Terminating "rat race" dentistry

Jan. 1, 2002

by Roger P. Levin, DDS, MBA

A recent client was a poster child for what I call "rat race dentistry." This 47-year-old dentist was burned out and at least 15 years from retirement. His practice was scheduled seven weeks ahead, participated in a myriad of dental insurance plans, and had below-average production. The dentist worked extra days to accommodate emergencies and larger cases. His family was unhappy because he was never at home. He reported that he was "Sick of the rat race," but had no clue as to what to do about it.

Stop the rat race
The first step was to analyze this client's schedule. What many dentists fail to realize is that scheduling weeks or months in advance produces high volume but low average production per patient. They're working twice as hard with little to show for it. It is possible to work at a reasonable, more productive pace without working extra days to accommodate emergencies and larger cases.

The other problem with "rat race" dentistry is staff burnout. Let's face it: we don't pay them enough to stay around under high-pressure circumstances. If they wanted a high-pressure environment, they probably wouldn't work in a dental office.

Scheduling solutions
After a full analysis, we began to reorganize the practice. Here are some of our solutions.

  • We broke the schedule into productive zones and began scheduling minor procedures beyond seven weeks to accommodate emergencies and more productive cases.
  • We also found that a great number of emergencies came from insurance plans with the lowest reimbursement. It made sense to eliminate those plans from the practice. Although it decreased revenue by 15 percent, focusing on more productive dentistry increased production by 37 percent in less than six months. The net gain was 22 percent in 6 months — 37 percent growth minus the 15 percent gross production loss. More importantly, the dentist cleared an additional 17 percent of the schedule in the next seven weeks to accommodate emergencies, new patients, and larger cases.
  • We found that 40 percent of hygiene patients were overdue. By adding a second treatment room and hiring a hygiene assistant, we reduced the rate to 14 percent in six months. Since the dentist now had a more flexible schedule, he was better able to perform exams and identify needed and desired treatment. This contributed to an overall production increase.
  • The next step was to ensure that the doctor did not work more than his scheduled number of hours. With improved verbal skills and scripting, the team learned to handle the schedule in a highly disciplined manner.
  • Formerly, collections averaged 8-12 weeks following treatment. The practice also did not collect patient co-payments until the insurance had paid its portion. We immediately switched to requesting the projected co-payment plus an additional 10 percent prior to beginning treatment. This ensured that the patient would not end up owing a few dollars after the insurance co-payment, which eliminated the need to bill, write it off, or wait until the next patient visit. This increased cash flow substantially.

Currently, the total cash carried by the business is over four times what it was before, and the dentist has taken home a salary increase for the past three months. The staff reports that patients converted quite easily to the new system.

Many dentists find themselves in a similar situation. When that happens, it is important to reorganize the schedule and train your team to discipline your practice. Scheduling changes include setting a similar production goal for almost every day. This keeps volume and collections consistent, and the doctor can function like a marathon runner instead of a sprinter. This client is now more relaxed both physically and mentally, and fully enjoying the profession of dentistry.

Roger P. Levin, DDS, MBA, president and CEO of The Levin Group and the Levin Advanced Learning Institute, provides worldwide leadership in dental management for general dentists and specialists. Contact The Levin Group at (410) 654-1234.

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