Marketing the Specialty Practice- Dr. Mayer Levitt

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There have been many articles written espousing the strategy of marketing a specialty periodontal practice to the staff of the referring generalists. It is not a new concept. The thinking behind this is that in many cases, the hygienist at the generalist’s office may spend more time with a prospective specialty patient than the general dentist. And while the generalist, in an effort to be politically correct, might recommend two or three specialists for a patient to choose from, many patients will ask the hygienist or perhaps another staff member for a specific recommendation. Who would they recommend? Hopefully, it will be your office.So it is very important to keep both your name and your face in front of these staff. By making monthly in person deliveries of fresh donuts, cookies, and candies, tickets to sporting or cultural events, or perhaps specialty sponsored continuing education programs – anything to show these staff members that you are thinking about them – you are letting them know that they are special. At the same time, you are reinforcing the possibility that when a referral is to be made, your office will be at the top of the list for consideration.I believe that this type of marketing only works well for offices with whom you already have a strong referring relationship. It continually solidifies your image and your position in the referring structure. This first tier level of practices, however, usually only represents about 20% of the doctors who refer to you. And even though these doctors probably send you 80% of your cases, they still are a relatively small group. I would like to describe the mechanics of an idea to enlarge that group – a way to get more offices to be at that first tier level. This idea is centered around a party hosted by your office. Here are the details:

The party should be held in the Spring or Fall in order to eliminate the possibility of severe winter weather and the heavy vacation schedules of the summer months. While this party is obviously being hosted by you for social purposes leading to new business, it needs to have a specific advertised topic that should be mentioned in the invitation. Examples might be to introduce or demonstrate something new or high tech like a laser or perhaps state of the art voice activated periodontal charting software. It could be very effective to have something non-dental. You might have a psychologist colleague who could deliver a humorous half-hour presentation on personality types. Title – “We all know many of our patients are crazy – let’s find out why!” You might have a connection with a well – known local personality in sports, TV or theatre who could entertain your guests.
It is neither wise nor practical to schedule the party around Christmas or Thanksgiving. That is when everybody and his uncle has a party, so there is the distinct possibility of competition or a conflict.
Identify five to seven practices that are second tier who have the potential to be first tier. These second tier practices are offices that currently refer patients to you – they just don’t refer enough patients to you. You like the doctor personally, and he or she is clinically sound or has the potential to be. But for some reason, these offices have never been the referral source you hoped they would be.
Before you decide on a date, survey the targeted offices as to the best day of the week for both doctor and especially staff to attend your party. Your goal is to attract as many staff from these practices as possible, so you have to be sensitive to childcare issues or job requirements. These targeted offices should be made aware that you are arranging a date around their attendance. You need a very friendly, outgoing, upbeat staff person from your office to be making the calls and to convey the desired message
Once the date has been set, send invitations to these targeted offices as well as to your first tier group. You certainly don’t want to exclude the first tier, because it is always fun and easy to interact with them. Just remember that the focus of the party is on making new friends and new connections
A catered buffet type meal from 6 to 8 PM works best, along with coffee, cold drinks, beer and wine. It is absolutely essential to hire a caterer so that staff and doctor have no responsibilities other than to be perfect, entertaining hosts.
Prepare a nametag for each visiting staff member that also includes their job description (hygienist, assistant, scheduling coordinator, financial coordinator) and the name of the doctor for whom they work. These tags should be typewritten for neatness and a more professional look. Assign one or two of your staff members to be the official greeters as everyone descends on your office. A handshake and a very warm hello goes a long way towards making the new arrivals feel welcome and comfortable.
At the party, it is the responsibility of each of your staff members to engage visiting staff members in dialogue – professional or social. Approach this as a job. You all have a specific task. Mingle – circulate – be a host or a hostess. Share what you do – find out what they do. Look for opportunities to introduce new people that you have met to one another. Be careful not to let any one person totally monopolize your time.

This party is a one and a half to two hour opportunity to connect and bond. You want your visitors to have a great time, and to be totally impressed with how concerned you are that in fact they are having a great time. If you are this attentive to them, it is reasonable for them to assume that you will treat their patients in the same caring manner. Put a face and a personality to each nametag. And as soon as the party is over, before you have the opportunity to forget, write down your thoughts and specific impressions about the new staff members that you met.
A few days after the party have a staff meeting to assess the connections that were made. Short, hand written notes should be sent from staff to staff, doctor to doctor. And within two to three weeks, where geographically possible, staff members should set up a follow up lunch date to build on the relationships formed at the party. Hopefully, your staff will have really connected with many of the targeted offices, and the mission will have been accomplished.
At this point the doctor needs to aggressively pursue the progress that he or she made at the party. Invite the potential referring doctor to lunch, or perhaps to be your guest at a professional day (implant seminar, etc.), or maybe a round of golf. And best of all, you might want to follow up these actions with a patient referral from your office. The doctor cannot afford to be shy or reticent. The message to be communicated is NOT that you want more referrals, but that you can help the referring doctor to achieve better cases. You have decided that you want to work with fewer practices that are clinically excellent. You and your office are user friendly, provide state of the art therapy, and fabulous customer service. You would like the opportunity to demonstrate this level of care.

With careful attention to the smallest of details, an office party can be the catalyst for creating new and profitable professional relationships.

10 Strategies for Successful Staff Retention

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Why do staff members often feel underpaid, underappreciated, and overworked? Conversely, why do doctors complain that they are taken advantage of, manipulated, and short-changed? This resultant dichotomy of views is one of the major contributing factors to high staff turnover – an incredibly costly and stressful ordeal that naturally sends the wrong message to patients regarding the leadership ability of the dentist. Patients love to see familiar faces when they return to the office and cherish long-term comfortable relationships with office staff members.Retaining a loyal, hardworking, and talented staff is the number one management challenge in dentistry today, because you just can’t have a great practice without a great staff. Successfully managing a dental practiced is much too complicated to do alone. Staff retention is a complex issue, but it ultimately revolves around two main areas – compensation and communication. From my perspective a s a management consultant, having worked with hundreds of different dental practices, I would like to offer my observations about 10 strategies that successful dentists employ to create great relationships with their staff members.

1. Develop a vision for your practice and then clearly share it with your staff. If your staff doesn’t know what the vision or the mission is, that is a problem. If your staff knows the vision, but doesn’t share or support it, then that is an even bigger problem. Everyone needs to be on the same page. As time goes by, the doctor needs to fine-tune and reinforce the vision, leading by example and continuing to coach and motivate the members of the team.
2. Understand the realities of the marketplace. Good staff is hard to find. Make a commitment to hiring the best possible person for each position and don’t compromise. Be willing to pay for talent. It is much less expensive in the long run to pay a little more for the right staff person who will ultimately become a cherished long-term employee. Allow existing staff to have a definite role in the hiring process. And remember to be flexible – in today’s world, job sharing might be a viable option.
3. Create the best workplace environment for the staff. This would include a good benefits package, up -to – date technology, and continuing education opportunities. Good staff like to work with other good staff. It is difficult to be a positive influence in a negative environment. Ask yourself this difficult question, “Would I want to work here? Would this be an attractive opportunity if I were looking for a job?”
4. Let your staff know that you care about them and appreciate their efforts. Surveys show that what staff want most, even more than money, is positive reinforcement from their immediate supervisory (the doctor) that they are doing an excellent job. Don’t be so quick to continually criticize or find fault. Look for opportunities to thank your staff on a daily basis for good job performance. Institute a program for quarterly staff reviews as opposed to annual reviews. Offer praise where appropriate and make suggestions for areas that need improvement. More importantly, never reprimand or correct a staff member in front of a patient or another staff member.
5. Clarify job descriptions and assign specific responsibilities. Be sure to hold staff accountable for their performance. Resist the temptation to micromanage. Design daily, weekly, and monthly reports that clearly measure job performance. If you can, measure something, you can improve it. For instance, track your over the-counter collections, the number of new patients, dollars lost from last minute cancellations and no-shows, and scheduling and production goals. These are barometers of how successful your systems are and by definition how successful your staff members are in their specific jobs.
6. Bonus/incentive plans work wonders. This is based on the greatest management principle in the world. Very simply, if you reward behavior you want to receive, you will receive more of that behavior. Bonus incentives are win-win plans: staff morale is high because they share in increased profits, and you are happy because the office achieves higher levels of productivity and profitability. Plans can be designed to motivate individuals or the team as a whole. However, plans should not be written in stone. They have to be periodically tweaked as the practice grows to new levels.
7. Learn to have productive and meaningful staff meetings. Oftentimes, staff meetings disintegrate into gripe sessions with lots of finger-pointing, bruised egos, and nothing getting accomplished. To prevent this from happening, create an agenda of topics to be discussed and distribute it a week before the meeting, thus giving all participants ample time to prepare. Try to stay on message and don’t get sidetracked. Written reports should be delivered by assignment. One 90 minute meeting every three weeks is probably adequate. Nothing short of a world war can cancel a staff meeting – everyone, especially the doctor, needs to respect the importance and sanctity of these meetings.
8. Consistent morning huddles (10 to 15 minutes in duration.) These can be essential for good communication between doctor and staff, and more importantly between the clinical staff and the administrative staff. The doctor should attend and participate in the huddle, which is led on a rotating basis (daily or weekly) by individual staff members. At the huddle, establish the three best times for emergencies to be seen, which patients need reminder calls, which hygiene patients need doctor exams, and review and fine-tune appointment schedules, as well as expected collection arrangements.
9. Dealing with the Queen Bee syndrome. There is often a talented, influential, and typically long-term employee who decides the rules of the office don’t necessarily apply to her. Perhaps she consistently comes in late or disregards some of her assigned responsibilities. Since she is an important team member, the doctor avoids a personal confrontation and handles the problem by doing group therapy at staff meetings. “We all have to do our best to arrive at the office on time.” Everyone knows that the comment is intended for one individual and not the other staff members. This technique is insulting to all the other responsible team members. Successful practices will not tolerate the behavior of the queen bee and as difficult as it may be, will make the decision to let this person go.
10. Live by an updated, well-written, state-of-the-art policy manual. Many practices never understand the logistics required to make the successful transition form a “mom and pop” operation to a major business. Vacation time, hours of operation, personal days, pregnancy leave, seniority, telephone use, internet use, workplace protection, dispute resolution, proper attire, body piercing – every possible contingency should be covered in detail. Favoritism should be avoided at all costs.

Assembling the perfect staff is a difficult and time consuming process. It doesn’t happen overnight. In fact, even with a concerted effort to hire the best possible people, it could take a few years to find the right blend of talent and personalities. So doctors, when you are fortunate enough to reach this happy day when all the pieces to the staff puzzle are in place, the last thing you want to happen is for key personnel to leave and have you be back to square one. I suggest that if you implement the strategies outlined in this article, your chances of retaining your team members will be greatly enhanced.

Use the GOLDstein Standard…

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Use the GOLDstein Standard and Never Again Start a Root Canal You Can’t Finish

Your safety net to guarantee super-productive endodontic treatment scheduling

By Michael D. Goldstein, DDS, FAGD

When I was partnered with Dr. Kit Weathers at our two-day, hands-on endodontic “Root Camp” seminars, we were regularly amazed at the improvements in efficiency that our attendees would make following their hands-on training. In fact, the typical Root Camp participant increases his or her hourly endo production between $184 and $242, depending on whether the tooth is anterior or posterior. During Root Camp, I would analyze fee and productivity statistics from each doctor’s “pre-seminar survey,” and I presented data obtained from the surveys. The survey included information about the volume of endo cases being treated, as well as the fee charged and the time scheduled to complete the root canal. I compared the numbers with the averages of the previous six Root Camp classes so students could better understand how they “measured up.” I then provided specific recommendations concerning fees and efficiency improvements and I discussed the expected impact of making these positive changes in the practice.The Science of “Endonomics” I’ve even coined a word to describe my conclusions- “Endonomics.” Endonomics refers to the study of how improved endodontic skills impact the economics of the typical dental practice.

There’s no question that following Root Camp, each doctor has a better understanding of the importance of efficiency while performing his or her root canals. They understand how even small decreases in their endo treatment times translate into large increases in their hourly production. Further, they understand the tremendous cost to their practices when they schedule a single-visit molar root canal appointment, and then discover that they’re unable to complete the case. At Root Camp, Dr. Weathers teaches an entire segment about how to decide in advance, which root canal cases you should treat and which ones you should refer. He calls this segment, “Knowing When to Hold Them and When to Fold Them (does anyone remember the great Kenny Rodgers?).”

Despite the improvement in their endo treatment skills and efficiency, and the better understanding of which cases they should be treating or referring, many students are still hesitant to schedule certain root canal cases because they’re afraid they may “get in over their heads.” This hesitancy has a lot to do with the potential financial devastation that would occur from starting a root canal procedure that they cannot complete. In fact, looking at the calculations from a recent Root Camp group, if one of those doctors scheduled a molar root canal that he could not complete, he would waste 1 hour and 46 minutes and lose $830 for the lost, single-visit scheduled appointment.

The agony of an unexpected endodontic treatment referral

There are many negative consequences that occur when you begin a root canal in your office and then must unexpectedly refer the patient to another dentist to complete the treatment:

• The patient perceives that they wasted a visit at your office
• The patient usually ends up paying more for the root canal

• The patient may experience a time-delay in getting the necessary root canal treatment completed

• Patients don’t like having to leave your office in the middle of treatment

• Patients may later question your judgment on other dental matters

• You lose a minimum of $400-$500/hr of production
After weighing the benefits of treating more involved and complicated root canal cases against the potential dangers of being unable to complete the case, I created the GOLDstein Standard for Endodontic Treatment Scheduling that positively assures that you will never start a root canal until you are certain you can complete it.

The stein Standard- Never start a root canal until you are certain you can complete it.

The key to effectively using the GOLDstein Standard is to begin with a thorough clinical and radiographic diagnosis. This will help you rule out any tooth you may consider too complex for your abilities. Perhaps you cannot visualize the entire length of the canals on the pre-op x-rays, or maybe you’ve never performed a root canal on an upper molar. For whatever reason, you’ve identified the possibility (even if small) that you may have difficulty with the treatment.

So, Mrs. Jones presents to your office on emergency with a draining fistula adjacent to tooth #30. Because, you’re not 100% confident that you can locate all the canals, but you want to attempt the treatment, you tell her, “Mrs. Jones, we’re going to schedule you a short appointment to get this infection under control.”
If Mrs. Jones is in pain, you can tell her that you will “get the pain under control” as well. Basically, you’re not telling the patient that you will begin the root canal. You simply schedule a pulpectomy, which is code D3221. The complete explanation of this code is D3221 pulpal debridement, primary and permanent teeth. Pulpal debridement for the relief of acute pain prior to conventional root canal therapy (not to be used when endodontic treatment is completed on the same day).

What’s the worst that can happen in this situation?

Using the above guidelines, let’s examine the worst-case scenario with Mrs. Jones’ treatment. You’ve scheduled Mrs. Jones for a thirty-minute appointment, to give you an opportunity to access the infected molar, locate the canals, and medicate and temporize before later beginning the root canal. I recommend you spend no longer than ten to fifteen minutes trying to locate all the canals. If after that time you’re unable to find all the canals, you should medicate and temporize the tooth.

From Mrs. Jones’ perspective, you’ve accomplished all of your stated objectives. You’ve gotten the infection and/or pain under temporary control; and you’ve accomplished this painlessly and efficiently. Just as importantly, you haven’t “stressed out” over a difficult case and created your “own canal” or perforation through the furcations or the root. You then explain to Mrs. Jones that the nerve treatment will be accomplished by a dentist more experienced with this procedure and the complexities seen in this particular tooth. You should confirm the restorative treatment that will occur after the root canal, and bill the patient for the pulpectomy (D3221). Instead of an uncomfortable last minute change in your treatment plan and scheduling, the patient is happy and you haven’t lost productive scheduled time on your appointment book.

A summary of the benefits of using the GOLDstein Standard with this “worst-case scenario” is listed below:
• The patient’s treatment plan was not unexpectedly changed at the last minute.
• The patient is now out of pain.
• The infection is less likely to increase or spread.
• You’ve only used 30 minutes of scheduled time from your schedule.
• You’ve produced at more than $250/hr. during the visit.

A better case scenario

Another possibility that will often occur during Mrs. Jones’ 30-minute appointment is that you will “miraculously” locate all the canals and determine absolutely that you can comfortably complete a root canal on the tooth in question. One option is that you then perform the pulpectomy, place a temporary medication and reappoint Mrs. Jones to perform a complete root canal and restoration at the next visit. The benefits of the “better case scenario” are as follows:
• The patient is assured that the root canal procedure will be painless.
• The patient is less likely to cancel or not show at their next appointment, since the fear of pain is removed.
• You know positively that you can complete the root canal at the next visit.
• You know precisely how long to schedule the appointment.
• You are more likely to schedule the restorative treatment at same time, which leads to a very productive appointment.

As far as billing for the procedure, I recommend that in most “better case scenarios,” you bill for the entire root canal procedure at this visit. You can “brag” to your patient that this visit will be covered as part of the root canal fee. If the pulpectomy visit was scheduled as an emergency or “work-in” appointment, then most insurance companies will cover the fee for the code 3221, and then later pay the full fee for the root canal billed on another day. Under this circumstance, the exclusion of the same dentist being paid for a pulpectomy and the root canal has been lifted.
Important Clinical Tip: Always take your working length measurements before closing the tooth during this initial visit.

There is no better time to take a working length measurement than immediately after accessing and locating all the canals. This will save you valuable time during your next visit. . An added benefit is that you have confirmed the canals are patent and you are better able to calculate the exact time needed for the next appointment.
The best-case scenario

The most ideal occurrence at Mrs. Jones’ pulpectomy appointment is to open the tooth, locate all the canals, perform the complete root canal, and possibly the restoration, at that visit. I realize that it’s difficult to imagine how you can find the necessary time to complete the root canal when at most, you have blocked 30 minutes on your schedule. Here are some suggestions for how you can find the time:
1. Modify the treatment on your next scheduled patient (or your current patient if you’re working in the pulpectomy appointment)
When you realize that few dental procedures yield a greater hourly net profit than root canal therapy, it’s easy to understand how substituting an endo procedure for a less productive procedure can improve your overall production. That, coupled with the timesavings of not having to schedule a second appointment to renumb, isolate and relocate the canals, makes this substitution a profitable choice. Very often, the next patient on the schedule will not mind shortening his scheduled appointment when the option exits.

2. Wait to confirm your next patient is showing up before dismissing Mrs. Jones.

I remember having once dismissed an emergency pulpectomy patient who presented with a painfully infected lower molar. Although I was able to easily locate the canals, and could have completed the endo, I temporized the tooth and reappointed the patient because I had a crown and bridge treatment scheduled just ten minutes away. Shortly after the patient had left the office, we received a call to inform us that my “crown and bridge” patient was not going to make her appointment. It’s still uncomfortable to calculate the lost production due to that poor decision.

3. Tell the patient they may be in chair for several hours.
You will be surprised how long a patient will happily and patiently wait around your office for treatment. When patients are accurately informed about the time involved and are given the choice to stay and have the treatment done that day or reschedule, many choose to stay. Very often, a patient has taken a personal day from work to be at your office. Many patients would welcome the opportunity to complete their treatment that day, thus saving them another day off of work. When given a two, to three-hour plus period of time to “work-in” the root canal treatment, a number of five to fifteen-minute segments can be “borrowed” to comfortably complete the procedure.

The GOLDstein Standard gives you the ability to treat cases you might otherwise refer due to complexity or lack of time on your schedule
We’ve thoroughly discussed the importance of not beginning root canal cases you cannot complete. Equally important is the need to keep productive endodontic cases you can efficiently and comfortably treat in your office. The GOLDstein Standard gives you a tool to help you gauge the complexity of the treatment as you develop your endodontic skills. With endodontics having a lower overhead than most dental procedures, there are very few procedures that a GP performs that yield a greater net profit.

Reasons to try the GOLDstein Standard on your next challenging root canal case

In summary, using the GOLDstein Standard when scheduling difficult endo cases can offer you the following advantages:

• There will be no scheduling surprises for your patient.
• There will be no scheduling surprises on your schedule.
• You should produce at least $250+/hour performing a pulpectomy.
• The second treatment visit will be extremely efficient.
• Working in a root canal treatment helps you fill gaps in your schedule.
• You remove the risk that you may be needlessly referring productive root canal treatment that you can be effectively and efficiently treating in your office.
• You totally eliminate the stress of unplanned referrals.
With the GOLDstein Standard, even if you’ve started a root canal that you later discover you’re unable to complete, you will not upset your patient, you will not upset your schedule, and you will have not risk leaving the tooth in worse condition than you found it.

Ten Steps for an Efficient, Stress-Free Recall Exam

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By Michael D. Goldstein, DDS, FAGD

As a dentist, it’s impossible to pick up a journal or attend a seminar without being exposed to a host of ideas about how to “predictably” improve your efficiency and increase your income. Upgrading to the latest laser technology, learning efficient endo or implant techniques, and becoming a recognized cosmetic dentistry expert are just a few of the techniques often discussed. One seldom-mentioned subject is the periodic oral evaluation (0120), often called the recall or recare exam.

Think about it. If a dentist works 200 days per year with one hygienist who averages seeing eight recall patients per day, that dentist will perform 1,600 recall exams per year. With two hygienists, that works out to 3,200, and so forth… you get the idea. If it were possible to trim just four-minutes of time from each exam, a dentist with one hygienist could potentially save 106.66 hours per year, or the equivalent of 13.33 eight-hour workdays. Since an average dentist’s time at chairside is worth $300 + per hour, I calculate a potential savings of at least $32,000 per year. Of course, if a dentist has more than one hygienist working, the savings would be much, much more. All that extra income for just making a few strategic changes to the way the recall examination is conducted. And as an extra bonus, the recall exam will be stress–free.

With a little training of your dental team, it’s possible to make all recall exams go smoothly, efficiently and stress-free. The key to successfully achieving these goals is having the hygienist accept the responsibility for clearly communicating every detail of the patient’s condition and the treatment performed during the visit. Once the dentist enters the operatory, the dental hygienist will verbally communicate all the details pertaining to the patient’s treatment and oral health. The dentist should not have to flip through a chart or “click” through a computer file to get information about the patient. Additionally, the most current radiographs should be displayed, either on a view box or a computer monitor. Below is a guide for the sequence of the examination process:

  • Address family and personal issues first.

    The hygienist will begin the communication by addressing personal matters concerning the patient.

    “Dr. Jones, Mary’s daughter, Lucy, just had her first child…”

  • Inform the dentist about the patient’s health status and blood pressure.

    Since the patient’s medical health is an important priority, we verbally acknowledge any changes that have occurred with the patient’s medical status since the previous visit. We also acknowledge when there have been no changes to the health history. Additionally, the patient’s blood pressure reading is communicated at this time.

  • Inform the dentist about the patient’s radiographs.

    If radiographs were taken, the hygienist should point out,

    “As you requested, we’ve updated Mary’s full-mouth x-ray today.”

    All x-rays are taken under the direction of the dentist, so if the policy of the office is to update the panorex every three-years, then the dentist did request it. The dentist should always review new radiographs while the patient is observing.

    • Special Tip:

  • Inform the doctor, OUT LOUD, when x-rays are not necessary.

    I also recommend that when the patient is not due for new x-rays, the hygienist loudly proclaims,

    “Mary was caught up on her x-rays, so none were taken today…”

    Too many times, from the patient’s perspective, it appears that dentists are constantly taking x-rays. By hearing this announcement at least once per year, patients should no longer have this perception.

  • Announce all clinical procedures performed on the patient during the appointment.

    The hygienist should announce every service that she performed or discussed with the patient. The dentist should not have to consult the computer or the chart to discover this information.

  • Verbally point out all dental problems noted during the cleaning.

    A hygienist spending 40 to 60 minutes, or more, with a patient, cleaning and polishing every surface of every tooth, will sometimes notice conditions that a dentist may occasionally miss during the examination. While the dentist is focused totally on the patient, ready to begin the examination, the hygienist should verbally acknowledge all conditions she noted during her clinical time with the patient.

    • Special Tip:

  • Rate the patient’s oral hygiene competency level.

    The dentist and the hygienist should designate a numerical system to categorize the patient’s oral hygiene level. For instance, a score of “10” could designate a patient that presents at the beginning of the appointment with an immaculately clean mouth. Conversely, a score of “2” may designate a patient with heavy calculus, and remnants from yesterday’s Philly cheese steak sandwich present on the lower molars.

    Years ago, before instituting this system in my own office, I remember an instance when I examined a teenager whose mouth looked quite healthy.

    Not realizing that my hygienist had just politely reprimanded this patient about her poor oral hygiene, I proceeded to praise her for doing a great job taking care of her teeth. After all, by the time I arrived into the operatory, this patient’s teeth were beautifully clean, and there was no evidence of chronic perio problems. Now, if I hear that the patient’s “O.H. Index” is “4,” before I begin my exam, I know that regardless of what her mouth looks like now, my job is to reinforce my hygienist by trying to motivate this patient to do a better job with her homecare.

  • Announce your clinical findings during the examination.

    I’ve found that there’s no better way to get a patient’s undivided attention than by talking about him or her to someone else. As you examine the patient’s mouth, call out your findings to the hygienist, aware that your patient will be intently listening to your every word.

    “The back portion of the lower right first molar has a large crack that I’m afraid will work its way into the nerve in a very short time. Make a note for us to put top priority on fixing this tooth right away, in order to prevent a serious nerve problem.”

    Along with communicating problem areas discovered during the exam, I recommend that the dentist call out all normal findings as well.

    “The lips, cheeks, and frenum are normal. The palate and oral pharynx are fine. Occlusion, TMJ, gingival, tongue…”

    …you get the idea. Your patient must know that you’re performing an oral cancer screening, TMJ screening, periodontal examination, and all the other valuable services you provide during this “periodic evaluation.”

  • Document the results of your examination.

    A wonderful tool to educate a patient about the value and thoroughness of their recall exam is to use a document to record the findings of your examination. I designed an “Oral Diagnosis Form” to be completed at each recall visit. The form is a tool to record all the systems that are being examined and all conditions that warrant close follow-up or further treatment (Please call or email Dr. Goldstein to receive a copy of this form). Most of the time, there will be check marks on the majority of the items on the form, as most areas will appear normal. For the items that require additional explanation, the hygienist can provide detailed comments on the form. She may include a note about the patient’s need to floss more frequently, or the importance of having tooth number 12 crowned before if fractures. The Oral Diagnosis Form can now become a part of the patient’s record until the next recall visit. As a bonus, it can be photocopied and given to the patient to serve as a patient motivation tool.

    It can also serve as a reference for any staff member to consult when communicating with a patient about a future recall appointment.

    • Special Tip:

  • Decide on the time required and the services to be provided at the patient’s next recall visit.

    I have a pet peeve about the way some offices schedule their recall appointments. Many offices schedule a full 50 or 60-minutes for each and every recall patient visit. Think about how inefficient that is. Too many times, I’ve seen a patient with a full-dentition and significant calculus given the same amount of time for his appointment as a patient with an upper denture and six lower anterior teeth retaining a lower partial denture.

    The key to efficiently scheduling the next recall visit is having the dentist and hygienist decide together, during the current recall visit, what will be performed and how long the next visit should take. A patient requiring a full-mouth series and a fluoride treatment during today’s visit will certainly not require the same time allotment the next time, when only a prophy and examination will be performed.

Hold a staff meeting to discuss each of the items mentioned in this article. Once the dental hygienist assumes the role of “emcee” and facilitator during the recall examination, efficiency will dramatically increase. Use these tips to save valuable time and enjoy stress-free hygiene recall exams

Through Goldstein Management, Dr. Goldstein currently enjoys working one-on-one with dental offices to help them implement systems and ideas, such as the ones suggested in this article. His goal is to help a doctor reduce stress and increase profitability, even during challenging economic times. Dr. Goldstein can be reached at DrMike@GoldsteinManagement.com, or by calling 770-467-0467. He offers a free telephone consultation and practice analysis to determine how he can be of service to your practice. Visit www.GoldsteinManagement.com for more information.

It’s the Little Things that Count

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By Michael D. Goldstein, D.D.S., F.A.G.D. (Reprint from Dental Economics)

I’m often overwhelmed by the number of ways available for us, as dentists, to express our concern to our patients. When you stroll down the exhibit aisles at a dental meeting, read a management journal, or attend a patient-management seminar, you are deluged with suggestions on improving your relationship with patients. Usually, the suggestions are high-tech and high priced.Cable-TV and VCRs in each operatory is one suggestion. Or $900 sunglasses with a small TV screen built in that my patients can slip on and watch while I’m working away. How about a cappuccino bar in the waiting room … excuse me, reception area.

Just the other day, I returned a long-distance telephone call from another dentist’s staff member. I was quickly put on hold. While I waited, I heard about all the high-tech options available at this office, such as an intra-oral camera, air abrasion cavity preparation, implants, etc.

After more than 4 1/2 minutes of this, I became impatient and hung up. I wonder how many patients would hold on longer than I did? If I were a new patient, all the high-tech, fancy dental gadgets and techniques in the world couldn’t entice me to call back an office where the courtesy of acknowledging a waiting caller was ignored. The simple things can really be important.

Eight simple things costing less than $1 that show patients you care

The following eight items are a sampling of the “little things” we do everyday in my office for my patients’ comfort. Each “patient amenity” costs less than a dollar and makes my patients feel special and pampered.

Item 1: Vaseline on the lips – Cost: 5¢ per application

We’ve been applying Vaseline to the lips of all our patients for more than 20 years. It amazes me how appreciative our patients are of this small effort. The older ladies especially enjoy not leaving with cracked and bleeding lips. We now load the Vaseline into the back of a 5cc Monojet syringe that has the tip cut off to allow for easy dispensing. We place a little dab of Vaseline out for every procedure.
Once you begin pampering your patients in this manner, they will expect it every time.

Item 2: Individual packs of tissues – Cost: 20¢

Most of our patients are given their very own packet of facial tissues before we begin their dental treatment. We don’t wait for their noses to run or saliva to drip down their necks. It’s a little item, but you’ll immediately notice how appreciative your patients are when you give them their very own personal packets.

Item 3: Protective sunglasses ¬– Cost: 15¢ per use

Most of us now provide our patients with protective glasses before we begin a procedure that could result in splashing. By having the glasses tinted, we’re further improving our patient’s comfort by shielding their eyes from our dental light. If you don’t think your dental light can be annoying, just sit in your dental chair and observe the view from down there.

For the kids, we have little Mickey and Minnie Mouse sunglasses that fit them better. I bought hundreds of pairs at a really great deal, so we let the kids take the glasses home (after we clean all the blood and spit off, of course).

Item 4: A cover or afghan for our cold-blooded patients – Cost: 0¢ (my mother-in-law made me the afghan)

If your dental office is like mine, your operatories vary in temperature from 87 degrees to 65 degrees. The other day, I sat down to begin a three-hour procedure in Room 1, which was way too warm. After I turned on the fan, my patient, who obviously had zero blood circulation (I probably should have checked her pulse), complained of being too cold.

Instead of my assistant and I stripping off layers of clothing to be comfortable, we covered our patient with an afghan. We have several older patients who routinely request the afghan, especially in Room 2, which is 10 degrees cooler than the rest of the office. My assistants are so sharp; they remember the “cold-blooded” patients and offer the afghan before they ask.

Item 5: Valium, 5mg – Cost: 15¢

We use a lot of Valium at our office, and occasionally, we’ll give it to a patient. I rate Valium right up there with the papoose board when it comes to patient behavior management. Seriously, having patients take just one 5mg Valium 30 minutes to an hour before treatment can significantly improve their comfort and their cooperation.

We routinely dispense Valium to patients undergoing major restorative treatment (two hours or more). We also give Valium to patients who have difficulty holding their mouths open widely or for long periods of time and to patients who are apprehensive. Patients who take Valium almost always comment on how much easier the treatment was than they had expected, and they often require less local anesthetic during treatment.

When we offer the Valium, we say, “We’re going to give you a muscle relaxer to make it easier for you to hold your mouth open during your long dental visit.” We also ask these patients to arrange alternate transportation, so they don’t have to drive themselves home after treatment.

One bit of caution: It can be difficult to predict exactly how a single 5mg Valium tablet will affect a patient. I’ve had a 220-pound man fall asleep on one pill, and a 90-pound elderly woman not feel affected by two pills. After hundreds of uses, I have not experienced one negative reaction from my patients.

Item 6: Stereo with headphones – Cost: 25¢

We have some patients who can’t stand the sounds of the drill and the suction. For them, we offer a small cassette/radio with headphones, or a CD/Walkman. We encourage our patients to bring in the music they like to listen to and even their own players. I’ve found, however, that once a patient has the Valium in his system and has been painlessly numbed, he really doesn’t care about listening to music. For this reason, our stereos get very little use.

Item 7: A plastic rose for my female patients – Cost: 40¢

For the last 12 years or so, I’ve been giving most of my female patients a plastic, long-stemmed rose following their treatment. We buy the roses by the gross and keep all of our operatories well-stocked with the white, pink, yellow and red flowers.
After analyzing the tremendous positive response these flowers elicit, I finally determined that the way I present the rose is significant. Typically, I say, “Mrs. Taylor, this is for you for being such a wonderful patient today.” I even go to the trouble of color-coordinating the rose with the patient’s outfit (my wife, Fern, will laugh at this statement because she doesn’t believe I could color-coordinate a tuxedo on a penguin). Even if the patient is a “pain” to work on, I’ll say, “Mrs. Taylor, I know that this appointment was difficult for you, and this rose is a thank-you for putting up with us and getting through the treatment.”
Patients frequently tell me about their large arrangements of these roses at home. They never seem to throw them away. Giving a rose to a patient also makes me feel good, which is a very large bonus.

Item 8: Calling a patient by name – Cost: 0¢

If you’re like me, remembering a patient’s name and using it is a very difficult task. Just the other week I was discussing this very matter with my partner, Kip Withurs. Because of my “name-learning disability,” my sharp assistants print each of my patients’ names in large block letters on their tray cover to remind me to use it.

Item 9: Give your patients more than they expect

One of the greatest books on practice management I’ve ever read is “The $100,000 Practice and How to Build It” (I’m almost there), written by Robert P. Levoy in 1966. In the book, Bob used the word “potlatch” to mean giving the patient more than they expect (just as I’ve given you more than the eight items I promised.) Using some or all of the “low-budget” patient pampering techniques described will give your patients a feeling of “potlatch” from their dental experience.

If you still feel you must have interactive video games and a juice bar in your office to be successful, I won’t argue with you. I only hope that you’re already using the personalized patient comfort suggestions that I’ve outlined. Sometimes, it’s the simple things done with sincerity and concern that have the most impact.

Elements of the Office Policy Manual

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The following is a list of items you must include in your office policy manual:

  • Categories of employment
  • New employee orientation
  • Meal periods
  • Leaving work during shift
  • Resignation
  • Attendance and tardiness
  • Confidential information
  • Unprofessional conduct
  • Accident reporting
  • Corrective actions
  • Personnel file
  • Recording work time
  • Payday
  • Paycheck deductions
  • Performance reviews
  • Overtime training
  • Verification of license
  • Employee benefits
  • Time off, holiday pay, etc.
  • Jury duty, voting, other leave
  • Unemployment insurance
  • Workers’ compensation
  • Personal telephone calls
  • Internet use
  • Dress policy
  • Dental care for staff and family
  • Safety in the workplace
  • Substance abuse
  • Drug and alcohol testing

Additionally, there are many legal disclaimers that must be included for your manual to be complete. Your legal professional should be able to provide the necessary language.

Planning Ahead for Early Retirement

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by Dr. Mayer Levit

For many of us who have been in practice since the 60’s, dentistry has offered us a wonderful lifestyle and the opportunity to be involved with a challenging and respected profession. But times have changed. Our litigious society has forced us to practice defensively — you need a masters degree in record keeping to satisfy risk management. The emergence of managed care has lowered our profit margins, forcing us to work additional hours to produce the same amount of dollars. The expense and aggravation of OSHA compliance continues unabated. Overhead costs, even in well-run practices, are exceeding 65%. In conversations with my colleagues, early retirement or “Earlier than originally planned” retirement, is an issue that is discussed with increasing frequency. The purpose of this article is to offer suggestions on how an early exit might be accomplished.

Unfortunately, most dentists cannot afford to retire early, even if that is their desire. Statistics show that only 15% of our profession by age 60 have the financial strength to live in retirement at anywhere close to their accustomed standard of living. For many dentists, the appraised value of their practice (by whatever method used) represents a substantial amount of money – but if this asset is not liquid, what good is it! As we often say, you can’t pay your bills with receivables!

The chances of finding some young dentist with a big satchel full of money, willing to purchase your practice, are remote at best. So what about financing! Well, for many reasons, bank financing has become a very difficult process. Welcome to the 90’s! Banks, these days, only write secured loans – a loan collateralized by equity. Young doctors don’t have much equity – in fact, most of them are in moderate to serious debt from educational loans. Banks no longer lend money based on income potential. So unless a young doctor can find someone to co-sign a note for the purchase price, what usually happens is that the seller will have to finance the purchase by taking back a lot of paper with an extended pay- back schedule. Since most young doctors do not have the management skills or business expertise to operate your practice, this becomes a very risky situation. If you leave and the practice gets into trouble, you may never see your money.

An arrangement that I feel offers the selling dentist the best possible chance to receive a fair value for his practice is a careful and well thought our plan implemented five to ten years prior to the expected retirement date. This plan involves:

a. hiring a younger doctor to work as a paid associate for twelve to eighteen months. At this time, you only have to paint in broad brush strokes what you envision happening if the relationship proves to be successful.
b. creating a partnership agreement with this doctor that specifies a five to ten year buy-in of your practice, while you are still there, working, advising, and teaching. This is followed by a five to ten year buy-out of the balance of the practice after you have retired.

You can’t get to plan (b) unless plan (a) is successful. You may find you made a poor choice. This can happen. If patients and staff do not relate well to the new doctor, the transition will not be successful. In order to protect yourself, only sign a one-year employment agreement. If the new associate does not live up to your expectations, do not be afraid to try again. Two points to remember:

  1. You don’t really make money on an associate, certainly not enough to compensate you for the hours and energy you must devote helping the associate build his practice.
  2. You don’t need or want a revolving door policy with associates. Patients and staff dislike it. Your sole purpose in hiring an associate is to allow you to complete your retirement plan.

There must be adequate physical space for the associate to work without interfering with your normal scheduling routine. And I think it makes no sense for the new associate to work in your office only when you are not there. You need to be working together in order to observe his dynamics with patients and staff If an expansion of your existing space is necessary, it should probably be done on a gradual basis as the associate becomes busier and you become comfortable that the relationship is working. By the time you are ready to offer partnership status and a buy-in arrangement – in other words, when you are convinced the marriage will work – you and your new partner-to-be should be well on your way to visualizing a physical space that will allow both of you to practice full-time.

It will probably take at least six months to complete a partnership agreement. I advise NOT involving lawyers until you and the associate have discussed every conceivable issue and contingency you can think of: compensation, vacation time, division of responsibilities, transference of patients, insurance, involvement or non-involvement of spouses, etc. What happens if one of you becomes disabled! What happens if one of you dies! What happens if after a few years, even with all this planning, the partnership isn’t working out! As painful as it may seem, now is the time to plan for a possible divorce. When the two of you are comfortable with your arrangements, then bring in legal assistance to prepare the documents.

The details of a buy-in/buy-out arrangement are far too complicated to discuss in the format of such a brief article, but I feel that two elements of the arrangement should be mentioned here:

  1. A formula must be determined that places a value on the practice for both buy-in and buy- out purposes. This formula cannot change without the consent of both parties.
  2. The selling doctor receives a substantial, non-refundable cash deposit at the time of the buy-in.

Once you have reached this stage of the plan, you can feel confident that retirement is achievable and on-track. It is up to both of you to make it work from here. By design, the terms of the partnership agreement should impose harsh penalties on either doctor who reneges. One of my favorite sayings is that for a deal to be a good deal, it has to be good for both parties. From the buyer’s perspective, the above-mentioned arrangement ensured a total turnover of the retiring doctor’s practice with all its inherent good will. Patients had a chance for all these five to ten years to observe the younger doctor. They may, in fact, have seen him for emergency treatment. Patient retention should be 85%-95% provided staff remains stable.

A new physical space was created, allowing both doctors to practice efficiently. In the ideal scenario, six months before the selling doctor retires, a third doctor is introduced into the practice. This doctor will become the purchasing doctor’s new associate for twelve to eighteen months, and the entire process repeats itself. From the point of view of the seller, this arrangement allowed the retiring doctor to have received income during the buy-in years and the confidence to realize that he would receive all of his buy-out dollars because the younger partner now was established and had acquired the management skills to conduct the practice in a profitable manner.

Avoiding the Stress of Staff Turnover

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A successful dental practice depends on a talented and productive staff. To retain that staff, a dentist must provide a supportive work environment.

More than any other variable in a dental practice, a talented and supported staff is a key to a dentist’s success. Dentistry is difficult and demanding, and a dentist who tries to shoulder the burden of managing the office without the proper assistance, soon becomes frustrated and discouraged.

Creating and molding a compatible staff is not an overnight process. Potentially, it could take a few years to find the right blend of talent and personalities. So it stands to reason that after working hard to assemble a team, the last thing you want is staff to leave. The purpose of this article is to describe my philosophy of how to maintain, manage, and retain a great staff.

Treat staff with respect. They are your emissaries.. They don’t work for you, they work with you. Never criticize or reprimand a staff member in front of a patient or another staff person.

Compliment staff members routinely.Look for ways to say something positive about their performance. They have a tough job and need to be commended. It takes no effort at all to thank someone or praise them, and it certainly creates good will.

Pay staff well.Although salary is third or fourth on the list of employees’ requirements for job satisfaction, everyone likes to feel recognized by a good pay check.. With the constant pressure of rising overhead, and the need to examine and justify every expense, do not be penny wise and pound foolish.

Delegate to the extreme.Let your staff know how much you depend on them. A job becomes much more interesting when you assign large amounts of responsibility. Time and again, I have seen people grow in their jobs because I have expressed my confidence in their ability to handle complex situations.

Try to create a schedule that eliminates stress.Working Monday, Tuesday, Thursday and Friday reduces stress and gives everyone relief from the hectic routine of busy, consecutive days. Working four days a week with a day off midweek — no matter how long those days have to be to generate your production goals — is less stressful on your staff than working five days in a row, with only the weekend off. It is also a great plus and appreciated by the staff to have a non workday in the middle of the week.

Whenever possible give staff extra time off in addition to scheduled vacations.As long as the office is covered by a dental assistant for emergencies and front-desk personnel for appointment control, it is of little consequence to reward staff with time out of the office if you are away on vacation or attending a continuing education course.

Pay staff members a yearly salary.I have never believed in employees punching a time clock. Because I am very conscious of the value of their time, we rarely work into the lunch hour and almost never work late. If we finish ahead of schedule, I let the majority of my staff leave early. With this approach, on the rare occasion that I must work late, overtime never becomes an issue.

My staff knows they are functioning as a team.Because of this, I don’t advocate specifying a certain number of sick or personal days as a staff benefit. I expect everyone to show up every day.

Expect people to work at 85 percent to 90 percent efficiency, day in and day out.If you expect 100 percent effort all the time, your staff may get burned out and leave because of stress. At crunch time when I need 110 percent effort, I know I can get it and don’t feel guilty asking for it.

Be professional with your employees.Listen to their problems. Talk about their children and families. Banter with them — trade jokes and stories. However, don’t feel the need to socialize with them after hours.

Think twice about having your spouse work in the office.This can make staff feel supervised and spied on. I also think it stifles creativity. And what happens when there are two dentists in the practice? Should both spouses have the opportunity to work in the office? A sure prescription for chaos! There are exceptions to every rule, and you must evaluate the pros and cons of your own circumstances.

These principles have worked well for me during the past 29 years. Many staff personnel have worked 10, 15 or 20 years for me and continue to do a fabulous job. There is no substitute for continuity. Patients are comforted by seeing familiar faces.

Think of your staff as family. Be caring and understanding. A soft, low-key approach to staff management will help create a solid, loyal, and dedicated group of wonderful people who have the potential to make every day in your office easier.

Scheduling Efficiently A Profitable Resolution for the New Year

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by Dr. Mayer Levitt

Let’s examine what appears to be a very successful solo dental practice as we enter the 21st century:

  • The doctor works a four day week – approximately 35 to 36 hours of patient care.
  • The doctor is scheduled four to six weeks ahead.
  • There is a considerable amount of comprehensive and cosmetic dentistry being performed.
  • A talented support team is in place.
  • Two full time hygienists work each day the doctor does.
  • The doctor and staff regularly update their knowledge through continuing education.
  • The physical plant is adequate.
  • Collections and accounts receivable are reasonable since financial arrangements are executed properly.
  • The hygiene practice is healthy with a nice mix of soft tissue management.
  • Fifty to sixty percent of the patients are covered by some form of dental insurance.
  • The practice welcomes twenty to twenty-five new patients per month.

What could be better? What could be improved? As a management consultant, I have worked with over 100 practices that exhibit the above characteristics. Believe it or not, they share some serious problems:

1. In busy practices, treating lots of patients, there is a great deal of stress in trying to maintain a timely schedule. And we know that patients respect our time in direct proportion to the way we respect theirs. So timeliness is key.
2. Often times the doctor thinks an associate is needed to help process the volume of patients.
3. The doctor feels successful, yet at the same time is concerned that patients have to wait five to six weeks for an appointment. There is no flexibility in the doctor’s schedule because of this backlog of patients. The doctor feels a loss of control over his or her life. This is certainly not ideal customer service.
4. There is a tendency to postpone definitive dental treatment because there is such a long wait for an appointment.
5. The doctor feels maxed out and can’t seem to find a way to get to the next level of profitability other than working more hours.
6. The problem of how to control capacity is constant. Should fees be raised, should hours be expanded, should the facility be expanded or changed.

Notice that I haven’t categorized or sized this practice by gross production dollars. No philosophical discussions about amalgam vs. non amalgam. Insurance dependant or non insurance dependant. Accepting assignment of benefits or not accepting assignment. Those are all important issues, but have little relevance to the topic of how to schedule efficiently.

The most important management system in a dental practice is scheduling, because the only thing we have to sell is our time. Yet most practices are terribly inefficient in scheduling, wasting two to four hours of time virtually every day. I didn’t say they weren’t busy – I said they weren’t efficient. There is a huge difference between being busy and being profitable. I believe that when an effective scheduling system is introduced into a practice:

  • the stress level of everyone can be significantly reduced.
  • the appointment backlog can be cut in half.
  • the need for an associate is often eliminated.
  • production is increased dramatically without raising fees or altering the mix of the practice.
  • every hour in the practice becomes a productive hour no matter what procedure is being performed.

Every scheduling system that I have ever heard about, read about, or seen promoted by the national practice management gurus is a variation on what is called BLOCK scheduling. Save certain blocks of time everyday, some in the morning and some in the afternoon, in order to begin major dental treatment. The rest of the day is saved for smaller procedures, crown inserts, and exams. According to block scheduling, if you follow these guidelines, you are guaranteed to produce your target production number for that day. Those target numbers are fictitiously (in my opinion) created by charging out the full fee for the procedure when it is started. This is done so that insurance forms and statements can be generated.

The big problem with this type of scheduling is that nobody ever explains to the scheduling coordinator how to finish the procedure. So I often see try in visits of crowns, bridges, partials and dentures condensed into very short appointments so they won’t take up very much of the doctor’s time. You see, the scheduling coordinator is supposed to schedule each day to a certain target dollar amount. And the computer tells her that the second and third and fourth visits of prosthetic treatment have no value. Why? Because they were already charged out at the initial visit. So these procedures get squeezed into the wrong place with inadequate amounts of time so that the MOD amalgam can get scheduled. At least, says the scheduling coordinator, that has a dollar value, even if it may only be $90. So if I squish enough of these $90 appointments in, I have a chance to reach my target production goals.

My scheduling system is totally different.

1. Every hour of the entire day should be profitable, not just the blocks where “major” work is scheduled. Major treatment can be scheduled all day long.
2. Through a comprehensive analysis of every procedure performed by the doctor, the fee charged for that procedure, and the time it takes to perform that procedure, a dollar value per hour or half hour can be established for every procedure.
3. Based on the hourly and daily production goals that each practice sets for itself, certain procedures will be categorized as productive and others will be classified as non productive.
4. Those procedures categorized as productive are arranged one after the other in an appointment schedule on the left side of the page. These are prime time appointments because of the dollar value assigned to them.
5. Any procedure that doesn’t meet the valuation criteria for productivity is placed on the right side of the page in a time slot that doesn’t interfere with the profitable procedure scheduled on the left. These side booked appointments are further categorized into “doctor required” or “non doctor required.” Examples of doctor required would be small fillings or emergency treatment. Non doctor required could be alginate impressions, re-cementing temps, X-rays, etc.
6. A set of eleven scheduling rules that I have developed covers every contingency as to what procedures can be scheduled opposite each other. For example, doctor required right side appointments can not be scheduled when on the left side you are performing operative, endo, prep temp impression visits for crowns and bridges, or final impressions for removable prosthetics. Doctor required right side appointments can be scheduled when on the left side you are performing try – in visits for crowns, bridges, partials and dentures. Non doctor required visits can be scheduled anytime there is an available room and an available dental assistant.

I teach doctors and staff the details of this system in a six hour seminar, so it would be impossible to describe anything more than a few examples in the format of a short article. Notice that production for all four of these appointments is between $400 and $615 per hour. I am not suggesting that you change your current system of charging out everything at the first visit. I am merely suggesting, that for scheduling purposes, you understand the dollar value for each appointment time. Just as it is unrealistic to credit production of $2100 for the first visit of the three unit bridge, it is just as unrealistic to assign no dollar value for the next three visits required to complete that bridge.

Requirements:

1. Two full time dental assistants who are highly trained, people-oriented, and artistic. Delegation to these dental assistants to the full extent of your state dental practice act.
2. A minimum of two equally equipped dental treatment rooms (even better with three) available to the doctor at all times exclusive of hygiene.

Benefits of this scheduling system:

1. By understanding the true value of each block of time, it now becomes possible to expand the time allowed for multi-visit procedures (like try-ins), and still have a very profitable visit. The stress level is greatly reduced when the doctor is not performing “doctor intensive” procedures all day long.
2. Each hour of every day has the potential to be profitable based on your hourly target production goals that relate to your fees and your clinical pace.
3. The backlog is reduced by as much as fifty percent within three to four months because now you have a system of moving non-profitable half hour visits (small fillings, a simple extraction, etc.) into a right side visit that will accommodate them.
4. The profitability of each hour increases because of your ability to schedule right side visits in the appropriate slots where they don’t interfere with the main left side production. The average practice, as described in the beginning of this article, with national average fees, will increase production minimally by $100,000 in the first 12 months of using this system.

No scheduling system will work if the doctor abuses the system. The day can be designed perfectly by the scheduling coordinator, but it will totally fall apart if the doctor does definitive therapy for emergency patients, gets trapped in the hygiene room with a treatment presentation, or unrealistically decides that more treatment can be done in an inadequate time block.

Here is how to evaluate your current scheduling efficiency. Calculate how many hours the doctor worked in 1999. Divide the number of hours into the total doctor production and that will give you the actual dollars produced by the doctor per hour. Now I want you to do an exercise. Focus on the 15 or so most commonly performed procedures like anterior composites, posterior composites, amalgams, endo, posts, crowns, bridges, partials and dentures. When evaluating operative, think in terms of quadrant dentistry. In this exercise, calculate how long it would take for the doctor to perform each procedure if these three ideal criteria existed:

1. The patient is completely anesthetized when the doctor begins the procedure.
2. A dental assistant is assigned to that room for the duration of the procedure.
3. Nobody bothers the doctor – no phone calls or other distractions from front desk.

For example, how long would it take to do the actual dentistry for a quadrant of amalgams, or two complex posterior composites, or a prep, temp and impression for a single crown if the patient was totally numb, a dental assistant was at your side for the entire procedure, and nobody interrupted the procedure. It may be hard for you to imagine this set of ideal circumstances if they rarely happen in your office. But I guarantee that when you now evaluate your production by dividing the dollar value of the procedure by the time it takes to perform the procedure, the production per hour will be increased by $75 to $100 over the 1999 totals. Why?
The difference between what was produced per hour in 1999 and what should have been produced is the measurement of the inefficiency of your current scheduling system.

And when you add up the number of hours worked in a year (typically 1700 to 1800), you can easily see that scheduling inefficiency is costing at least $100,000 per year.

As the old saying goes, if you continue to do what you’ve always done, you will continue to get what you’ve always got. Doing the same thing you’ve always done, day in and day out, week in and week out, and expecting to get a different result is my definition of insanity. Perhaps it is time for a major re-evaluation of your scheduling system.

“Endonomics” and the Healthy Dental Practice

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by Michael D. Goldstein, DDS, FAGD
(Reprint from Dentistry Today and LVI Visions)

After participating in more than forty EndoMagic! Root Camps, I’ve come to appreciate the tremendous benefit and positive impact that efficient and predictable endodontic procedures can have on a practice. In fact, I’ve studied this trend and named it “Endonomics,” and I spend a lot of time analyzing “endonomic” trends as reported by the doctors attending our seminars.

There is no question, that improved endodontic skills can greatly reduce the stress of performing root canals on your patients. In fact, I’ve seen many cases where root canals went from being the most dreaded to the most enjoyable procedure in the practice.

Most dentists understand how improving the efficiency of their endodontic procedures can help their gross production and their profitability. Few dentists fully appreciate the potential for positive economic benefits from their increased skills. In this article, I would like to explore the economic potential of improving the efficiency of your endodontic procedures, and I would like to discuss your fees for performing root canals in your office.

Having majored in math while in college (many decades ago), and genuinely enjoying analyzing numbers and dental practice trends, I decided to put my skills to use to develop some practice information concerning endodontics that was available nowhere else. I wanted to evaluate fees for services, along with efficiency (how long it takes to provide the service) in order to draw conclusions that would be pertinent to the dentists in attendance at our two-day seminars. With that in mind, about three years ago, I began gathering fee and time information from the each dentist in attendance at our Root Camps. After years of analyzing the numbers, I was able to draw certain conclusions concerning the economics of root canal treatment.

One of the most frustrating aspects of my analysis concerned finding the average procedure fees for our dentists to gauge his or her own fee schedule. Unfortunately, all the published fee surveys were either outdated, or from a very different dental population source. I couldn’t find data current enough to be useful. It’s for that reason, I’ve been compiling average fee and time data from the doctors attending our seminars. In fact, the fee data referenced in this article represents the average numbers from the attendees at our previous six seminars. I believe this data is the most accurate and pertinent available to our readers.

The Myth of Crown and Bridge Production

Typically, whenever I’m with a group of dentists discussing office production and income, it seems that the focus is always on crown and bridge procedures. The interesting fact about the crown and bridge is that, according to Gordon Christensen, about 80% of it is single unit. Below, I’ve created a chart showing typical fees and costs for providing a molar root canal compared to a single unit crown.

Figure 1

Of course, your fees and expenses may be different than what’s listed above. We do find, that in most practices, the fees charged and the time needed to provide the two procedures are about equal. You can see from this chart (Figure 1) that due to the lower overhead and the likelihood of having only one treatment visit, the root canal is a more profitable procedure in most offices.

In fact Charles Blair of the Blair, McGill and Hill Group states, “I am convinced that there is no greater potential for increasing your net hourly revenue than by doing your own uncomplicated endodontic procedures efficiently. My analysis has consistently shown endodontics to have the highest dollar-per-hour and highest dollar-per-visit payoff of any procedure we do.”
Charles Blair, DDS, Editor
The Blair/McGill Advisory

Incidentally, Dr. Blair attended Root Camp and has seen the huge potential that most dentists have in their practices to improve their endodontic services to their patients. Through his Revenue Enhancement Program and his Profits Plus Seminar, he has helped many of his clients understand the important roll that Endo should have in improving their bottom line.

In the May issue of his popular newsletter, The Blair/McGill Advisory, Dr. Blair provided financial statistics for general dental and specialty dental practices. These numbers were tabulated from about 400 of his clients from across the country. My most interesting observation was that due to their low overhead (34.7% compared to the G.P. at 62%), the endodontists had the greatest profitability of all the dentists surveyed. Now it doesn’t take an actuary to surmise from this information, that increasing the amount of endodontics a G.P. does should have a very positive effect on their net profit.

Let’s look at this potential by evaluating the typical endodontic fees and hourly production doing endo.

What We’re Charging for Endo

Before we discuss what we’re charging for endo and how much an hour we’re producing, we should look at the typical GP’s overall production.

According to Dr. Blair, the typical G.P. is grossing around $435,000 with $100,000 or so coming from their hygiene production. Working 203 days per year that means they’re grossing $1,650 per day or $206 per hour on average. By comparison, lets look at what the Root Campers who’ve attended our seminar over the past eight months are averaging with their endo:

Averages from dentists attending previous six seminars

Now isn’t it interesting, that the more complex the procedure gets, the lower the hourly production. You would think it would be the other way around, but due to the inefficient way most dentists practice endodontics, they loose efficiency when treating multirooted teeth.

Another interesting fee comparison is my survey of the endodontists on the south side of Atlanta, Georgia. Keep in mind that fees on the south side of the city tend to be lower in general than in the “big city” itself.

Averages from endodontists on the south side of Atlanta

The Amazing Truth About our Root Canal Fees

On average, the Atlanta south side endodontists’ fees were 45.2% higher than our Root Camp attendees’ fees, and that’s not even considering the retreatment category. The greatest fee differential was the anterior fee. The $680 average endodontist fee is 53.8% greater than the $442 average general dentist fee at our seminars. It seems that the endodontists understand that the typical dental patient is much more motivated to treat an anterior tooth endodontically than a posterior or other non-cosmetically critical tooth. Besides, have you ever noticed that whenever your patients hear the word “root canal,” they think of two things…pain, and the molar root canal fee. Whichever tooth is involved, their perception is that it will cost the same as Aunt Betty’s molar root canal. You may not feel comfortable raising your anterior root canal fee by 53.8% all at once but you may want to consider an immediate 10% to 25% fee increase.

What it takes to increase hourly production by $100 per hour

A fascinating exercise that I do with every seminar group, after we compare their fees and treatment times with the norm, is to calculate how much more efficient they need to be performing molar root canals to increase their hourly production by $100. Keep in mind that this increase in hourly production directly impacts profitability, as there is no increase in overhead. The results consistently demonstrate that an increase in efficiency of only 21-22% accomplishes this goal. That’s an improvement of about 22-23 minutes in a procedure now averaging one hour and 46 minutes.

What is the impact on your practice of performing efficient endodontics?

The most fascinating and exciting statistics I’ve discovered involve the results from our surveys taken at least two months following a dentists participation at one of our technique seminars. On average, we’re seeing an increase of 10% on a doctor’s endodontic fees.

What’s more interesting is the improvement in speed that we consistently see. The chart below compares the average treatment times before and after the Root Camp.

Average Root Canal treatment times before and after Root Camp

The reporting dentists must be having far less stress than before in their endo treatment, because they reported a perception that they improved their endo efficiency by an average of 51%. In actuality, my numbers indicate an improvement of about 27%. The dentists also reported that on average, their monthly gross income doing endodontics increased by $2,000.

Based on a 10% fee increase and the time improvements noted above, I’ve charted out the average improvement in hourly production seen after learning new techniques.

Average hourly production before and after seminar

The perception of the dentist after the root camp was that their hourly production increased by $231 an hour, fairly close to the calculated values on the chart.

The endodontic “goldmine” in your practice

We mentioned earlier that the average GP is personally producing $206 per hour. When you evaluate the dollar-per- hour calculations doing endo, you can see how root canals can easily become the most productive part of your practice. Even the less efficient doctors before taking our seminar were reporting endo hourly production far above the overall average.

When you improve your skills, with or without an increase in your fees, the improvement in hourly production is incredible. Once trained, the doctors perform root canals at an hourly rate, which is 267% greater than the average GP’s hourly production. That’s the difference between $551/hr. and $206/hr. When coupled with decreasing the stress related with treatment, I can think of no more efficient way to boost the net profits in a practice.

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