The Practice You Promised vs The Practice They Joined

 

The Practice You Promised vs The Practice They Joined

Why recruitment problems often begin with expectations, assumptions and words that were never properly defined

A clinician can join a new practice genuinely excited about their future.

The website looked impressive. The recruitment advert sounded perfect. The interview went well. They were told there would be support, development, clinical freedom and mentorship.

Six months later, they are unhappy.

The practice owner is equally frustrated.

“But we told them exactly what the job was like.”

And the clinician says:

“This isn’t what I was promised.”

Who is right?

Quite possibly, both of them.

Because one of the biggest causes of dissatisfaction within a working relationship is not necessarily that somebody has deliberately misled somebody else.

It is that an expectation has been created without sufficient clarity about what that expectation actually means.

And that matters enormously when we are trying to recruit and retain great clinicians.

 

The expectation gap

There is a well-established concept known as Expectation-Disconfirmation Theory. Put simply, we compare what we experience with what we expected to experience.

If reality exceeds our expectations, we are likely to experience positive disconfirmation.

If reality broadly matches our expectations, those expectations are confirmed.

But when the reality falls below what we were expecting, we experience negative disconfirmation, which is associated with dissatisfaction.

We see this with patients all the time.

Two patients can receive almost exactly the same service and respond very differently.

Why?

Because they did not necessarily arrive with the same expectations.

If I have created an expectation of an extraordinary, seamless experience and then deliver something merely adequate, the patient may be disappointed.

If another patient expected something fairly ordinary and receives the same service, they may be delighted.

The service has not necessarily changed. The relationship between expectation and reality has.

Now apply exactly the same thinking to recruitment.

A practice can inadvertently create very high expectations through:

• its website
• its social media
• its recruitment advertisement
• the recruitment pack
• conversations before interview
• the interview itself
• the language used when making an offer.

Words such as:

• Supportive
• Progressive
• Flexible
• Great team.
• Clinical freedom.
• Career development.
• Mentorship

All sound attractive.

But what exactly do they mean?

Because if the clinician’s interpretation of those words is different from the practice owner’s interpretation, you may already be building disappointment into the relationship before the clinician has completed their first day.

 

 

Words do not come with universal definitions

This is where the second problem appears.

We often communicate as though words have fixed meanings.

They don’t.

We hear a word and unconsciously attach our own definition to it.

Take the word supportive.

To a practice owner, supportive might mean:

“My door is always open if you have a problem.”

To a clinician it might mean:

“Someone will proactively check in with me every week, review my cases and help me develop.”

Neither definition is necessarily wrong.

They are simply different.

 

 

What about clinical freedom?

Does that mean the clinician can choose the materials they use?

Choose appointment lengths?

Determine their own treatment plans?

Decide which treatments they offer?

Set their own fees?

Refer treatments they do not wish to provide?

Work entirely independently?

Again, until we explore the meaning of the words, we may believe we agree when actually we have agreed to two completely different things.

And perhaps nowhere is this more important than with the increasingly sought-after word:

 

 

Mentorship

Many clinicians are now actively looking for practices offering mentorship.

Mentoring in dentistry can be enormously valuable. Published dental guidance describes mentoring as a developmental relationship in which a more experienced person helps another develop their ideas, learning and professional development.

But that definition still leaves an enormous amount to be negotiated.

I regularly hear clinicians say:

“I was promised mentorship, but I haven’t had any.”

I can equally imagine a principal responding:

“Of course they have had mentorship. I’m available whenever they need me. They didn’t reach ok so I assumed they didn’t need me.”

There is the problem.

They never established what mentorship meant.

 

 

 

Before offering mentorship, define mentorship

If mentorship is going to form part of a job offer, it needs to become something much more tangible than an attractive word in a recruitment advertisement.

The clinician and mentor need a truthful conversation about what is actually being offered.

For example:

What clinical support is required?

• What does the clinician want help with?
• Treatment planning?
• Diagnosis?
• Endodontics?
• Oral surgery?
• Restorative dentistry?
• Complex consultations?
• Private treatment planning?
• Clinical confidence?
• Support when something goes wrong?

The clinician needs to be able to articulate what they are hoping to receive, and the proposed mentor needs to be equally clear about whether they have the experience, competence, capacity and desire to provide it.

Where will the mentor be?

Will the mentor be:

• working in the practice alongside the clinician
• in the practice on particular days
• available remotely
• available by telephone
• available by message
• somewhere else entirely?

“Available for support” is very different from “working in the surgery next door”.

 

Are there formal mentoring sessions?

If there are tutorials or mentoring meetings:

How often do they happen?

• Weekly?
• Monthly?
• As required?
• How long are they?
• Thirty minutes?
• An hour?
• Who books them?
• And what happens if the diary becomes busy?

One of the easiest promises to make during recruitment is:

“We’ll make time for mentoring.”

One of the easiest things to lose six months later is that time.

 

What happens during a mentoring session?

Is it:

• case-based discussion
• clinical teaching
• reflective discussion
• treatment planning
• reviewing radiographs and photographs
• career development
• troubleshooting
• observation and feedback?

Who sets the agenda?

Does the mentee arrive with cases and questions?

Does the mentor determine what should be covered?

Or is that agreed collaboratively?

 

 

Does the mentor observe the clinician?

Some clinicians imagine mentorship will include somebody spending time in their surgery watching how they work.

The mentor may have no intention of doing this.

Again, neither assumption is necessarily wrong.

But it needs to be discussed.

If observation is included:

• How often?
• For how long?
• Will the mentor observe complete appointments?
• What feedback will be provided afterwards?
• And is the clinician equally able to observe the mentor?

 

 

What does mentorship cost?

This can be another enormous source of misunderstanding.

Is mentorship genuinely complimentary as part of the role?

Or is the clinician paying for the mentor’s expertise and time?

If there is a cost, how is that being paid?

Is there:

• a separate mentoring fee
• an invoice
• a deduction from monthly remuneration
• a different associate percentage
• a reduced percentage while mentoring takes place?

There is nothing inherently wrong with charging for expertise.

There is a considerable problem with somebody discovering later that something they thought was included has actually been charged for indirectly.

 

What does being a mentor actually mean?

There is another important question that is often overlooked:

what qualifies the person to call themselves a mentor?

Are they formally trained in mentoring, registered or accredited with a recognised professional body, working to an established ethical framework and appropriately indemnified for the mentoring they provide?

Or does the title simply mean that they are a more experienced clinician who is willing to share their clinical knowledge?

Clinical experience can be immensely valuable, but being an experienced dentist and being an effective mentor are not automatically the same thing. Mentoring requires more than knowing how you would manage a case; it involves helping another clinician think, reflect, develop judgement, recognise the boundaries of their competence and take increasing responsibility for their own decisions.

Both practice and clinician therefore need to understand exactly what the word mentor represents in that particular relationship: the mentor’s training, qualifications, experience, scope, responsibilities, boundaries and accountability. Once again, the title alone tells us very little.

What does being a mentor actually mean here?

 

 

 

An explanation before the event. An excuse afterwards.

This is a principle I return to again and again.

Whatever is discussed clearly beforehand is an explanation.

Whatever only becomes apparent afterwards risks sounding like an excuse.

Imagine a clinician being told at interview:

“We provide mentorship. Your mentor is normally in the practice on Tuesdays and Thursdays. You will have a protected 60-minute mentoring session once a month. You will bring the cases you want to discuss. Every three months we will schedule a half-day when you can observe your mentor or they can observe you. You can also contact them between sessions for advice on urgent cases. The mentoring arrangement is reflected in the remuneration structure, which we will explain fully before you accept the position.”

That clinician can make a decision.

They may say:

“That sounds perfect.”

Or:

“Actually, I am looking for much more hands-on clinical support than that.”

Both are good outcomes.

Because recruitment should not be about persuading somebody to accept the job.

It should be about discovering whether there is a sufficiently good match for both parties to want the relationship.

 

The interview process should uncover differences, not obscure them

We sometimes behave as though a successful recruitment process is one that ends with somebody saying yes.

I disagree.

A successful recruitment process is one in which both sides understand enough about each other to make an informed decision.

That means some candidates should decide not to join.

And some practices should decide not to appoint.

That isn’t failed recruitment.

It is successful filtering. Ideally this happens before an application form is completed or an interview scheduled

Finding out three weeks before somebody  is appointed that your definitions of mentorship are incompatible is infinitely better than finding out nine months later through frustration, resentment and resignation.

 

Mentorship is only one example

The same conversation needs to happen around many of the words regularly used when recruiting clinicians.

If you say you offer career progression, what progression is actually available?

If you describe yourself as supportive, what behaviours demonstrate that support?

If you promise clinical freedom, where are the boundaries?

If you say the practice is flexible, flexible about what?

If you talk about a great culture, what would I actually see, hear and experience if I spent a week inside the practice?

If you promise development, what investment of money, time, teaching and opportunity sits behind that promise?

The more important the word is to the candidate, the more dangerous it is to assume that you share its meaning.

 

For clinicians: don’t just ask whether mentorship is available

If mentorship matters to you, “Do you offer mentorship?” is probably the wrong question.

It is too easy to answer yes.

Instead, ask:

“Could you talk me through exactly how mentorship works here?”

Then explore it.

Who will mentor me?

• What experience do they have?
• When are they available?
• How frequently will we meet?
• What happens during those meetings?
• Can I bring cases?
• Can somebody observe me clinically?
• Can I observe them?
• What happens when I need help during a clinical session?
• What is included?
• What would I pay for separately?
• What responsibility do I have for making the mentorship work?

You are not being difficult.

You are making sure that the job you think you are accepting is the job that actually exists.

 

For principals and practice managers: don’t sell the dream

Of course you want your practice to sound attractive.

But sustainable recruitment is not about creating the highest possible expectation.

It is about creating the clearest possible expectation.

Describe the practice that genuinely exists.

• Talk about what is brilliant.
• Talk about what is still developing.
• Explain what you can offer.
• Be equally clear about what you cannot.

And when an important word enters the conversation, resist the temptation to assume that everyone around the table shares its definition.

Ask:

“When you say mentorship, what does good mentorship look like to you?”

“When we say flexibility, what do you understand that to mean?”

“What would you need to experience here to genuinely describe us as supportive?”

Those conversations may feel more demanding during recruitment.

They are considerably easier than the conversations required when somebody is disappointed six months later.

 

Recruitment is the beginning of the relationship, not the sales process

Perhaps we need to stop thinking quite so much about how to make vacancies sound attractive and think more about how accurately we are describing the relationship we are offering.

Because retention does not begin after somebody joins.

Retention begins during recruitment.

It begins with the expectations we create.

It begins with the language we use.

It begins with the questions we ask.

And it begins by recognising that agreement on a word does not necessarily mean agreement on its meaning.

When expectation and reality are aligned, both clinician and practice have a far better foundation from which to build trust, development and a long-term working relationship.

When they aren’t, disappointment is almost inevitable.

My philosophy remains simple:

A problem can only be present in the absence of a truth-full conversation.

So perhaps before your next clinician accepts your vacancy, or before you accept your next associate position, there is one question worth asking:

Have we really understood each other, or have we simply used the same words?