Roger P. Levin, DDS, MBA
Every business fights overhead. The problem is that overhead tends to rise as business flattens out.
Dental practices are no different. We not only experience many of the usual economic variables that confront small businesses, but a host of others peculiar to health care. Dealing with overhead is a challenging management issue and certainly needs to be a major focus. My philosophy is that the highly efficient and successful practice should have an overhead structure approximately 7 to 10 percent below the national average for dental practices. In order to effectively operate today, overhead must be controlled.
Delegation and the Team
A key element in decreasing overhead is to increase efficiency. Many dentists are still performing functions in the practice that should be performed by well-trained members of their teams. In fact, dentists should only perform tasks that, according to state law or licensure, would be illegal for anyone except the dentist to perform. If the regulating bodies allow a team member to perform a certain function, then a team member should be trained to carry out that function.
Remember, the dentist is always the highest producer in the practice. His/her time should be used for the highest level procedures.
Delegation is a key factor in management. Most practices severely under-delegate clinical tasks, as well as management and treatment-planning.
We can use sealants as an example. Here is an elective procedure that, for the most part, can be handled from beginning to end without involving the dentist. A hygienist should be able to examine a patient and make a recommendation about sealants that is within the parameters and guidelines established by the doctor. The hygienist should not have to wait for the dentist`s approval in order to recommend sealants for a patient. The hygienist can and should discuss sealants with a patient, explain the treatment plan and describe the application. The hygienist should be capable of selling the case. All of this can be done without the presence of the dentist. The practitioner can confirm the hygienist`s decision during the clinical examination.
At this point, the hygienist will take over the case. It may be more costly for the hygienist to work with an assistant during the placement of sealants, but it is certainly more cost effective for him/her to place the sealants instead of having the dentist do the procedure.
More People, More Time
Involving staff in more functions enables the doctor to spend more time on higher-level procedures.
Perhaps your hygienist has never worked with sealants. Take the time to provide the needed training. Motivation and enthusiasm will be increased. When the hygienist is ready to take charge of all sealant cases, the dentist will be free to work on more productive procedures. This way, the office is focused on productivity and overhead will be reduced.
It is also essential that the hygienist be able to participate with the front-desk person in coordinating the scheduling of sealants, which is different than scheduling hygiene appointments. Billing for sealants and dealing with insurance must be clearly understood by the front-desk staff, if financial arrangements are going to be effectively communicated. Again, the dentist does not need to play a role in these procedures once the systems are established.
Top dental practices are beginning to streamline all the systems in their offices. They are training staff and delegating procedures. If your staff needs training, ask a sales representative to come in and demonstrate the technique for sealants to the hygienist and dental assistants. If you do not understand what to do in regard to billing and insurance, you might call one of the sealant companies and ask for their assistance. Most manufacturers can answer questions about insurance coverage, but sealants, like most other elective procedures and services, have erratic coverage policies. All of this must be communicated to the patient.
Because of the number and diversity of consultations I have experienced, there have been numerous opportunities to write a variety of scripts for use in dental practices. I am a staunch advocate of providing scripts for almost every type of conversation that takes place in the office in order to assure quality control and communication. The front-desk staff should have a script that explains billing and insurance policies for sealants, etc.
Delegate everything you possible can. If you find that you are not legally required to be the one to do it, train someone else to do it and then delegate.
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.