I Hired an Old Colleague. She Got Blood on a Patient's Shirt.
The hiring mistake nobody warns new owners about: assuming past familiarity means present fit. My worst hire was someone I thought I already knew — and the cost wasn't in her salary.
I'm doing an extraction.
Routine. Lower premolar. Patient's reclined, mouth open, suction in.
Except — the suction wasn't actually doing its job.
Because the assistant holding it didn't actually know how to position it. She was just kind of waving it near the field.
I look up between deliveries and see blood running down the patient's chin, onto their neck, soaking into the collar of their shirt.
Not a little blood. A lot.
Their light blue shirt was now mostly red on one side.
I stopped. I stabilized the field. I cleaned up the patient myself. I apologized. I sent them home with a gift card to a clothing store.
And then I went into the back, closed the door, and tried to figure out how I got here.
The hire I thought was a slam dunk
The assistant in that room was someone I'd worked with at a previous job.
Years before. Different office. We'd known each other professionally for a while. When I was starting my practice and ramping up the team, she texted me — perfect timing, she was looking, she'd love to come work with me.
I thought it was kismet.
I knew her. I'd seen her work — or so I thought. She was familiar. She came pre-vetted in my head, even though I'd never actually been the one signing her paycheck.
I skipped half my normal interview process. We had coffee, talked about old times, signed paperwork the next week.
Within a month I knew something was off.
Within two months I had patients complaining.
Within three months I had blood on a patient's shirt.
The thing I didn't see coming
Here's what I had to admit to myself in the back office that day:
I had never actually evaluated her competence. I had evaluated my comfort with her.
In a previous job, she'd done fine. Adequate. Got the work done. Nothing flagged.
But what I hadn't realized was that her competence in that job was 80% provided BY the systems around her. The senior assistants. The protocols. The structure. The constant supervision.
When I hired her into MY practice — a year-one startup with no systems, no protocols yet, no senior assistant to lean on, and a doctor (me) who couldn't watch every move because I was running everything else — she had none of those scaffolds.
And what I saw was who she actually was without them.
Familiarity is not vetting. Comfort is not competence. Past performance in someone else's system is not present performance in yours.
She did not know how she had been getting by. She just thought she was the senior assistant now because there wasn't another one above her — and she defended that confidence aggressively when anyone questioned a single thing she did.
What my team actually looked like in year one
Let me back up — because the disaster hire is only half the story. The other half is what was working.
Office manager: my brother
This is the part of my story that I rarely share.
I hired my brother to run office operations.
On paper, that's a terrible idea. Family in the business. Mixed personal and professional. Everyone has horror stories.
It was the best hiring decision I made in year one.
He wasn't a dental industry person. But he was someone I could trust completely. Someone whose loyalty wasn't a question. Someone who would tell me hard things because he was my brother first and my employee second.
When everything else was uncertain — patients, cashflow, the team, the lease — he was the constant. I knew exactly what I was getting. He knew exactly what he was signing up for.
Family-as-hire is a hard generalization to give as advice. Sometimes it works. Often it doesn't. For me, it worked because of who he is, not because it's a strategy I'd recommend universally.
My first "do-everything" hire
On the clinical and front desk side, I started with one girl who did both.
Front desk duties when patients weren't in the chair. Assistant duties when they were.
In year one, this is what your first real hire often looks like. You don't yet have the volume for a dedicated front desk AND a dedicated assistant. You need a generalist who can flex.
She was great for the stage we were in. As we grew, the role broke. The needs became too specialized.
The upgrade: experienced RDA + trained front desk
As we got busier, I made the harder decision to split the role into two — and the right move was upgrade, not duplicate.
I brought on a more experienced RDA (registered dental assistant) who could actually take the clinical load off my chair without me having to micromanage.
And I hired a trained front desk who could own scheduling, billing, and the patient experience as her actual specialty.
This meant transitioning out of the original do-everything girl. Hard conversation. Real loss. But the right call for where the practice was going.
Associate and RDH: about a year in
I didn't hire an associate dentist or a registered dental hygienist until about a year in.
Not because I didn't want to. Because the patient volume wasn't there to support them yet, and hiring them before the volume would have hurt them and hurt me.
Half-empty schedules demoralize good clinicians. And a half-utilized payroll line is the fastest way to undo your cashflow runway.
When I finally hired the associate, it was because hygiene recall had built up enough that I needed help, not because I was guessing.
The hiring patterns I trust now
From all of that — the brother, the do-everything girl, the upgrades, the ex-colleague disaster — here's what I actually believe about hiring in year one.
Hire for the stage you're in, not the stage you wish you were in
Year one needs generalists, scrappy people who can flex. Year three needs specialists. Don't hire year-three specialists into a year-one practice — they'll be bored, demoralized, and underutilized.
Familiarity is not vetting
If you've known someone in a previous job, you've seen them inside someone else's system. You have not seen them inside yours.
Don't skip the real interview process for someone you think you already know. That's the hire most likely to blindside you.
Loyalty is a feature, not a substitute
My brother worked because his loyalty and trust were the constants in a chaotic year. But loyalty without competence isn't enough, and competence without loyalty isn't enough either. Both matter.
Upgrade beats duplicate
When the role outgrows the person, the answer is rarely "hire another one like the first." It's usually "hire one person who's actually trained for the bigger version of the role." That's a harder conversation, but a cleaner team.
Wait on the hires that need volume
Associate. Hygienist. Specialist. These hires need patient volume to support them. Hiring before the volume hurts everyone.
If I could rewind to that extraction room
The lesson isn't "don't hire people you used to work with."
The lesson is: when you hire someone you used to work with, run the same interview process you'd run for a stranger.
Ask them to do the work. Watch them do it. Listen for what they say about their last manager. Notice whether they take feedback or defend themselves.
The ex-colleague who couldn't suction wasn't a bad person. She was a person whose previous job had been carrying her — and I had assumed her past performance was hers. It wasn't.
That's the hiring mistake nobody warns new owners about.
Comfort is not competence.
Familiarity is not fit.
One question for you (hit reply)
What's the hire you assumed would work because you already knew them — and what happened?
I read every reply. If you're staring at a hiring decision right now and want to talk through it, my 15-minute Ownership Clarity Calls are free.
— Jennifer