Roger P. Levin, DDS, MBA
It`s time to stop complaining about hygiene departments. Many barely break even or even lose money. I also have heard that there is a major shortage of hygienists and that hygienists` salaries are too high. Now, I`m not saying that these statements are not true. I`m simply saying that we can`t continue to complain about hygiene departments because they can be extremely profitable.
Actually, any practice not experiencing at least a 35 percent profit margin from the hygiene department is no where near its potential. I have seen practice after practice using hygiene systems with a 35 percent profit margin or greater. Chances are that if your hygiene department is not experiencing similar profitability, it is because it is not being run to reach its potential.
Hygiene is a Profit Center
The hygienist`s role is critical in the dental practice because he or she can offer patients a high-quality service. As with any high-quality service, the hygiene department should be profitable. In addition, it should supply half of the production handled by the dentist and also help to increase referrals because of the strong, long-term relationships formed between the hygienist and patient.
While each of these roles of the hygienist is crucial for practice growth, we will focus mainly on increasing the hygiene department`s profitability because that is the major problem experienced by many dental practices. First of all, you need to understand that most hygiene departments are run by evolution, not by systems. Most dentists enter practices with little experience. As the dental practice grows, most areas of the practice, including the hygiene department, simply evolve over time without a great deal of business or financial planning. Because of this evolutionary process, your hygiene department runs more by habit than anything else. To make your hygiene department profitable, it must be systemized and run with sound business principles.
The first step is to analyze the length of the hygiene appointments. I recently asked a client`s hygienist to discuss periodontal disease with each patient. She already spent one hour with each patient and informed me that she needed at least 10 more minutes for the discussion. She believed that anything she did in the appointment took at least 10-15 minutes. I have no doubt that we could have worked her up to two hours per appointment if she did all the things that I would like.
While her time frame was excessive, the scaling aspect of most prophylaxis appointments actually requires about 20-30 minutes. Then, you have to add in the dental and medical history, probing, flossing and so forth. While being realistic, the hygiene appointment`s length should only be as long as is needed. You will not need to allow interpersonal relationship-building time because it can take place during clinical time. Hygienists have a perfect opportunity to talk to patients and build relationships while they are scaling.
Once you determine the appointment`s length, dedicate half of the scaling time to patient education on new and elective dental procedures offered by the practice. A good hygienist can sell a lot of elective dentistry to patients who will appreciate the practice more than ever.
The hygienist also should work to increase case acceptance for any needed services. Many offices do not take the time to perform the proper diagnostic tests to discern which services are necessary. Full-mouth series and probing should be completed regularly. This is how you begin to funnel patients back into the practice for treatment.
Expect Growth
Because your hygiene department should be profitable as well as refer patients to the practice for additional treatment, your practice will grow. However, there will most likely be a time when the growth requires more hygiene time, but does not warrant a second hygienist. What do you do? I recommend that you institute a hygiene-assistant position. This enables the practice to increase hygiene production by roughly 30 percent with a minor investment in the hygiene assistant.
The hygiene assistant can handle all non-hygiene duties and any minor hygiene responsibilities. For example, completing the dental and medical-history update, taking any radiographs, preparing the patient for treatment and cleaning the hygiene rooms can all be the assistant`s duties. This enables the hygienist to perform the functions he or she does best. In essence, you have created a dentist/assistant system for your hygiene department to maximize efficiency.
Analyze Your Hygiene Program
Just like the overall practice, every month you should examine the hygiene department`s finances, patient no-shows, failed appointments, total production, total collections, collection/production ratio, production referred to the practice and so on. Studying these statistics helps you to identify ways to improve and maximize the hygiene department`s productivity.
We cannot continue to idly complain about our hygiene departments. They should be profitable and viewed as a practice strength, not a weakness. After all, can anyone afford not to maximize every opportunity to offer treatment-especially to patients already in the practice?
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.
