.

She looked at us like, "You have got to be kidding." I looked at her like, "You have to be kidding. I have never been to a dinner where they wouldn't bill my office."

The night was not going well. We went to the bar, used all of our $6 to buy two beers, and stood there. We had been there about 35 minutes when I said to my wife, "You ready?" And she replied, "I thought you would never ask." We were out of there in about 30 seconds. We went to a quaint little place (that was not the VFW) and had a nice dinner.

I want to get involved in the community but I felt like this was kind of like a Hallmark holiday. It seems like they have this "Best of" just to sell ads for the newspaper and to sell tickets to the dinner. There are just 40 people that are really happy (oh, and the newspaper people are happy too). The others are ticked because they didn't win and and others are ticked because they bought a table for 6 at the dinner and a half page ad and won third place.

The voting stopped about 3 weeks ago, the dinner was Wednesday, and I still don't know if I won. I guess it is just as well, as I have a really bad attitude about the whole thing anyway.

The paper comes out on Fridays and one came in the mail today. I went to it to see if they have the winners. Nope. This weeks paper has all the ads and NEXT week is when they will reveal the winners. I guess I should have stayed at the dinner.

Well, we are off to the pediatrician to have David's legs measured. Just kidding. I have a full plate. I'm hoping there will be some funny stuff so I can bring it back here for you on Monday.

Have a great Friday and weekend.

john

Lights. Camera. Action!

Hey all,

Happy Wednesday!

On Friday, I told you about my daughter's birthday cake, but I realized I forgot to put the pictures in. Sorry about that, I know you don't care that my two of my staff members started a cake business. But, you see, the pictures would have brought this all together and I forgot. Would you forgive me if I put the pictures in now? It will be worth it.

(Don't forget to double click on the image and it will get bigger and you can see the detail)



This weekend was busy for me; I had to do two public appearances. That sounds so Hollywood, doesn't it?

My church is getting behind a Thanksgiving Day food drive called Bags of Love.
I talked to the ones that organize it and to the church. The church was going to announce it to the members and someone said, "Why don't you do it?"

"Whoa, you mean get up in front of the congregation and talk?"

"Yeah, just tell everyone about Bags of Love."

"Okay, I guess."

Sunday was the big day. Let me tell you - this was not easy. I could have easily gone up there and told everyone that Bags of Love is an envelope that has food items on it. You go out, buy a reusable bag, and you put items on the envelope in the bag.

I did that, but I have to do things like this with some style. So I thought I would bring my whole family up and talk about how my family prays for the poor but it was time to put our prayers into action and do something about it. I was going to tell them that around the dinner table we talk about how some people don't have this.

But when you get up there in front of 600 people, it is SO SCARY. Everyone is staring at you. I was shaking like a leaf. I had an idea of what I wanted to say, but once I started to hear my voice on the speakers, I thought, "Holy sh!t, I am totally freaking out here!" It becamce an out of body experience. When I got back to my seat, I had sweat coming out of every pore on my body.

On Monday, I was asked to do a TV show. Now, it is not what you think. It was not Good Morning America or Larry King Live. No. It was Joy to our Town, on Channel 55. Channel 55 is a local Christian station and they do 15 minute segments on things going on in our town. One of my patients works there and asked me to do a dental minute (or 15).

I got there about 9:30 for a 10am appearance. I was a basketcase. I followed directions to the studio and had a seat. I looked through the door and saw a small studio set up like a living room, with two leather chairs facing each other and a little coffee table. It was a tiny room with about three cameras and a couple of lights. They had me sign a few releases and then sat me in the chair opposite the host.

If you haven't done this, it is nothing like you see on TV. This room was so small that you had to duck under cameras and step over light stands, taped down wires on the ground. The only place that looked normal was the two chairs and the coffee table.

We talked about what we were going to discuss on the air. They put my mic on and laid down the ground rules: Do not look at the camera, look at the host. Talk more than you think is necessary; short answers are a killer. The people behind the cameras will give you cues to how much time is left. Is that clear?

"Uhhh, yeah."

"Can I get you some water?"

"Uh, yes, considering there is a squirrel in my mouth and I can't feel my tongue."

I think I did pretty well. I was much better than the day before, even though it was another out-of-body experience. I wasn't that nervous, if you can believe that. I was just trying to not forget the things I wanted to say. We talked about access to care and some options for the working poor. Talking about dentistry with someone I don't know is what I do almost all the time.

As an aside, I was doing some research about this issue and student loans was part of the discussion. Did you know that the most expensive dental school is a state school? The University of Southern California has a dental school and it is $65,000 a year to go there!

And here I am thinking $27,000 a year to go to the greatest school is expensive. Are you kidding me? University of Florida College of Dentistry is a steal! The problem is: 1500 applicants for 83 spots. Wow.

Anyway, we finished up the TV interview and I have to say, I am a natural. No, just kidding. But really, I wasn't too bad. They were going to tape eight 15 minute spots that day, so by the time I was done, they were already prepping the next person. "Thank you so much for coming. You remember how to get out."

Do you have any experiences with media? Do you do a radio spot? Tell me about it; inquiring minds want to know.

Have a great Wednesday.
John

The big D - and I don't mean Dallas

Hey all,

My daughter Madison turned 10 last week. Double digits. If she is 10, that means I am 41...s!#t! (I could swear I just started this profession.)

She had a great little party. I tell you this because my assistant and one of my front desk staff started a specialty cakes business. I don't think they have been paid real money for anything yet but they are doing lots of cakes for friends and such. They have purchased everything they need to make any type of cake. They made the cake for my daughter's party. It was pretty special.

SmileyBandz are in, and I have to say, they are pretty cool. I had an orthodontist come in and he bought 100 packs (for $1.19 each. We are selling them to our patients at $2 per pack). Now hopefully he will tell two friends, and they will tell two friends and so on and so on. And then you will find me on a beach in Malibu somewhere. Yeah, like that's going to happen...

I am reading a book called The Charm School, and I really like it. This is the second book I have read on my electronic reader, and I have to tell you, it is tough. I am still getting used to not having a book in my hands. I think it is ruining my reading experience.

One last thing before we get started: it is supposed to be in the 40s this weekend. Two days ago, it was 89 degrees here and today I am busting out the fire pit and the marshmallows. It is going to be nice. Good times.

Today I want to talk about divorce. (No, honey, if you are reading this, this is not about our marriage.) I want to talk about having a seemingly-wonderful family in your practice. You like the whole family, parents and kids, and they really like you.

But then things start to happen in their house. You only see them twice a year, but you start to notice things are different between the two of them. They used to come in together (sometimes the whole family came together). But now they come in individually. You can tell something is wrong when you ask them, "How's it going?"
The next time they come in they drop the bomb on you. "We are getting a divorce."

You hate it for them. You know they are both good people and it is tearing them both up. It affects everyone. The little kids appear to be okay, but the parents seem to go in stages. They are upset but quiet. The next time you see them they are a bit more outspoken about their spouse.

My assistant has to know. Most of the time she will break down and ask the wife (who will usually sing like a bird). I spend a lot of time talking to my patients, and my assistant is right there with me. So she will be invested as much as I am.
She is very personable and genuinely likes them. (I have to admit that when she is on vacation, some patients are visibly disappointed that she isn't here.)

My assistant and I will go back and forth. "You ask him."

"NO WAY! You ask her."

So when they are checking out or when the hygienist leaves the room, she will ask them. We once had a young couple that got a divorce but they continued to live in the same house. So she told us they had gotten a divorce and that they were living together, but didn't say anymore about it. We wanted to know what really was going on; it was like a soap opera. About three years later, my assistant just couldn't take it anymore and asked her. Crazy story, but she ended up marrying his best friend.

After all the dust clears, how does it affect our relationship with this particular family? We try not to schedule them on the same day. We have had a couple of bad scenes when the two come in at the same time. (I mean, they used to come in on the same day and when they left 6 months earlier, putting them on the same day did not seem like a problem.)

We had one man call and say that he wasn't going to be able to make it to his cleaning because when he pulled in he saw his wife's car in the parking lot and he didn't want any part of that. We had one woman waiting in the parking lot for her ex to finish. I think we had to call the cops that time.

The kids are a totally different story. Now I said earlier that the little ones seemed unfazed. If they are a teenager, you can tell something is wrong. Teenagers are kind of a weird bunch anyway, but they almost seem more reclusive. It is tough for me to watch.

Usually when the family unit is in place, one of the parents is in charge of the teeth. After the divorce, when the other parent has some teeth responsibility, it can be difficult. One parent brings them and they have 7 new cavities and they then blame the other parent because he/she doesn't make them brush their teeth, or care about what they eat or drink. Then we, as dentists, are kind of put in the middle. That isn't that big of a deal, it just something we have to handle.

Divorce must be so hard. I watched my parents go through it, and it was rough on both of them. When it happens to your patients, you go through it with them. It can be easier sometimes, but most of the time it is tough, as a professional, to handle all the emotions of your patients.

Just something to think about. Have a great weekend. If you need me, I will be hanging around the fire pit with a cigar and a glass of red wine (and a marshmallow on a stick).

john

The Scarlett Letter

Hey all,

I want to thank you all for commenting on Friday's blog. I truly appreciate your support and your translucency. I know I have said this a billion times, but I write to make you all feel less alone. This time, you all made me feel less alone.

I am still not over everything that is going on in my life so, let's talk about this a minute.

I have been a dentist for 15 and a half years. I have been paying for insurance for the entire time. Now, I am talking about malpractice insurance and general insurance. If someone slips on a wet spot on your floors and gets hurt, your general office insurance will take care of it. So why do I get all bent out of shape when someone brings a complaint to me?

Most of your comments were, "You are a good guy, don't worry about this a bit." I wish it were that easy. I know I should just say to them, "Talk to my people."
And I would if it weren't for that one question...

"Have you ever had a claim against you?"

It is everywhere. Every time you fill out any sort of dental application, any insurance form. I liken it to being arrested. Let's say you get arrested, then forever you have to answer the question, "Have you ever been arrested?"

Or, God forbid, you have been convicted of a felony (I haven't, but I sure have done enough stuff to know that I have been damn lucky). That stuff never leaves you. They don't ask if you were acquitted. They want to know anything about it. They just want to put you in this one "arrested" box.

So we are back to the question above. They don't ask you if the person that put a claim against you is a crazy lady. Or the guy that was coming after you is a vindictive man with anger issues. They don't care if you had to pay $1 or $3million. They put in you in this box and you are there forever. This is a box that I don't ever want to be in.

My father had a patient that he tried like mad to please. He did everything he could for her, and she was never happy. After countless appointments, he said, "I just can't help you anymore."

She got an attorney and went after him. He was 62 at the time, and he said, "You know what? I don't care anymore. I have been paying this malpractice insurance for 32 years and have never used it."

So he told her to talk to his insurance, and she did. Now, it is going to behoove the insurance company to just pay the plaintiff. I mean, before they hear anything, they know that if it goes to court it is going to cost them X. So if the settlement is less than X, why fight it?

Principle goes out the window. They don't care if they think they will win or not. They don't care if the doctor's name gets smeared all over the place. It is all about the Benjamins. This is a real problem. If they take a couple of these gold diggers to court and the court tells them to get lost, then the gold diggers will stop going down this path.

And I am going through a bit of the same thing. What if it is going to cost me $2,000 for her emergency room bills? Write it off as the cost of doing business.
Isn't that worth it to me and my stomach to not drag this out?

Just pay her, I won't have to check the "claims against you" box, and then I can sleep again (I am really sleeping okay). I have put this out of my mind; I haven't heard from them in about a week.

In the comments, some of you wrote to tell her to take a flying leap. That would be fine - if that would end it. But it wouldn't. She would go straight to an attorney and then all hell would break loose. I think she will still go an attorney and he will probably laugh at her. But all it takes is one attorney, who probably doesn't have anything to do right now, to decide to take a fishing trip into my records.

In closing, I think it is silly to think that, in this litigious world that we live in, we are not going to have to go through this. It is silly to think that we are going to go through life and not have to check this box. Physicians go through it and there is no scarlet letter. I remember in dental school one particular instructor told us that half of us were going to be sued in the first three years of practice. I thought he was crazy, but if you talk to enough dentists, they have all gone through it. If not peer review, then a settlement or a full-blown, knock-out fight in court. So many people have gone through it.

Another dentist called me because she had heard something was up and she said, while I was telling her about this issue, she is going through it with someone right now (and she is an LVI-accredited dentist).

I know this stuff happens and it must get easier as I get older. Because we learn, as we grow as professionals, that crap is going to happen. We just have to learn how to handle the crap better.

What do you think? Anyone wearing the "C" for claim on there scrub top?

I will talk to you on Friday,
john

No rain...but is it pouring.

Friday - yeah baby!!!

You know that it is smack dab in the middle of hurricane season here. While there have been a couple of named storms this year, not one has even threatened Florida. But even without the threat of hurricanes, we do still get a lot of rain and thunderstorms.

Yesterday it rained. Not alot - just a late evening rain for about 40 minutes. What's the big deal, you ask? Well, it hasn't rained here in 32 days; it has been driest October on record. So, while it wasn't much, we will take it. I tell you about the weather because, even though it is not raining outside, it is pouring in my office.

I have to tell you that I usually am a free-flowing idea kind of guy, but lately my mind has been on only one thing. I didn't want to tell you because I am kind of embarrassed. Not embarrassed, more ashamed.

As you know, I pride myself on being a very good dentist and treating people with exceptional service. But this year has been kind of rough. I don't have too many issues with patients, but lately I have had a rash of them. I have put off telling you, but now I am just going to come out and say it.

A woman come into my office for her first visit. She had gone to an endodontist and she didn't get along with him. Every tooth in her mouth crowned. Now, five years after her full-mouth reconstruction, she has 4 abscesses in the lower anterior.
The endodontist had diagnosed everything and even sent me a letter. I turned on the charm when she got here, and everything went really well.

I told her I would do 2 pulpectomies the first time I saw her, put some calcium hydroxide in the canals, and let them sit for a month. Then she would come the second time and we would do the same thing on the second two teeth. She loved me and told me so. She said she didn't have any money, but paid in advance for 3 of the root canals.

She came for the first visit and it went well. I told her I would see her in a couple of weeks for the second appointment to do the second two pulpectomies.
The second day she came in with a bit of an edge. No big deal - I had work to do.

We started the second two pulps (the second one being a retreat). I want to preface this next part with some philosophy. Lower anteriors are usually easy to get an endo access. But when they have crowns it is a bigger deal to me. I try to make the access very small and I want to make sure I have proper perspective when doing so. This being said, I don't routinely put a rubber damn on for my accesses. I usually gain access, then put the rubber damn on. (You now know where this is going.)

I got access, no problem, in the normal tooth. It was the re-treatment tooth that was giving me trouble. The access was fine but I couldn't get a file down the tooth. The number 8 file kind of hit something and bent and didn't get down. It was the hitting and bending that would lead to what happened next.

The file bounced out of my hand and landed on her tongue. No big deal. I was going to pick it up and before I could move to get it she shot up in the chair. I thought she overreacted a bit, but she spit it out and gave it to me. She laid back down and we went on. I finished both procedures without further incident.

Two weeks later she was supposed to come back to finish the root canals on the first two. She calls 15 minutes before the procedure and says, "I am not coming back and you know why."

This was coming out of left field to me. She claims that she left a message on the machine here at work. I never got it. It seems that what she said on the machine was that that night after the last procedure she had to go to the emergency room. She claims that when she jumped up to remove the file from her mouth that she hurt her back and when she turned sideways she hurt her neck. And then she said she was calling me today to ask me what I planned to do about it.

She said that all this happened at my office and as a result of me dropping a file.
She said, "I don't have medical insurance and I have all these hospital bills that are piling up and I don't know what to do."

I just sat there on the phone and didn't say anything. I couldn't believe this was happening. It was stunned silence. All these things are running through my head. She is crazy. She is some woman that doesn't have insurance and is looking for a big pay out. And she kept asking me what I was going to do about it.

I told her I wasn't going to do anything. She, of course, says something like, "I am not that kind of person that sues people." Then went on to say, "If you don't do anything, I might have to get other people involved."

I said, "Do you what you have to do." I told her that I would get some council on this matter and get back with her.

I've had time to think about it, and I have to tell you, it STINKS. I mean, it really stinks. Yes, I dropped a file in her mouth. Yes, she jumped up. But I think it would be the same if someone slipped and fell in the reception room. I know what you are going to say about the file and a rubber damn but...

I really care about the fact that she got hurt here. I wish it didn't happen. Should I feel responsible?

But I just didn't get the best vibe from her and there are a few reasons why. She came in for her first appointment with her "husband" and he did all the talking. She came to the second appointment by herself and I asked her where her husband was. She said that they are divorced but still living together, and the reason they got divorced is that he beats her. I was starting to put all the pieces together. Now I am in the middle of this thing.

I called my insurance and they are as much help as you guys would be if I asked you.
They said, "If you can find out how much they want and just settle amongst the two of you then we don't have to get involved but if you decide you want to get us involved we will start crawling all over everyone."

So it is going to come down to: how much will it cost me to make this thing go away? I do want to stand behind principle. "You are crazy, and if you want any money from me then you are going to have to go through my people."

I called her back and have left 4 messages on her home voicemail. Her ex-husband finally answered the phone yesterday and said, "She is in bed. She has been in so much pain that she hasn't really gotten out of bed in the last three weeks."

COME ON. Really? He and I went back and forth and he promised to send me all the bills from their hospital visit. I told him that I would look at them and then we would talk.

Apparently when it rains, it pours, and my friends, at my office it is pouring. I am in a bad mood and it doesn't look like it is going to get any better any time soon.

Have a good weekend. If you can encourage me with a nice comment that would really help.

I am going to drink... a lot (the AGD doesn't condone drinking to deal with your problems, but I think it may help).

Thanks.
john

The times... they are a-changin'

Hey all,

My mood hasn't changed since Friday so. It is supposed to be 92 degrees here today, this could be one of the reasons.

We have this nice (but old) building that was built in the late 70s. If you don't remember, we have 3600 square feet here. Well, air conditioning must be different now than it was 35 years ago. We have 5 (yes, I said Five) air conditioner units. Yesterday, one of the units stopped working. I swear I had sweat dripping down my back and my gloves were sticking to my hands. My assistants were grouchy yesterday because of tough working conditions. It sucks when you get up and you have pits.

I saw the Time Travelers Wife this weekend. YYYYYAAAAAWWWWNNN!!! I woke up half an hour later, looked over and my wife wass crying like a little girl. I leaned over and whispered, "I love you that much, too," and then went back to sleep. Hey, you have to take advantage of vulnerable moments like that.

I wanted to talk about... what else?... the economy. No, I am not going to talk about Obama; I am going to talk about how it is effecting the way we practice dentistry.

I want to give you a perfect example of what happens at my office. Three years ago, the dentist ruled the doctor/patient relationship. There were rules and policies in place that the dentist wanted. For instance, here we do a new patient exam. This is a 90-minute appointment that a new patient gets with me. We do X-rays, an interview with me, then data collection (cancer screening, bite, teeth and cavity check, TMJ, and perio).

We USED to be adament about not having the patient get a cleaning on the same day as the exam. This was a hygiene-driven rule. Looking back on it, it was kind of a stupid policy. The mindset behind the rule was that we needed to know the patient before we started treating them. We needed to know their dental health before treating them.

Let's say we scheduled the 90 minutes with me and then a cleaning afterwards and they needed premedication before a cleaning because of a hip replacement. Or they were going to be referred, because of major perio, directly to the periodontist. Then you have a hygiene spot going unused. Or what if they didn't show? Then you are screwed twice instead of once. Who cares if it was convenient for the patient? We had a policy and it wasn't going to be broken.

Now, if the patient wants to get their teeth cleaned on the day of the new patient exam, NO PROBLEM. I recognize there were some legitimate reasons for having those policies, but, we've relented.

A couple of other things come to my mind. The cosmetic guys really have been hit really hard in this economy. So the guys that shrunk their practice to veneers and full mouth reconstructions have either changed their hours to 10am-1pm three days a week or they are opening up their repertoire.

Ten years ago, a friend told me he didn't see kids. I was shocked. Kids are a huge part of my practice. Not the restorative part, but the cleaning of their teeth and seeing the whole family, from kid to great grandma. I wonder if he is reconsidering.

I have heard through conversations at study clubs that people that haven't been doing root canals for years are now picking the gutta percha back up. I am thinking this is a little bit dangerous.

I have tried to not get into doing things that won't be A+ stuff. For example, if I don't normally do root canal retreatments, I am not going to go out and buy chloroform (that is what they still use, isn't it?) and start that because my day is slow.

Okay, I know I tried to extract that #18 when I had no business doing so; I am chalking that up to a brain fart. But, I have definitely loosened up the reigns a little bit on my policies. It is not full-on "Whatever you want" policy, but it is getting close. If it is within reason, we are doing it. If it doesn't compromise A+ work, we are doing it. And you know what? I think the patients are really appreciating it. SERVICE. I keep preaching it and I hope we are doing it.

How are you practicing different? Have you loosened the reigns? Did you have stupid policies? Are you doing different procedures? How is it going?

Let me know. Don't tell me I am alone on this one.

Have a great Wednesday,
john

She makes how much?!?!

Hey all,

Hope everyone is having a good week. I had been having a really good week - until yesterday. It was a tough day. You know, you try to be good at what you do, you try to treat everyone nicely, you try to treat your employees well, and you feel like if you do all of that you might be able to make a pretty good career out of it.

Why does it seem so hard to do this sometimes? And what’s really hard is getting them all going at the same time. You could be doing awesome dentistry, but no one is coming in. Or lots of people are coming in but you just don't feel awesome about it. One day, your staff lounge is filled with gifts that patients baked for you; the next day someone says they were hurt at your office. Sometimes you can be looking at the new BMWs and thinking you would look good in that car (with your new Prada shades on) and then the next week you don't have the money to cover all the bills.

You have to be tough in this business. Just remember the higher you get the farther the fall is. The bigger you are the harder you fall (and I am getting huge in Europe!).

Now you know why some people will sell their practices to a management company because they don't want it anymore. "Take it and I will be an employee. That’s got to be easier than all this S@%T!" Okay, I am done with my pity party.

I have never talked about this, but it is something we all have to deal with. We have eight employees right now, and it has been as high as 11. Everyone that you have hired was been hired at a different time. Someone who is an assistant might have been hired when there were no assistants around. When you put out an ad to hire an assistant and you get four people applicants, it is very different than now, when if you put an ad out there, now you might get 50 applicants to choose from. When there is that much competition for a spot, you have bargaining power. When you have one good assistant and she has 4 offices to choose from you have to open up the wallet.

Now, my staff is pretty solid. I think things got a little crazy with babies and the economy, but I can't see me changing anything for a long time. I think everyone likes me and my style and is "picking up what I am laying down." (I don't know why but I like that saying, so you might hear it a lot). Sometimes staff encounter hardships, so I might give in to them a little more. You know, we’ve become a family and I want to help my family.

Now the real issue comes when they are friends. Because friends talk.

Pause for effect [go on, I’ll wait]…

You all know what I am saying. The assistant who has been at your office for 4 years is making the same as the assistant who has been there for 8 years. Before I go any further, all scenarios I use are totally fabricated. Fiction based on actual events, if you will.

So the two of them get together start drinking and of course start talking about work. They talk about their money issues at home and then it comes out. "Well, how much do you make?" Then everyone knows what everyone else is making. You, as a boss, are screwed.

They would never blame each other but they come to you. "I know it is slow but I have been here much longer then she has and I know I am more important." Translation: I am not going to ask for a raise now but it is coming.

I have a dentist friend that tells his staff that if they ever tell anyone how much they are being paid they will be FIRED. He tells them on the first day of work that the amount I pay you stays with you and never should get out. I am starting to agree with him. It would alleviate any pay issues.

This scenario used to be okay because of bonuses. In my office, the person that has been here the longest gets the best bonus. But now that there is no bonus, it is coming down to getting respect. And I get that.

I don't really think it is the money. I don't think that 50 cents an hour (a whopping $24 a week) is going to change someone's life, but it is the principle. And as much as I understand this, I don't know what to do.

I can give her $2 more an hour, but who gets a $2 an hour raise? And then you are talking about making her the highest-paid assistant in the Southeast. Who is she - Darrelle Revis (the best cornerback in the NFL, who decided he wasn't going to play until the Jets upped his contract to $20 million a year)? And quite frankly the assistant she is comparing herself to is pretty awesome too.

It’s a tough one. Any thoughts? What do you do? I am looking forward to hearing what you have to say.

The Gators have a bye week, thank fully. Have a great weekend.

john