Case Studies of Dental Practices

Case Profile: After 15 years in solo practice, this general dentist called me in because his schedule was too hectic. Located in a strip shopping mall near Atlanta, his practice has a blue-collar patient base and produced $817,000 last year. Bent on hiring an associate, the doctor`s overriding wish was "to have a schedule that is profitable but not stressed to the max."

Sally McKenzie, CMC

Case Profile: After 15 years in solo practice, this general dentist called me in because his schedule was too hectic. Located in a strip shopping mall near Atlanta, his practice has a blue-collar patient base and produced $817,000 last year. Bent on hiring an associate, the doctor`s overriding wish was "to have a schedule that is profitable but not stressed to the max."

Symptoms: Got a broken filling? Get in line, there`s a 10-week wait and nobody`s happy. Patients can`t believe how long it takes to get an appointment or the nerve-racking wait time in the treatment room ... the doctor`s turning to and from patients so often that he`s in a permanent state of dizziness and can`t catch his breath ... employees are grumpy and irritable about never getting a full 60-minute lunch break and getting out late at day`s end puts them on the verge of panic.

Discussion: Okay, I`m blowing the whistle, everybody out of the pool! There`s a drowning scare here and an associate dentist may not be needed as lifeguard. Let`s just tread a little water here while we examine some scheduling blunders and how to correct them. Since many of you are also in the clutches of SCHEDULE STRESS, I`ll depart from my usual column format this month and intertwine my observations with quick-fix recommendations.

Observations/Recommendations:

Observation #1: Scheduling coordinators are scheduling entire treatment plans at once. In other words, if four appointments are needed, they schedule all four, booking out the schedule too far in advance. Recommendation: Schedule one appointment for crown prep and one for crown seat, but not all four at once.

Observation #2: Inconsistencies in time scheduled for certain procedures. Case in point: Three patients scheduled for crown preps - the first for 90 minutes, the second for 70 minutes and the third for 60 minutes. Patient charts confirm that this information - or misinformation - was given to the scheduling coordinator by a hygienist or assistant who had not consulted the doctor. Recommendation: Prior to patient dismissal, the hygienist or assistant should ask the doctor to indicate what needs to be done next and how much time will be needed for the next appointment. This should be communicated to the scheduling coordinator in units of assistant time and doctor time.

Observation #3: Overscheduling ... picture this: Two ortho checks and seating a retainer scheduled opposite a 30-minute filling and a new patient exam. Recommendation: Once the "time needed" is communicated to the scheduler in units of doctor time and assistant time, this overscheduling should not occur. By indicating doctor time with a certain color, the scheduler will know not to schedule two of the same color blocks opposite each other.

Observation #4: Time and a half, case in point: #4 occlusal and #14 core buildup were scheduled for 60 minutes. Clinical staff employees were "padding" the time needed because they knew the doctor talked too much or that other procedures would need to be crammed into that time. Recommendation: This doctor needs to have a time and motion clinical analysis performed to determine why an hour is needed for two fillings. This is too much time.

Observation #5: Not paying attention, case in point: The patient`s chart indicated 40 minutes, but the scheduler blocked out 60 minutes for him. Recommendation: The scheduler must heed the amount of time noted on the chart.

Observation #6: Blank slate, case in point: The patient`s chart indicated neither the procedure nor the time needed. Recommendation: As noted in the second observation and recommendation, the clinical assistant or hygienist will ask the doctor - prior to patient dismissal - what procedure will be done at the next appointment and how much time will be needed. This information is not to be written on a post-it note, but is entered into the computer terminal in the treatment room (which this practice does not have) or written on the next line of the clinical chart or treatment-plan chart so it will become a permanent part of the patient`s record.

Observation #7: Filling time, case in point: Patient needed fillings for #2 Lingual and #18 Lingual. Doctor said "two appointments." Since the time requirement was not indicated, the patient was scheduled for two 60-minute appointments. Recommendation: Instead of simply diagnosing and listing treatment needed, the doctor needs to do complete treatment-planning which should include: procedures to be done, how many appointments, what will be done at each and the time needed for each. Maximize your chair time, Doctor. One way is by staying focused ... and doing more than one quadrant at a time, especially when fillings are involved.

Observation #8: Two appointments were scheduled for the previous scenario, but the doctor decided to take care of them in one appointment. Trouble is, the second appointment didn`t get cancelled because it had been prescheduled and no one told the scheduler that it was no longer necessary. Recommendation: Schedule only one appointment at a time.

Further Recommendations: Time should be reserved in the doctor`s schedule for crown and bridge. To determine how much time, look at crown and bridge activity for the preceding six months. For example, in the first half of 1997, the doctor performed 200 units of crown and bridge. This averages out to two units per day, a good indicator of how much time should be preblocked. Based on prior activity, hygiene days also can be preblocked daily for one perio patient in the morning and one in the afternoon.

Scheduling to doctor time and assistant time will certainly reduce the stress level here. Once all the above is implemented, we will look to see how far out the schedule is booked. If it is still more than three weeks out, a clinical analysis would be recommended to determine what else might alleviate the schedule squeeze, as well as the advisability of hiring an associate dentist.

Sally McKenzie is a Certified Management Consultant and president of McKenzie Management, Inc., a full-service, in-office dental management consulting company with clients across the U.S. and Canada. She can be reached at (800) 288-1877; e-mail McKenzie@earthlink.net; or visit her web site at www.mckenzie-mgmt.com.

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