There is a moment in every dental practice when you know a hard conversation is needed, and the easiest thing to do is postpone it.
Kelly Tanner, PhD, RDH.
Maybe it is about a team member’s behavior, the way people talk to each other, or a raise request that does not match the numbers. Right now, with labor costs projected to rise significantly by 2030, postponing those conversations is more expensive than ever.
Economists are clear that what you pay your team will continue to climb, which means what you get in return has to be intentional, measurable, and aligned with your culture.
The days of hoping problems solve themselves while payroll quietly increases are gone. Practices that thrive in this new environment will be the ones that are brave enough to talk honestly about performance, behavior, and contribution.
That starts with a willingness to sit down now -- not later -- and ask whether your team, your systems, and your culture are truly supporting the future you say you want.
Rising labor costs and why culture matters more than ever
Rising wages alone do not guarantee better results or a healthier practice. If you simply pay more for the same habits, you increase overhead without improving patient care, team morale, or long-term growth.
This is why investing in team culture is not a soft idea, it is a financial strategy. Culture shapes how people show up, how they treat one another, how they respond when things go wrong, and how committed they are to the practice vision.
When the culture is strong, team members bring ideas, support each other, and look for ways to solve problems before they reach the doctor’s door. When the culture is weak, small issues turn into drama, and people do the minimum, because they do not feel seen or respected.
In a world of rising labor costs, you cannot afford a culture that works against you, because the price of that misalignment compounds every year.
The myth of the indispensable person
One of the biggest threats to a healthy culture is the so-called indispensable person who does not live the values.
Maybe it is the hygienist with strong numbers who gossips and resists change or the assistant everyone relies on who talks down to others when stress is high. The team learns quickly that this person is untouchable, so their behavior gets a quiet pass because the practice is afraid of losing their skills.
The truth is that no one is truly indispensable if they are undermining the culture that keeps everyone else engaged. Doctors must ask themselves a hard question: Would they rather protect one high performer or protect the environment that allows the whole team to flourish?
When you tolerate behavior that contradicts your stated values, you are teaching the team that results matter more than respect and accountability. Over time, that lesson costs you far more in turnover, lost trust, and missed potential than replacing one misaligned person ever would.
Raises, accountability, and earning the ask
Accountability is not just for the people who are struggling; it is for everyone, including your top producers. In a healthy practice, no one is above feedback, coaching, or being asked to realign with the culture. That same standard should apply when team members ask for raises, because higher pay needs to be connected to higher value.
The better question than simply “Can I have a raise?” is “What have I done to earn the raise I am asking for?” Have I helped strengthen culture, supported my teammates, improved patient experiences, and contributed to smoother systems? Have I taken ownership of my role by learning new skills, using technology well, and leaning into the goals the practice has set?
When raises are grounded in visible contribution instead of comfort or tenure alone, they feel fairer, and they become easier for doctors to say yes to.
Let KPIs tell you where to improve
This is where key performance indicators (KPIs) become your best friends instead of something to fear. KPIs put real numbers around questions like how hygiene is performing, how well treatment is being scheduled, and how efficiently the front office is managing collections. They show whether the money you are paying in wages is actually connected to improvement in production, profitability, and patient care.
For each role, you can define a small set of metrics that matter most, such as reappointment rates, case acceptance, periodontal therapy percentages, or new patient conversion. These numbers do not tell the whole story of a person, but they do tell the truth about patterns you might otherwise miss. When a team member asks for a raise, you can both look at the same data and see whether the results support the request or point to areas for growth.
KPIs become a neutral mirror that helps everyone know when they are on track and when it is time to improve instead of relying solely on feelings and memories.
Team dynamics, emotional intelligence, and psychological safety
Numbers alone are not enough, because team dynamics and emotional intelligence are what make those numbers sustainable. The way people talk to each other in a huddle, how they handle conflict, and how they respond when plans change either fuel or drain performance.
Setting goals works best when it is a collaborative effort where every voice is heard and people understand why the goals matter. Emotional intelligence shows up when someone can receive feedback without becoming defensive or when they can give feedback without attacking.
It also shows up when a leader creates a supportive environment where team members feel safe to express concerns, ask for help, and offer ideas. That kind of openness is not about being soft, it is about getting the full picture of where gaps exist in systems, communication, and training.
When people feel they can speak up without being punished, you uncover problems earlier and can fix them before they damage culture or patient care.
Training, development, and not tolerating underperformance
Once you see the gaps, training and development become the bridge between where you are and where you want to be. Today’s dental practices cannot afford to treat training as a one-time event or an optional extra, because expectations and tools are changing too quickly. Investing in your team through coaching, workshops, and intentional development signals that improvement is part of the job, not a punishment.
At the same time, training must be paired with a clear message that chronic underperformance will not be tolerated. When someone repeatedly chooses not to grow, refuses feedback, or continues to act against the culture, keeping them on staff is unfair to the rest of the team. Reining people in when they drift is an act of leadership, while refusing to address ongoing misalignment is an act of avoidance.
In a season of rising labor costs, you simply cannot keep paying for roles that do not meaningfully support your goals and your culture.
Aligning money, metrics, and culture
All of this comes back to the invitation to have the hard conversation now instead of waiting for a better time. That conversation might be with a team member about behavior, with the whole group about culture, or with yourself about the standards you have been avoiding.
It might involve looking honestly at your KPIs, your payroll, and your true return on the people you have chosen to keep. It will almost certainly require courage, because changing patterns that have been tolerated for a long time is uncomfortable.
But on the other side of that discomfort is a practice where people are paid fairly, held accountable kindly, and developed consistently. It is a practice where no one is above the culture and where every person understands how their behavior and their numbers support the mission. In a world where labor costs are only going up, the most powerful decision you can make is to align your money, your metrics, and your culture, and that alignment starts with a single honest conversation.
Kelly Tanner, PhD, RDH, is a contributing author to DrBicuspid, where she shares insights and strategies to empower dental hygienists in their careers. As a leader in clinical training, professional development, and team dynamics, Tanner provides resources to help hygienists elevate their practice and personal growth. For further support, join her free Facebook group Next Level Dental Hygiene Career and Personal Development, and explore group training and on-demand courses at www.nextleveldentalhygiene.com.
The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.
