Ask Dr. Christensen

Aug. 1, 2006
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers.

In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers. If you would like to submit a question to Dr. Christensen, please send an e-mail to [email protected].


I attended a CE course recently in which the speaker encouraged attendees to raise fees and see fewer patients. After considering his comments seriously, I concluded that his concept does not fit the income level of my town and the significant dental treatment needs there. What can I do to serve my many patients well and still make a reasonable living?

Answer from Dr. Christensen ...

Your question is one I hear frequently. There are only a few concepts of dental-practice administration that are feasible in a typical practice in an average-income American city; however, some “boutique”-oriented speakers infer that the high-fee, low-patient quantity practice can be for everyone.

To make an adequate living for a typical professional family, the practitioner has to make a choice between having high fees and seeing a few patients per day, or having moderate fees and seeing many patients in a day. Unfortunately, it has been my observation over many years that the high fee level of oral care in many practices does not necessarily relate to the quality of service the patients receive in that practice. Additionally, I have seen numerous “boutique” practices fail in family-oriented communities.

I consider dentistry to be an important health service, and I feel practitioners should provide the highest-quality service possible. However, there are limitations to the quantity of services that a dentist can provide at a high-quality level. In my opinion, dentists can provide significantly more high-quality services if they expand the clinical responsibilities of the staff. Every geographic location in the U.S. allows at least some expanded functions for dental assistants and dental hygienists, and some states allow many expanded functions to be provided by qualified, educated staff.

I have always used staff to the maximum level the law allows, and because of the expanded expertise of my staff, I have been able to provide quality oral care quickly and at a moderate cost to patients.

The answer to your question is:

Examine the practice act in your area and determine what clinical tasks are legal for staff to accomplish.
Decide what clinical responsibilities you want to delegate.
Educate staff members or send them to courses to be educated on the tasks that you have selected.
Supervise staff members as they take on the additional clinical responsibilities.
Set your fees at levels you feel are fair for the patient and the practice, and that you would pay another dentist if the treatment were being performed on you.

I feel confident that as you expand the clinical responsibilities of your staff, your practice will grow, your staff members will be happier and more fulfilled in their positions, your productivity will increase, you will be able to serve more patients, you will feel honest in your dealings with your patients, and your income will increase.

Recently, I became concerned about the relative lack of adequate use of dental assistants in the profession. We have made a new comprehensive DVD for dental assistants, V4714 “Effective Use of Four-Handed and Six-Handed Dentistry.”

For more information, contact Practical Clinical Courses at (800) 223-6569, or visit our Web site at


How do you educate staff persons to accomplish slinical tasks that they have not been educated about in their dental assisting or dental hygiene programs?

Answer from Dr. Christensen...

In my experience, there are several methods to educate staff:
• In-service education sessions: As a group, staff members should decide on the topic and the person who will conduct the session(s). The instructor may or may not be the dentist. Also, the instructor may be from another office where the delegated task is being accomplished. Set up about an hour-long educational session before patient care begins for the day. The person providing the instruction should arrive early and set up any equipment or supplies necessary for the session. Staff should arrive on time and be prepared to participate. If possible, hands-on demonstrations or models should be used to show the task being taught. The involved staff members should perform the task during the session. They should be carefully observed in clinical practice by the dentist over the next days or weeks as they integrate the clinical task into practice.

• On-the-job education: This form of education is a natural follow-up after staff members have had the in-service education session(s). Those who are less competent with the task should work with someone who already knows the procedure and is doing it in practice. Patients should be advised about the educational procedure, and they should give their permission for the learning experience going on during their treatment.

Most patients are cooperative when they know they are assisting in educating a person, and some patients are interested n the details of the procedure.

•Continuing-education courses: This form of education is the least effective since some of the material taught in any CE course may not be what the dentist or other staff members want to do in their practice. If the information taught in the course is critiqued in a subsequent staff meeting and the acceptable material is implemented into practice, CE courses can contribute significantly to learning expanded duties.

Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known “CRA Newsletter.” He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.


In the “Improve Your Bottom Line” feature by Brian Hufford in the June issue of Dental Economics®, reference was made on page 42 of “the ability to fund a full IRA deduction of $5,000 in 2006.” The author points out that individuals age 50 or older can invest $5,000 in an IRA in 2006. For all others, though, the full $5,000 amount is not available until 2008. Until then, the maximum allowable amount is $4,000 for 2006 and 2007.

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