The Staff Problem You Keep Creating

“You can have all the right strategies in the world; if you don’t have the right people, you’re not going to go far.” — Jeff Bezos

A FEW YEARS BACK, a dentist friend of mine called me, frustrated. He had just lost his third hygienist in 18 months. His chairs were full, his books were strong, and his patients loved him. But he could not keep a team together. He asked me what he was doing wrong.

I asked him one question: How are you hiring? He told me. Resumes came in, he glanced at credentials, called a few references, and made an offer to whoever seemed competent and available. He had a practice to run. He needed warm bodies in those chairs.

That was the problem. Not the pay. Not the schedule. Not the patients. The problem started before anyone ever walked through the door.

Most owners of small private practices — optometry included — treat hiring as a back-office task. Get the position filled. Move on to the next fire. But nothing you do in your practice will compound faster — for better or for worse — than the people you hire into it. Get this right and almost everything else gets easier.

Here are four things I’ve learned along the way:

1. Hire for fit, not credentials. The resume tells you whether someone can do the job. The interview tells you whether they will — and whether they’ll still be doing it in three years. Front-end qualification matters more than back-end onboarding. Slow down at the front of the funnel. It’s the cheapest place to fix the problem.

2. Lead the team. Don’t just run the practice. Most owners treat management as scheduling, payroll, and the occasional review. That’s admin, not leadership. The people who stay with you long-term are the ones who feel they’re being developed, not just deployed. Independents have a structural advantage here that no corporate group can copy. You are right there, in the office, every day. Use that proximity. A two-minute conversation in the hallway between exam rooms, done consistently, will build more loyalty than any HR program ever written.

3. Remember who actually owns the patient relationship. Patients don’t experience your practice through the exam. They experience it through the greeting at the front desk, the optician helping them pick frames, the tech walking them through pretest. The OD is the expert. The team is the relationship. If you treat your staff like support roles, your patients will treat your practice like a transaction. Every employee is a touchpoint. Every touchpoint is either building loyalty or eroding it.

4. Have the uncomfortable conversation early. This is where most owners fail. We wait. We hope it self-corrects. It rarely does. Whether it’s a performance issue, a values mismatch, or a quiet disengagement, the cost of avoidance compounds. The conversation you don’t want to have today becomes the resignation, the turnover, or the cultural problem you’re cleaning up six months from now. Candor is not cruelty. Avoidance is.

My dental friend eventually slowed down his hiring process. He started qualifying for fit before he qualified for skill. He started having the harder conversations sooner. Last time we spoke, his lead hygienist had just celebrated her fifth anniversary with him.

Bezos was right. You can have the best location, the best equipment, the best marketing in town. None of it matters if the people inside the building aren’t right.

The strategy is the easy part. The people are the practice.