Is one person dragging your whole team down?
Is one person dragging your whole team down?
Orthodontists at AAO 2026 Want More Productivity Without More Staff. Sometimes It Starts With One Less.
This is the final issue of the hiring series. We’ve covered finding great people, keeping them and training them fast. Today is the hard one.
One of the questions orthodontists brought to AAO 2026 was this: how do I improve productivity without adding new team members? Most answers involve software. Mine starts with a harder look at the team you already have. And as you’ll see at the end, even my AI answer starts there too.
I’ve been talking about “staff infections” from stages for years. It’s the one person whose attitude spreads: the eye rolls in the huddle, the gossip in the break room, the “that’s not my job.” Everyone on the team sees it, and the doctor is often the last to act on it.
Harvard Business School researchers studied 58,542 hourly front-line service workers across 11 companies. Avoiding or replacing one toxic worker saved about $12,489 in turnover costs, mostly because good coworkers stopped quitting. A top 1% superstar added about $5,303. Keeping one toxic person off the team was worth more than twice as much as hiring a star.
The BIG warning
Don’t keep a staff infection because you’re scared of the empty chair.
I get the fear. Hiring is the #1 challenge in the AAO data, and starting over can feel worse than living with the problem. But every day that person stays, your best people learn what you’re willing to tolerate. That’s how you lose the ones you can’t afford to lose.
Here’s something I’ve noticed. A lot of that fear comes from how much lives in one person’s head. When nobody else knows how she runs the schedule or handles the insurance calls, letting her go feels like it would break the whole office. When your systems, SOPs and training manuals are written down and live inside your practice, that chair gets a lot less scary to empty. Your own team can now build most of that with AI, faster than you’d think.
Coach first, and give them a fair chance with three steps:
Name the behavior and the value it breaks. “In the last two huddles you rolled your eyes when a teammate spoke. Respect is one of our core values.”
Set a clear expectation and a timeline. Say what needs to change and when you’ll check in.
Document it and follow through. Write it down, meet when you said you would, and notice real effort.
If they choose not to change after that, make the call. Talk with your HR provider or an employment attorney before you let someone go so it’s done right.
Nobody holds your practice hostage
In my book I share a Hollywood story about Fantasy Island. As it goes, Hervé Villechaize, who played Tattoo, got famous for “The plane, the plane!” and asked producer Aaron Spelling to renegotiate his contract. Spelling set a meeting for the next week. When Villechaize walked into the lobby, every seat was filled with actors about his height, all reading Fantasy Island scripts. He told the receptionist, “Never mind, I’m okay,” and walked out.
That’s the power of Always Be Hiring. Run a job ad every quarter, even with a full team. You don’t have to hire anyone. You’re building a bench of great people who already know who you are, and when you know you have options, the tough decisions get a lot easier.
Then turn your team into recruiters. Tell them what a great fit looks like, and pay a finder’s bonus when someone they refer gets hired. Some offices I’ve worked with offer $100, so pick what fits your budget.
Referral bonuses are generally taxable wages, and rules vary by state, so check with your payroll provider before you launch one.
Crazy Enough to Work: The Alumni Pipeline
Your future team might already be in your waiting room. Patients who finished treatment years ago are in college or starting careers now, and their older siblings are job hunting. Put a “We’re hiring Smile Stylists” sign at checkout, mention it in your patient newsletter, and invite interested alumni to a paid shadow day. They already love your office. Check with your compliance advisor before using patient contact lists for recruiting. A sign at the front desk is the safe place to start.
The other half of “without more staff”
Once the staff infection is gone, something interesting happens. Your best people have room to breathe again. That’s the moment to give one of them a bigger job.
When practices ask me about AI, they usually expect me to point them to a new tool or an outside company. I point them to their office manager. The person who explains missed appointments to parents all day already knows where your practice loses time, and she’s a better fit to build your AI systems than any tech hire you could bring in. She can get patient follow-up going out on time and your huddle prep done before anyone walks in, and the work stays in your practice when she’s done.
I put together a free 45-minute training on exactly this for orthodontic practice owners and their office managers. It starts the second you register, and it covers three things: why someone already on your team is the best person to build your AI, where practices overpay outsiders every month, and how to get more done with the team you already have, without adding a hire.
The whole series, start to finish
Over four weeks we’ve covered the full cycle: find great people, keep them with culture, train them fast, and protect your team from the one person who drags it down. Trying something new couldn’t hurt, and one of these ideas might be the thing that changes everything for your practice.
Pick one this week. Post your quarterly ad, have the coaching conversation you’ve been putting off, put the alumni sign up at checkout, or sit down with your office manager over lunch and watch the training together.
Proactive, Productive, and Profitable,
Dino