No Field of Dreams

Case Profile: In a rural village on the fringe of Iowa City, a 9-year-old-just-barely-making-it general practice is in the process of carving out a slice of Americana. Antiques abound here, patchwork quilts line the walls, and Shaker furniture fills the reception room and front-desk area. Patients - mostly farm and factory workers - could care less about the décor as they struggle to make ends meet on their annual incomes of $25,000. What`s wrong with this picture?

Sally McKenzie, CMC

Case Profile: In a rural village on the fringe of Iowa City, a 9-year-old-just-barely-making-it general practice is in the process of carving out a slice of Americana. Antiques abound here, patchwork quilts line the walls, and Shaker furniture fills the reception room and front-desk area. Patients - mostly farm and factory workers - could care less about the décor as they struggle to make ends meet on their annual incomes of $25,000. What`s wrong with this picture?

Symptoms: Patient retention is pitiful. Production is at a bare minimum. The connection between doctor and staff is strained almost beyond the limit.

Observations: Dr. Liza is outgoing, ever-so-slightly arrogant, and smart as the dickens. The direct opposite is true of her staff - three timid gals who are dumber than a box of rocks. In talking with them, it was clear that they`re bonded together ... against the doctor!

Now to the nuts and bolts. Although there`s a computer system, the staff has never received training, and is all thumbs in its use. Practice systems are archaic. For example, they`re still doing the posting-on-pegboard routine. And the most glaring problem is the three-visit system for new patients: first appointment, X-rays; second, diagnosis/consultation; and third (for patients who hang around that long), hygiene.

Discussion: Doctor`s discretionary spending is way out of whack. To attract new patients and keep them, she`s been putting big dollars into home-grown, country-look furnishings. She must be thinking about that line from the movie, "Field of Dreams," that goes, "If you build it, they will come." Well, you can build it, Dr. Liza, but don`t expect to draw any crowds. This is a two-dentist town of less than 5,000 people. Figuring 50 percent goes to the dentist, that gives each practice a max of about 1,200 patients. With numbers like that, smart strategy would dictate holding on tight to every patient.

Treatment Plan: When a new patient calls to get his or her teeth cleaned, attempt to clean them on the first visit ... or you may not make it to a second, much less a third. At the very least, don`t have Betty Bimbette spouting off that, "Doctor`s philosophy is to do a complete exam prior to the hygiene visit." Just say, "That`s great! Know how to get here? Morning or afternoon?"

Don`t even discuss treatment. If the patient asks how much, Betty can say, "Depending on the type of professional cleaning you need, it can range between $75-$150, so bring $150 if you don`t have insurance. Payment can be made with cash, check, VISA, or MC." Only do $125 in services so the patient gets change back ... like McDonald`s. Gum disease? Call a time out to explain why you can`t do a professional cleaning today. You might have to eat that hour of production, but better to do that and get the body in the door, than for Betty to turn the patient away sight unseen.

My rule of thumb is: give `em what they want and teach `em the importance of professional hygiene and dental care to keep them coming back. And while you`re at it, let `em get to know you. A little rapport goes a long way anywhere, but especially around here.

Not one more dime on office décor ... not while the staff is functioning in the Dark Ages. Although there isn`t a rocket scientist in your employ, there`s plenty of unexplored potential that would serve your practice well with the right training. The wisest expenditure right now would be to bring in one of my consultants - or even someone else`s, if they`re of equal caliber - who`ll provide focused, one-on-one training in some crucial areas like hygiene, scheduling, production, recall, and/or collection. The cost of such an investment will become insignificant when compared with the return.

While you`re waiting for this training to take place - and to kick in - you may find it helpful to listen to my seminar-on-tape, "BREAKDOWN: The Hidden Signals of Practice Erosion." It`s a down-and-dirty guide to identifying snarls in the practice-management systems and fixing them.

Sally Says: It`s not often that I quote a philosopher, but for these words of wisdom by Nietzsche, I`ll make an exception. "He who would learn to fly one day must first learn to stand, walk, run, climb, and dance: one cannot fly into flying." This is no field of dreams, Doctor, but build it right and they will come.

Sally McKenzie is a Certified Management Consultant, nationally known lecturer, and author with more than 32 years in the dental profession. Her sole proprietorship, McKenzie Management and Associates, provides in-office systems` analysis of the business, clinical, and hygiene department; staff training; and offers a full line of educational-management books, audiotapes, and videos. McKenzie`s dental clients span 40 states over 20 years. She is a consultant to the Council on Dental Practice of the ADA. Call Sally at (877) 777-6151, or e-mail: sallymck@mckenziemgmt.com, or check out her Web site at www.mckenziemgmt.com.

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