Roger P. Levin, DDS, MBA
As dentistry becomes more competitive, practice management needs to develop into a science. Most practices do not design systems to fit their office needs. Instead, the systems have evolved with a tweak here and there, and exist from evolution rather than from decision-making.
Doctor Time
The dentist has the most valuable time in the entire practice. No one else is reimbursed at the same salary level, and the dentist is typically the owner as well. This means that, in addition to the dentist`s normal salary, there also should be a return on investment for owning the practice. This is typical for most business owners.
Given that the doctor`s time is the most valuable, it is essential that the time be used for the highest productive procedures. Instead, I find that most practices concentrate on:
* Filling in the schedule.
* Performing complex procedures in the morning.
* Staying scheduled as far ahead as possible.
Most scheduling systems are not carefully planned. Instead, they were either inherited or created years ago, and then upgraded to accommodate the current level of business. Most systems do not properly use the doctor`s or assistant`s time in the most efficient or effective manner.
In order to maximize the use of your time and to keep your staff motivated, you should begin to delegate. Delegation will not only excite your team, but it can increase your productivity by a minimum of 30 percent.
What Should Be Delegated?
You should delegate everything that a dentist is not legally required to do. This means that you must train assistants to perform all desired procedures and so they can provide the highest quality of care. However, in most offices, doctors perform many functions that are legally feasible by their assistants or hygienists or end up standing around while their assistants or hygienists are performing those services. Very few offices schedule doctor time and assistant time separately.
How To Do It
Each procedure in a dental office either requires doctor`s time or assistant time. Assuming that the assistant has been trained to handle all services that are legally allowed in your state, she should be the direct provider for those specific activities. In the meantime, the dentist should be treating other patients in another operatory.
For example, think about the basic crown preparation in general practice. Most doctors will schedule 60-90 minutes for this procedure. Inevitably, the dentist ends up using the entire appointment for a single patient. There may be a hygiene check along the way, but, usually, the dentist spends all of his time on that crown-preparation appointment.
After studying and analyzing over 1,500 office-scheduling systems, I have concluded that there is a tremendous amount of time wasted in this particular appointment. Certainly the dentist is needed for the anesthesia and preparation. Although different states have different laws about who may place the impression or the provisional, the dentist usually performs far more than necessary.
This extensive amount of the appointment does not require the dentist`s time or attention. A well-trained dental assistant can provide many of those functions. In the interim, while the assistant is providing direct services to a patient, the dentist should be in another operatory with another patient. This should be prescheduled, based on an understanding between the doctor and the assistant.
For example, at the initial phase of the crown-and-bridge appointment, the dentist may be needed for approximately 20 or 22 minutes. Afterward, the dentist may only be required to reappear to place the impression, place the provisional and provide intraoral occlusional adjustment (make sure you are aware of your state laws).
During the remaining 30, 40, 50 or 60 minutes of the appointment, the dentist should be in another operatory with another patient. This should be prescheduled using specific codes in the schedule, and will later result in a significant time savings for the doctor.
Do Not Double-Schedule
Do not infer that I am explaining the concept of double scheduling. Please be aware that double-scheduling means seeing two patients by a dentist at the same time. This is simply impossible, as you cannot be in two places at once. Double-scheduling inconveniences everyone in the office, most importantly the patient. One patient will have to wait, the dentist`s stress level is higher, the assistants may get confused because they are rushing and, finally, patients receive poor service.
Summary
Schedule doctor and assistant time separately. The dentist should be clearly scheduled in the proper operatory for that part of the procedure only he can do, not double-scheduled. At any given time, an assistant should be with the other patient, providing services and customer service. This relieves a tremendous amount of stress, increases productivity and allows the practice to run far more efficiently.
Dr. Roger Levin is founder and president of The Levin Group, a national, dental-management and marketing-consulting firm. He can be reached at (410) 486-1089.
