by Cathy Jameson, PhD
I'm booked out three months. My hygienist is booked out four months. We have no openings for new patients or emergencies. If I diagnose crown and bridge or a cosmetic case, I have to schedule the patient out into the future and hope for a cancellation. I like the income, and I don't want to see that drop. But, I don't want to be booked so heavily or so far out. The stress is wearing me to a frazzle. What should I do?
I hear this kind of statement often. Much is written about building a practice, increasing a patient base, marketing to attract new patents, etc. This kind of instruction and information is imperative. However, I am also seeing the flip side of this issue. Many practices - quality, comprehensive, fee-for-service practices - are too busy.
You may relate to the opening scenario. If you do, let me congratulate you. You are to be complimented for your success and popularity. People wouldn't be coming to you if you weren't doing a lot of things right! So give yourself and your team a pat on the back.
Being too busy is a good problem to have. But if you don't control your growth, your patient numbers, and practice management, success can become an overwhelming and consuming problem.
Let's look at some steps to take control of your business. If your goal is to have a smoothly running practice where patients have your complete and undivided attention; to have not just more, but all the time you need to provide the ultimate in dental care, then bite the bullet! Take the necessary steps to gain control. If you don't control your practice, your practice will control you!
Manage your schedule
Scheduling, or appointment control, may be the most difficult and stressful of all dental management systems. Few practices can honestly claim that their scheduling is perfect. The way you schedule will evolve as your dentistry evolves.
Identify those areas related to scheduling that cause stress. Make a concerted effort to work through those issues to achieve resolution. Two common causes of stress: s Too many patients per day, and s Booking patients too far into the future.
Plan to do a quadrant or a half-mouth per appointment. Try to treat patients in as few appointments as possible. For example, if a patient has decay in all four quadrants, schedule four one-hour appointments. That's only four times that the patient has to take off from work and come to your office, four times to be anesthetized, etc. Or, you could schedule two appointments for approximately 90 minutes each, doing half of the mouth at each appointment. Ask your patients which they would prefer. At least nine out of 10 will say, "Get me in. Do as much as you can." You will do the patient - and your practice - a tremendous service.
And for you? Three hours vs. four hours. With only one example and one patient, you've just saved an additional hour. How many times per day could you conserve time by doing as much dentistry as possible per patient? With the extra time you could:
- Spend more time with the patient.
- Reduce the amount of running from room to room and patient to patient.
- Increase production.
- Reduce stress.
- Increase the amount and scope of cases per day.
- Efficiently control the costs for each appointment: less anesthesia, fewer room turnarounds, etc.
Consolidate your appointments. Control your appointment book.
A key to business control is to delegate responsibilities when and where possible, according to the laws of your state. The doctor should be responsible for high-level tasks and delegate everything else. Delegation is also essential for improved productivity.
Dovetailing your appointment book is crucial, for it maximizes the time and talent of all providers. Determining when the doctor is occupied during a procedure is step one. Once a procedure is delegated (for example, temporization in many states), the doctor can be carefully scheduled into another treatment room with another assistant, or into a consultation.
Most practices can add one to two hours of available treatment time per day by engineering the appointment book more effectively. Delegation is a major part of effective scheduling.
Patient financing programs
Many patients ask for "one tooth at a time" dentistry. Practices offer this kind of treatment because of the investment. Dentists perform "one tooth at a time" because patients believe it's all they can afford.
Get involved with, promote, and use a patient-financing program. Present cases based on fewer, longer appointments. Should the patient hedge with declarations of limited finances, ask, "What if you could finance your dental care and spread the payments out over a period of time so that they would fit into your financial situation? Would you then allow us to get your mouth totally healthy in a few visits?"
Most people will answer "yes" - but only if the dentist does a good job of explaining, presenting, educating, and motivating.
Financing programs are a major asset when striving to do more dentistry on fewer patients a day. Most people don't care as much about the total investment as they do about how much it costs each month. Most families are on a budget; whatever the income bracket, fitting the payments for dental care into their budget can pave the way for patients to not only accept treatment, but to go ahead with the timely scheduling the dentists recommends.
If you are not maximizing your existing program, seek further training or access training materials (such as my book, Collect What You Produce, by PennWell Books.)
If your scheduling is state-of-the-art; if you are delegating when and where possible; if you are doing quadrant or half-mouth dentistry and are dovetailing your appointments, yet you're still too busy and booked out too far, then raise your fees - by a minimum of 10 percent.
More than likely, most patients won't even notice the fee increase. The law of supply and demand dictates that a well-organized dentist who is still too busy to provide optimum care is justified in raising fees. The few patients lost will mean more time for quality experiences and consultations with those who remain. You can do quadrant, half-mouth, arch, or full-mouth cases, either restorative or cosmetic. Your fees will be higher and will offset any patient losses. Studies by Dr. Charles Blair indicate that if you have a 65 percent overhead, and you raise your fees 10 percent across the board, your profit margin will increase by 28.6 percent. However, you would have to lose 22.3 percent of your "sales" before bottom-line profits are negatively impacted.
Let me assure you that if you raise your fees by 10 percent, 22.3 percent of your patients will remain. We have coached over 1,000 practices in the United States to superior success. We have seen these practices increase their fees consistently, but have never seen those increases force a mass exodus of patients.
If you are too busy, paring down the numbers makes sense. If you increase your fees by 10 percent without a drop in patient numbers, go up another 10 percent. Push the envelope. Always make sure, however, that the fees you charge are equitable for the services you render. Higher fees and fewer patients allow the dentist to give quality, focused attention to patients. Your profit margin will increase, and you can afford the equipment, materials, the lab, the team, and the coaching essential for continued, prosperous excellence.
Hire an associate
If you have incorporated the first four suggestions into your practice, you may need to consider hiring an associate. This is a major decision that warrants much consideration, planning, and advice. This can be a wonderful situation, or it can be the worst. However, an additional doctor can:
- Increase patient care to optimum levels.
- Take care of your "busyness."
- Expedite patient visits.
- Increase productivity.
- Relieve the pressure of having to see all of the patients by yourself.
Create the position of associate as carefully as you would create any other position in your practice. If the associate declines to become a partner, you can fill the position with another doctor. Do the best you can to make the position and the relationship successful for all parties.
Consider referring as much as possible. Carefully define your vision of the ideal practice. What kind of dentistry do you love the most? Concentrate on this, and refer everything else.
For example, if you want to focus your practice on comprehensive, restorative, and cosmetic treatment, then refer everything else and nurture your relationships with your specialists. Let them know what you are doing. Invite them to dinner or to your practice, or go to theirs. Show them examples of your dentistry. Let them know what kind of results you are achieving. Most importantly, send them patients; they will reciprocate. Referring patients does not mean you are losing patients or productivity, but that you are focusing on what you do best.
If you are too busy, it may be time to decide whether or not you wish to remain a managed-care provider.
List all of the programs you presently participate in. Measure them from plans that generate the most revenue to those that generate the least. As you build the fee-for-service part of your practice, start eliminating managed-care programs, beginning with those that are the least productive.
If your practice is totally fee-for-service, and you have incorporated all of the recommendations mentioned in this article, yet you are still too busy and unable to focus on patient care as you wish, then you should strongly consider not accepting insurance plans, period. It's a difficult choice to make, and not appropriate for all practices. Only you can decide.
Will you lose all patients? No. Will you lose so many patients that you will destroy your practice? Not if you handle the transition properly and carefully plan the change.
I can also promise that you will have time to plan and organize excellent cases. You will be able to orchestrate outstanding case presentations. You will be able to spend quality time with your patients and provide optimum care. You can reduce many of your operating expenses and have a profitable business.
If you choose to make the decision to drop insurance, do so with care and planning. If this step is executed poorly or without a strategic plan, the results can be disastrous. Done well, however, it can be successful. You must be clear on your vision and on your goals. You must be confident. You must be an excellent manager and leader.
These steps will help you gain control of your "out-of-control" schedule. Each step will help by itself. A combination of one or more of these steps will make a significant difference.
I have moved from conservative to liberal suggestions to take into account the wide variety of visions and differences among dental professionals. The choices you make will, as always, be your own. The critical factor is to make a choice. Being too busy is a compliment for any practitioner, but it can be problematic. Lack of control leads to chaos; chaos breeds stress. Learning how to control "busyness" will teach you how to manage stress.