The Manager in the Middle
Middle management can often present a challenge for dental office managers. The ever-changing dynamics in both large and small office dental practices can be very fluid.
Managing the people both under your care and those over you can have major challenges. It can be quite a tightrope act without a safety net and without careful attention, and it can be exhausting, defeating, and isolating.
Balancing Your Leadership / Management Style
One challenge of middle management is the balance between absentee management and its opposite, micromanagement.
In the extreme, either can negatively affect team performance and culture. Absentee managers can fail to provide the essential tools, training, and performance refinements needed for teams to achieve high performance.
This is not a once-and-done process, and the temptation to step away after the initial training period can affect the performance of your team and the ability to be confident and independent. When this occurs, processes get irregular, edges become rounded, and expectations are not held to the original standard.
By not actively engaging your team in the day-to-day, leadership can disconnect and become unaware of the daily issues and unmet expectations. Over time, the snowball effect of lower standards and lack of attention to detail can make processes more difficult, decrease efficiency, and affect the team’s culture and morale.
On the opposite end of the spectrum is the dreaded micromanager!
Micromanagers feel the need to control every aspect of a task, looking at the process more than the outcome and questioning every detail along the way. This can be frustrating for both sides of the team dynamic. Micromanagement can be taken as a personal insult and interpreted by individuals as a lack of confidence or trust in the skills of the individual and the team.
These types of actions will strain the team’s collaborative, creative, and relational aspects. Individuals become defensive and on edge, thus setting up adversarial relationships. Often, these actions result in team turnover as employees seek more supportive positions with other companies.
Finding the “sweet spot” between these two extremes should be the goal of leadership. Team members should be regarded as collaborators, engaged in a group effort.
A valuable tool to help increase your understanding is to walk a mile in your team’s “moccasins.” Take off the manager’s hat and sit at the front desk for the morning, spend the day working with the sterilization tech, or in the ops with the clinical team and doctors. Experience firsthand the challenges that your team manages daily.
By conducting regular check-ins, team meetings, and reviews, both one-on-one and by department, you will have the opportunity to hone skills, foster communication, celebrate successes, and provide training and feedback on areas needing focus and improvement. Training and retraining presented respectfully and properly will foster trust and optimal performance across the team.
Managing Up
Office managers also have a responsibility to manage, and this aspect of management can present unique challenges. Managing up requires understanding the owner/doctors’ goals, priorities, and vision.
As the manager, we often need to help those above define and set a course for the team. Once the course has been set, a 100% “buy-in” and communication of the vision and goals in the day-to-day practice is primarily the stewardship of the practice manager. This can include managing associate doctors.
Associates have their own unique circumstances; while being “in charge” in the clinical realm, they are employees and subject to the owner/management. This often puts the manager “in the middle” to help them clearly communicate with the owner, doctor, and the team. All this must happen while working within constraints such as limited time, staff, frequent changes, and finances, while meeting the owner/doctors’ expectations.
Managing up can also, at times, mean being a coach, a mom/dad, a trusted confidante, and a cheerleader all in one. All leaders need to exercise respect, support, and loyalty.
Understanding, listening, building trust, and then bringing solutions and direction is key to managing up.
Included in the job description is the act of providing accountability needed to keep the positive momentum and processes moving forward. Although difficult at times, delivering these conversations with respect and honesty is key to a successful practice and a fruitful doctor/manager relationship.
Meet the Challenge Head-On
Middle management can be a huge challenge. You can renew your enthusiasm and influence on those you manage both up and down and find balance by embracing these suggestions.
- Embrace feedback with a cheerful outlook and willingness to listen and improve.
- Set fair and clear boundaries for yourself and those on the team, and practice consistency in application.
- Cultivate activities and downtime outside of the office.
- Family, friends, and faith can renew the spirit and give new insight into everyday work challenges.
- Take the time to step back and practice the basics that got you promoted to the position in the first place.
Middle management is like a high-wire exercise that includes balancing encouragement with setting boundaries, along with stretching the doctors and team to meet and reach goals, while not crushing the morale and culture of your team. All this often without a safety net.
I hope that you get to walk the high wire with a smile, balancing the tasks with grace and accountability, and wearing a fabulous sparkly tutu! Do not look down, but always go forward to the goal! Middle managers have the unique opportunity to represent, influence, and encourage those under your care and leadership and positively support and affect those above you in the same way.
About the Author
Beverly Kicinski, DAADOM
Beverly Kicinski is the operations manager at North Penn Pediatric Dental Associates outside of Philadelphia, Pennsylvania. She oversees fifty employees and the daily responsibilities of this growing multi-location practice, which includes pediatrics, orthodontics, and a pediatric laser center.
Bev’s passions include implementing systems to improve communication and enhance a positive and productive culture. She has been a member of AADOM since 2024 and received her Fellowship in 2023. Beverly also earned her AADOM Mastership in 2024 and her Diplomat status in 2025.
Her multi-tasking and systems mindset stems from her “on-the-ground training” while managing six children and coaching women’s high school volleyball.
