Remember the Alamo

Case Profile: Southern Texas is the setting of this practice, San Antonio to be exact. It`s an interesting situation down here: three doctors, four hygienists ... two million dollars a year. Although the numbers sound impressive, remember the Alamo.

Sally McKenzie, CMC

Case Profile: Southern Texas is the setting of this practice, San Antonio to be exact. It`s an interesting situation down here: three doctors, four hygienists ... two million dollars a year. Although the numbers sound impressive, remember the Alamo.

Symptoms: Four hygienists, yet the hygiene schedule`s got holes so big it looks like the site of a Texas-sized shootin` match. And to add salt to the wounds, hygiene salaries are hovering at 43 percent of revenues. To make matters even worse, the patient base - previously relied on for filling holes in the schedule - is drying up like tumbleweed in the desert.

Observations: We`ve got a preblocked schedule here that seems to be very much out of sync. Here`s how each hygienist`s daily schedule breaks down - and I do mean breaks down - seven appointments for perio therapy and only three appointments for recall patients.

Discussion: You know that I`m usually very reluctant to dispute recommendations made by other consultants. But here`s an exception. We`ve got a practice with an existing patient base of 3,000. Now, if only three recall patients are seen by each of four hygienists, that`s 12 recalls per day, 60 per week, which works out to 3,000 recall visits per year. But, at a minimum of two recommended recall visits per patient per year, we`re talking a possible 6,000 recall visits that need to be scheduled - but when? Clearly, there`s quite a bit here that doesn`t add up. Why preblock the schedule for so much perio therapy? The practice doesn`t have patients to fill seven perio treatments per hygienist per day! Poor Dirty Nelly, the scheduling coordinator, is under strict orders: If there still are holes in the schedule two days out, she should go ahead and "fill `em with anything." Well, Nelly, with all her scurrying around calling past-due patients, never makes much headway. When the majority of patients are working-class people - and practice hours are 8 a.m. to 5 p.m. - the odds of filling those slots are slim to none. Even when patients don`t give her an immediate "no," she doesn`t have the training to get them to say "yes." The best she seems to get is, "I`ll call you back." But nobody does.

Treatment Plan: Scheduling tied to a goal is admirable, but preblocking needs to be done based on history, not hopes. In other words, how many quadrants of scaling and how many perio-maintenance appointments did the practice actually do in the past six months? This easily can be documented by generating a computer report detailing how many given procedures are done in any given time frame. If the need turns out to be less than seven appointments per day per hygienist, the scheduling coordinator needs to begin calling past-due recalls and filling the holes for the next four weeks. But, first, she needs some training on how to get recall patients to schedule. I recommended that Nelly listen to my audio tapes, "Telephone Effectiveness To Improve your Patient Retention," to learn what to say and how to overcome patient objections.

Sally Says: Management consultants are only as good as the information they process, multiplied by their experience, filtered through their expertise. Weigh the recommendations they make before implementing them. If the numbers don`t look right, don`t bet the ranch on it.

Sally McKenzie is president of Dental Partners/McKenzie Management, a full-service, in-office dental management company. She can be reached at (800) 288-1877; e-mail dentalpartners@dpi-mckenzie.com; or visit Sally`s Web site at www.dpi-mckenzie.com.

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